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December 26, 1990, Vol 264, No. 24 >
ARTICLE | December 26, 1990

Environmental Illness: Title and subTitle BreakA Controlled Study of 26 Subjects With '20th Century Disease' FREE

Donald W. Black, MD; Ann Rathe, BA; Rise B. Goldstein, MSW, MPH
[+] Author Affiliations

Reprint requests to the Department of Psychiatry, University of Iowa College of Medicine, 500 Newton Rd, Iowa City, IA 52242 (Dr Black).


JAMA. 1990;264(24):3166-3170. doi:10.1001/jama.1990.03450240068042
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References

Environmental illness is a polysymptomatic disorder believed by "clinical ecologists" to result from immune dysregulation brought on by common foods and chemicals. We systematically evaluated 26 subjects who had been assigned a diagnosis of environmental illness. The subjects indicated a strong interest in their diagnosis, were generally satisfied with their clinical ecologist, and were dissatisfied with traditional medical approaches. Subjects reported varying treatments, including dietary restrictions, avoidance of offending agents, and physical treatments. Using the Diagnostic Interview Schedule, we found that 15 (65%) of 23 subjects met criteria for a current or past mood, anxiety, or somatoform disorder compared with 13 (28%) of 46 age- and sex-matched community controls. We conclude that patients receiving this diagnosis may have one or more commonly recognized psychiatric disorders that could explain some or all of their symptoms.

(JAMA. 1990;264:3166-3170)

