Contributions of societal and geographical environments to "chronic Lyme disease": the psychopathogenesis and aporology of a new "medically unexplained symptoms" syndrome.
Lyme disease is a relatively well-described infectious disease with multisystem manifestations. Because of confusion over conflicting reports, anxiety related to vulnerability to disease, and sensationalized and inaccurate lay media coverage, a new syndrome, "chronic Lyme disease," has become established. Chronic Lyme disease is the most recent in a continuing series of "medically unexplained symptoms" syndromes. These syndromes, such as fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity, meet the need for a societally and morally acceptable explanation for ill-defined symptoms in the absence of objective physical and laboratory findings. We describe factors involved in the psychopathogenesis of chronic Lyme disease and focus on the confusion and insecurity these patients feel, which gives rise to an inability to adequately formulate and articulate their health concerns and to deal adequately with their medical needs, a state of disorganization termed aporia.
Division of Rheumatology and Connective Tissue Research, Department of Medicine, Lyme Disease Center, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903-0019, USA. sigallh@umdnj.edu
Leonard H
LH
Sigal
Afton L
AL
Hassett
D002908:Chronic Disease; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005221:Fatigue / Q000209:etiology; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008193:Lyme Disease / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*; D008603:Mental Health; D012924:Social Conditions; D013315:Stress, Psychological; D013577:Syndrome