![]() ![]() 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 adult sequelae onto the physical environment. Furthermore, biological and physiological sequelae stemming from early, chronic trauma have been identified which could explain many of the multisystem complaints. 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. Often, supportive psychotherapy establishes a therapeutic alliance which facilitates cognitive therapy to restructure distorted beliefs. This paper suggests how various therapeutic techniques can be employed with difficult patients. ![]() These studies have been helpful therapeutically for some patients in selecting the path that leads to wellness. 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. 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. The second path involves restructuring distorted beliefs about chemical sensitivities. 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. 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. There are two distinct paths down which patients “diagnosed” with environmental illness/multiple chemical sensitivities (EI/MCS) can travel. Advocates claim this phenomenon is so ephemeral that the principles and methods of toxicology do not apply and that a scientific paradigm shift is in order. Hypotheses about physiological processes and mechanisms are implausible and unsupported by evidence. Symptoms are synonymous with disease and attributions are synonymous with cause. The toxicogenic theory presupposes low-level chemical sensitivity or intolerance without objective signs to a plethora of diverse chemical agents. Clinical studies of IEI cases consistently identify greater incidence of current and premorbid lifetime psychiatric disorders and co-morbidity with functional somatic syndromes that are fashionable ‘diagnoses’. The psychogenic theory is supported by provocation challenge studies which demonstrate that appraisals of ‘reactions’ are unreliable and cognitively mediated. The polysomatic symptoms are amplifications of complaints common to the general population, psychophysiological manifestations of stress and the stress-response, or symptoms of psychiatric clinical syndromes. The psychogenic theory presupposes that idiopathic environmental intolerance (IEI) is an overvalued idea explained by psychological and psychosocial processes. Social desirability was unrelated to any rating or performance dimension for either gender. Among men, Psychasthenia was unrelated to annoyance ratings, and was inversely related to the increase in smell intensity ratings. Among women, high Psychasthenia was related to higher increase in ratings of mucous membrane irritation, fatigue, and annoyance from other aspects of the environment than smell during challenges, and was related to a higher increase in reaction time variability. Trait anxiety was measured by the Psychasthenia scale of the Karolinska Scales of Personality (KSP), and social conformity by the KSP Social Desirability scale. ![]() Healthy women ( n = 20) and men ( n = 18) were exposed to increasing levels of toluene and n-butyl acetate in a challenge chamber, during which they repeatedly rated smell intensity and annoyance, and completed neurobehavioral tests. The study examined the impact of trait anxiety and social conformity on ratings and test performance during controlled solvent challenge. ![]()
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