REFERENCES

1 +
American Academy of Allergy and Immunology.  Clinical ecology . J Allergy Clin Immunol. 1986;;78:269. Position statement.
2 +
American College of Physicians.  Clinical ecology . Ann Intern Med. 1989;;111:168-178. Position statement.
3 +
California Medical Association Scientific Board, Task Force on Clinical Ecology.  Clinical ecology: a critical appraisal . West J Med. 1986;;144:239-245.
4 +
American Academy of Allergy and Immunology.  Controversial techniques . J Allergy Clin Immunol. 1981;;67:333-338. Position statement.
5 +
Bell IR. Clinical Ecology: A New Medical Approach to Environmental Illness . Bolinas, Calif: Common Knowledge Press; 1982;.
6 +
Crook WG. The Yeast Connection. 2nd ed. Jackson, Tenn: Professional Books; 1985;.
7 +
Levin AS, Byers VS.  Environmental illness: disorder of immune regulation . Occup Med State Art Rev. 1987;;2:669-681.
8 +
McLellan RK.  Biologic interventions in the treatment of patients with multiple chemical sensitivities . Occup Med State Art Rev. 1987;;2:755-777.
9 +
Randolph TG, Moss RW. An Alternative Approach to Allergies . New York, NY: Lippincott & Crowell Publishers; 1980;.
10 +
Dickey LF. Clinical Ecology . Springfield, Ill: Charles C Thomas Publisher; 1976;.
11 +
Trowbridge JP, Walker M. The Yeast Syndrome . New York, NY: Bantam Books Inc; 1986;.
12 +
Committee on Environmental Hypersensitivities. Report of the Adhoc Committee on Environmental Hypersensitivity Disorders . Toronto, Ontario: Ministry of Health; 1985;.
13 +
Black DW, Rathe A.  Total environmental allergy: 20th century disease or deception? Res Staff Phys. 1990;;36:47-54.
14 +
Stewart DE, Raskin J.  Psychiatric assessment of patients with '20th century disease' ('total allergy syndrome') . Can Med Assoc J. 1985;;133:1001-1006.
15 +
Terr AI.  Environmental illness: a clinical review of 50 cases . Arch Intern Med. 1986;;146: 145-149.
16 +
Terr AI.  Multiple chemical sensitivities immunologic critique: clinical ecology theories and practice . Occup Med State Art Rev. 1987;;2:683-694.
17 +
Brodsky CM.  Allergic to everything: a medical subculture . Psychosomatics. 1983;;24:731-742.
18 +
Pearson DJ, Rix KJB, Bentley SJ.  Food allergy: how much in the mind?: a clinical and psychiatric study of suspected food hypersensitivity . Lancet. 1983;;1:1259-1261.
19 +
Rix KJB, Pearson DJ, Bentley SJ.  A psychiatric study of patients with supposed food allergy . Br J Psychiatry. 1984;;145:121-126.
20 +
Terr AI.  Clinical ecology in the workplace . J Occup Med. 1989;;31:257-261.
21 +
Robins LN, Helzer JE, Croughan J, Ratcliff KS.  The NIMH Diagnostic Interview Schedule: its history, characteristics, and validity . Arch Gen Psychiatry. 1981;;38:381-389.
22 +
American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders , Third Edition. Washington, DC: American Psychiatric Association; 1980;.
23 +
Stangl D, Pfohl B, Zimmerman M, Bowers W.  A structured interview for DSM-III personality disorder . Arch Gen Psychiatry. 1987;;42:591-596.
24 +
Pilowsky I, Spence ND. Manual for the Illness Behavior Questionnaire . 2nd ed. Adelaide, Australia: Department of Psychiatry, University of Adelaide; 1983;.
25 +
Derogatis LR. Symptom Checklist 90 Revised: Administration, Scoring and Procedures Manual . Towson, Md: Clinical Psychometric Research; 1977;.
26 +
Zimmerman M, Coryell W.  The validity of a self-report questionnaire for diagnosing major depressive disorder . Arch Gen Psychiatry. 1988;;45: 738-740.
27 +
Spitzer RL, Endicott J. Schedule for Affective Disorders and Schizophrenia . New York, NY: Biometrics Research Division, New York State Psychiatric Institute; 1978;.
28 +
Schlesselman JJ. Case Control Studies . New York, NY: Oxford University Press; 1982;.
29 +
Black DW.  Somatoform disorders . Primary Care. 1987;;14:711-723.
30 +
Sparks PJ, Simon GE, Katon WJ, Altman L, Ayars GH, Johnson RL.  An outbreak of illness among aerospace workers . West J Med. 1990;; 153:28-33.
31 +
Andreasen NC, Black DW.  Somatic treatments . In: Introductory Textbook of Psychiatry . Washington, DC: American Psychiatric Press; 1991;:475-509.
32 +
Coryell W, Zimmerman M.  HPA axis abnormalities in psychiatrically well controls . Psychiatr Res. 1987;;20:265-273.
33 +
Robins LN, Helzer JE, Weissman MM, et al.  Lifetime prevalence of specific psychiatric disorders in three sites . Arch Gen Psychiatry. 1984;;41:949-958.

