Regul Toxicol Pharmacol 1996 Aug;24(1 Pt 2):S96-110
Clinical consequences of the EI/MCS "diagnosis": two paths.
Staudenmayer H.
Allergy Respiratory Institute of Colorado, Denver, USA.

There are two distinct paths down which patients
"diagnosed" with environmental illness/multiple
chemical sensitivities (EI/MCS) can travel. Along
the first path, beliefs about low-level, multiple
chemical sensitivities as the cause of physical
and psychological symptoms are instilled and
reinforced by a host of factors including toxicogenic
speculation, iatrogenic influence mediated by
unsubstantiated diagnostic and treatment practices,
patient support/advocacy networks, and
social contagion. Intrapsychic factors also reinforce
this path through the motivational mechanism
of factitious malingering, or unconscious
primary and secondary gain, mediated through
psychological defenses, particularly projection
of cause of illness onto the physical environment.
The second path involves restructuring distorted
beliefs about chemical sensitivities. Explanations
of the placebo effect, the physiology of the stress
response, and the symptoms of anxiety and
panic facilitate the direction of EI/MCS patients
onto this path. A decision model is presented to
discriminate among toxicogenic and psychogenic
explanations of the EI/MCS phenomenon,
based on appraisal of reaction and physiologic
and cognitive responses during provocation
chamber challenges under double-blind, placebo-
controlled conditions. These studies have been
helpful therapeutically for some patients in selecting
the path that leads to wellness. This paper
suggests how various therapeutic techniques
can be employed with difficult patients. Often,
supportive psychotherapy establishes a therapeutic
alliance which facilitates cognitive therapy to
restructure distorted beliefs. In the process of
finding alternative explanations to chemical
sensitivities, the etiology of symptoms is related
to stressful life events, including childhood
experiences which may have disrupted normal
personality development and coping capacity.
Furthermore, biological and physiological sequelae
stemming from early, chronic trauma have
been identified which could explain many of
the multisystem complaints. The incidence of
childhood abuse reported by EI/MCS patients
is strikingly high, and it is recollection of trauma
that many EI/MCS patients avoid by displacing
the psychologic and physiologic adults sequelae
onto the physical environment. The reenactment
of these experiences may be necessary in the
therapy of some affected individuals. Despite
the significant therapeutic effort expanded, some
patients who are imprisoned by a closed belief
system about the harmful effects of chemical
sensitivities are resigned to travel down the path
which ultimately leads to despair and depression,
social isolation, and even death.

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Psychol Med 2002 Nov;32(8):1387-94
Psychiatric and somatic disorders and multiple
chemical sensitivity (MCS) in 264 'environmental
patients'.
Bornschein S, Hausteiner C, Zilker T, Forstl H.
Psychiatric Clinic and Department of Toxicology,
I, Medical Clinic, Technical University of
Munich, Germany.

BACKGROUND: An increasing number of
individuals with diverse health complaints are
currently seeking help in the field of environmental
medicine. Multiple chemical sensitivity (MCS)
or idiopathic environmental intolerances (IEI)
is defined as an acquired disorder with multiple
recurrent symptoms associated with environmental
chemicals in low concentrations that are well
tolerated by the majority of people. Their symptoms
are not explained by any known psychiatric
or somatic disorder.

METHOD: Within a 2-year period we
examined 264 of 267 consecutive
patients prospectively presenting to a university
based out-patient department for environmental
medicine. Patients underwent routine medical
examination, toxicological analysis and the
structured clinical interview for DSM-IV
psychiatric disorders (SCID).

RESULTS: Seventy-five per cent of the patients
met DSM-IV criteria for at least one psychiatric
disorder and 35% of all patients suffered from
somatoform disorders. Other frequent diagnoses
were affective and anxiety disorders, and
dependence or substance abuse. In 39%
a psychiatric disorder, in 23% a somatic
condition and in 19% a combination of the two
were considered to provide sufficient
explanation of the symptoms. Toxic chemicals
were regarded as the most probable cause in only
five cases. The suspected diagnosis of MCS/IEI
could not be sustained in the vast majority of cases.

CONCLUSION: This investigation confirms
previous findings that psychiatric morbidity is
high in patients presenting to specialized centres
for environmental medicine. Somatoform
disorders are the leading diagnostic category,
and there is reason to believe that certain
'environmental' or MCS patients form a special
subgroup of somatoform disorders. In most
cases, symptoms can be explained by well-defined
psychiatric and medical conditions other than
MCS, which need specific treatment. Further
studies should focus on provocation testing in order
to find positive criteria for MCS and on therapeutic
approaches that consider psychiatric aspects.

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Ann Allergy 1993 Dec;71(6):538-46
Adult sequelae of childhood abuse presenting as environmental illness.
Staudenmayer H, Selner ME, Selner JC.
Allergy Respiratory Institute of Colorado, Denver 80222.

Sixty-three patients with polysomatic complaints
attributed to sensitivity to environmental
chemicals had detailed clinical assessments and
diagnostic psychologic evaluations. Objective
medical parameters failed to substantiate their
beliefs that multiple chemicals were the cause of
their problems. A group of 64 patients with chronic
medical conditions and defined psychologic
disorders not attributed to chemical exposure
served as controls. Approximately half the patients
in each group underwent long-term psychotherapy,
and in these patients, the prevalence of
physical and sexual childhood abuse was significantly
higher (P < .05) among the cohort of
women who attributed their symptoms to environmental
or chemically related illness. These data
suggest that somatization may reflect sequelae of
childhood abuse and may play an important role
in the illness experienced by women who believe
they are sensitive to environmental chemicals.