Robert Kellner. 260 pages. Washington, D.C.: American Psychiatric Press; 1992. $32.00.

Oxymoron or not, this book is best described as a brief encyclopedia. Dr. Kellner succeeds in efficiently summarizing research and clinical experience with a challenging group of patients—those who seek care for physical symptoms that have no known biomedical cause or treatment. The first nine chapters discuss common symptoms or syndromes in which psychologic factors may play a role: fibromyalgia, chronic fatigue, globus, dysphagia, dyspepsia, irritable bowel syndrome, urethral syndrome, hyperventilation, and chronic pain. Each chapter includes discussions of clinical features, the roles of psychologic and physiologic factors, diagnostic classification, and methods of treatment (sometimes illustrated with case vignettes). The final chapters consider various mechanisms for the production of physical symptoms: somatization, hysterical conversion, and intentional deception.

Most of the topics receive comprehensive and up-to-date attention. Controversies about the cause of specific syndromes (for example, the chronic fatigue and irritable bowel syndromes) are discussed thoroughly. Evidence for the efficacy of various treatments (for example, pharmacotherapy, traditional psychotherapy, hypnosis, relaxation training, and biofeedback) is presented without apparent bias. Treatment suggestions are practical and clear. The weaknesses I identify are understandable. The causes and management of chronic pain cannot be adequately discussed in a single chapter. Some of the chapter divisions mirror a common pitfall of clinical practice; symptoms are considered in isolation according to the specific medical disorders that they most resemble. The clinical evaluation of chest pain suffers greatly by ignoring the associated abdominal pain, diarrhea, and dizziness. In this book, the narrow focus is most evident in the four chapters on gastrointestinal symptoms, which often coexist. A later chapter on the process of somatization, in general, helps to reintegrate the syndromes discussed.

This book compares well with its competitors in comprehensiveness, fairness of presentation, and clinical usefulness. It is a useful reference for primary care physicians, medical specialists, and psychiatrists working in medical settings.