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1 +
American Academy of Allergy and Immunology.  Clinical ecology . J Allergy Clin Immunol. 1986;;78:269. Position statement.
2 +
American College of Physicians.  Clinical ecology . Ann Intern Med. 1989;;111:168-178. Position statement.
3 +
California Medical Association Scientific Board, Task Force on Clinical Ecology.  Clinical ecology: a critical appraisal . West J Med. 1986;;144:239-245.
4 +
American Academy of Allergy and Immunology.  Controversial techniques . J Allergy Clin Immunol. 1981;;67:333-338. Position statement.
5 +
Bell IR. Clinical Ecology: A New Medical Approach to Environmental Illness . Bolinas, Calif: Common Knowledge Press; 1982;.
6 +
Crook WG. The Yeast Connection. 2nd ed. Jackson, Tenn: Professional Books; 1985;.
7 +
Levin AS, Byers VS.  Environmental illness: disorder of immune regulation . Occup Med State Art Rev. 1987;;2:669-681.
8 +
McLellan RK.  Biologic interventions in the treatment of patients with multiple chemical sensitivities . Occup Med State Art Rev. 1987;;2:755-777.
9 +
Randolph TG, Moss RW. An Alternative Approach to Allergies . New York, NY: Lippincott & Crowell Publishers; 1980;.
10 +
Dickey LF. Clinical Ecology . Springfield, Ill: Charles C Thomas Publisher; 1976;.
11 +
Trowbridge JP, Walker M. The Yeast Syndrome . New York, NY: Bantam Books Inc; 1986;.
12 +
Committee on Environmental Hypersensitivities. Report of the Adhoc Committee on Environmental Hypersensitivity Disorders . Toronto, Ontario: Ministry of Health; 1985;.
13 +
Black DW, Rathe A.  Total environmental allergy: 20th century disease or deception? Res Staff Phys. 1990;;36:47-54.
14 +
Stewart DE, Raskin J.  Psychiatric assessment of patients with '20th century disease' ('total allergy syndrome') . Can Med Assoc J. 1985;;133:1001-1006.
15 +
Terr AI.  Environmental illness: a clinical review of 50 cases . Arch Intern Med. 1986;;146: 145-149.
16 +
Terr AI.  Multiple chemical sensitivities immunologic critique: clinical ecology theories and practice . Occup Med State Art Rev. 1987;;2:683-694.
17 +
Brodsky CM.  Allergic to everything: a medical subculture . Psychosomatics. 1983;;24:731-742.
18 +
Pearson DJ, Rix KJB, Bentley SJ.  Food allergy: how much in the mind?: a clinical and psychiatric study of suspected food hypersensitivity . Lancet. 1983;;1:1259-1261.
19 +
Rix KJB, Pearson DJ, Bentley SJ.  A psychiatric study of patients with supposed food allergy . Br J Psychiatry. 1984;;145:121-126.
20 +
Terr AI.  Clinical ecology in the workplace . J Occup Med. 1989;;31:257-261.
21 +
Robins LN, Helzer JE, Croughan J, Ratcliff KS.  The NIMH Diagnostic Interview Schedule: its history, characteristics, and validity . Arch Gen Psychiatry. 1981;;38:381-389.
22 +
American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders , Third Edition. Washington, DC: American Psychiatric Association; 1980;.
23 +
Stangl D, Pfohl B, Zimmerman M, Bowers W.  A structured interview for DSM-III personality disorder . Arch Gen Psychiatry. 1987;;42:591-596.
24 +
Pilowsky I, Spence ND. Manual for the Illness Behavior Questionnaire . 2nd ed. Adelaide, Australia: Department of Psychiatry, University of Adelaide; 1983;.
25 +
Derogatis LR. Symptom Checklist 90 Revised: Administration, Scoring and Procedures Manual . Towson, Md: Clinical Psychometric Research; 1977;.
26 +
Zimmerman M, Coryell W.  The validity of a self-report questionnaire for diagnosing major depressive disorder . Arch Gen Psychiatry. 1988;;45: 738-740.
27 +
Spitzer RL, Endicott J. Schedule for Affective Disorders and Schizophrenia . New York, NY: Biometrics Research Division, New York State Psychiatric Institute; 1978;.
28 +
Schlesselman JJ. Case Control Studies . New York, NY: Oxford University Press; 1982;.
29 +
Black DW.  Somatoform disorders . Primary Care. 1987;;14:711-723.
30 +
Sparks PJ, Simon GE, Katon WJ, Altman L, Ayars GH, Johnson RL.  An outbreak of illness among aerospace workers . West J Med. 1990;; 153:28-33.
31 +
Andreasen NC, Black DW.  Somatic treatments . In: Introductory Textbook of Psychiatry . Washington, DC: American Psychiatric Press; 1991;:475-509.
32 +
Coryell W, Zimmerman M.  HPA axis abnormalities in psychiatrically well controls . Psychiatr Res. 1987;;20:265-273.
33 +
Robins LN, Helzer JE, Weissman MM, et al.  Lifetime prevalence of specific psychiatric disorders in three sites . Arch Gen Psychiatry. 1984;;41:949-958.

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