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Somatic symptoms beyond those generally associated with a whiplash injury are increased in self-reported chronic whiplash. A population-based cross sectional study: the Hordaland Health Study (HUSK)

Myrtveit, Solbjørg Makalani; Skogen, Jens Christoffer; Wenzel, Hanne Gro; Mykletun, Arnstein
Journal article, Peer reviewed
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URI
http://hdl.handle.net/11250/302192
Date
2012
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  • Institutt for nevromedisin og bevegelsesvitenskap [1645]
  • Publikasjoner fra CRIStin - NTNU [19757]
Original version
BMC Psychiatry 2012, 12(1)   10.1186/1471-244X-12-129
Abstract
Background: Chronic whiplash leads to considerable patient suffering and substantial societal costs. There are two

competing hypothesis on the etiology of chronic whiplash. The traditional organic hypothesis considers chronic

whiplash and related symptoms a result of a specific injury. In opposition is the hypothesis that chronic whiplash is

a functional somatic syndrome, and related symptoms a result of society-induced expectations and amplification of

symptoms. According to both hypotheses, patients reporting chronic whiplash are expected to have more neck

pain, headache and symptoms of anxiety and depression than the general population. Increased prevalence of

somatic symptoms beyond those directly related to a whiplash neck injury is less investigated. The aim of this study

was to test an implication derived from the functional hypothesis: Is the prevalence of somatic symptoms as seen in

somatization disorder, beyond symptoms related to a whiplash neck injury, increased in individuals self-reporting

chronic whiplash? We further aimed to explore recall bias by comparing the symptom profile displayed by

individuals self-reporting chronic whiplash to that among those self-reporting a non-functional injury: fractures of

the hand or wrist. We explored symptom load, etiologic origin could not be investigated in this study.

Methods: Data from the Norwegian population-based “Hordaland Health Study” (HUSK, 1997–99); N = 13,986 was

employed. Chronic whiplash was self-reported by 403 individuals and fractures by 1,746. Somatization tendency was

measured using a list of 17 somatic symptoms arising from different body parts and organ systems, derived from

the research criteria for somatization disorder (ICD-10, F45).

Results: Chronic whiplash was associated with an increased level of all 17 somatic symptoms investigated (p<0.05).

The association was moderately strong (group difference of 0.60 standard deviation), only partly accounted for by

confounding. For self-reported fractures symptoms were only slightly elevated. Recent whiplash was more

commonly reported than whiplash-injury a long time ago, and the association of interest weakly increased with

time since whiplash (r = 0.016, p = 0.032).

Conclusions: The increased prevalence of somatic symptoms beyond symptoms expected according to the

organic injury model for chronic whiplash, challenges the standard injury model for whiplash, and is indicative

evidence of chronic whiplash being a functional somatic syndrome.
Publisher
BioMed Central
Journal
BMC Psychiatry

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