Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Reconsidering the role of psychosocial factors in functional dysphonia Vincent Deary a and Tracy Miller b Introduction Functional dysphonia can be defined as loss or alteration of voice when there is no detectable, or only minor, organic pathology. So defined, it is the commonest pres- entation to speech and language therapists, accounting for up to 40 000 new cases in the UK per year. Its classification and nomenclature are a matter of ongoing debate. Common terms in use are muscle tension dys- phonia, psychogenic dysphonia, hyperfunctional dyspho- nia and functional dysphonia, but there is no consensus as to their use, with terms that are synonymous for one author being distinct for another [1,2]. For the purposes of the following review, functional dysphonia was taken as the superordinate term, encompassing the others. This is in line with the study by Baker et al. [2] and with the use of the term ‘functional’ now recommended in other medically unexplained symptoms [3,4]. There is more consensus in the fact that individuals with functional dysphonia experience higher levels of anxiety, depression and poor general health [5–7] and poorer quality of life [6,8] than normal or illness controls. There is agreement that multiple factors are likely to play a role in the genesis and maintenance of functional dysphonia [9] but conceptual models differ as to how they explain the interaction of these factors with voice [10]. The following review will survey recent findings on the psy- chosocial factors associated with functional dysphonia and propose that a broadly conceived cognitive beha- vioural therapy (CBT) model of medically unexplained symptoms (MUS) can contribute to our understanding and treatment of functional dysphonia. This model has been successful in conceptualizing and treating other MUS such as chronic fatigue syndrome (CFS) and irri- table bowel syndrome (IBS) [11–14]. Its key assumption is that in any condition there will be an interaction of three domains: what predisposed the individual to it; what precipitated the illness episode; and what factors – physical, cognitive, behavioural, affective, social – are perpetuating it. This model will be used to structure the literature review. a Department of Psychology, School of Life Sciences, Northumberland Building, Northumbria University and b Department of Speech Voice and Swallowing, Freeman Hospital, Newcastle Upon Tyne, UK Correspondence to Vincent Deary, Senior Lecturer, Department of Psychology, School of Life Sciences, Room 147 Northumberland Building, Northumbria University, Newcastle Upon Tyne NE1 8ST, UK Tel: +44 191 227 3446; e-mail: vincent.deary@unn.ac.uk Current Opinion in Otolaryngology & Head and Neck Surgery 2011, 19:150–154 Purpose of review Functional dysphonia, defined as alteration or loss of voice in the absence of physical pathology, is known to be associated with a variety of psychosocial factors including anxiety, depression and reduced quality of life. Models of functional dysphonia have tended to conceptualize the voice disorder as being the result of a failure to acknowledge and/or express this associated distress. The current literature was reviewed to identify psychosocial factors that predispose to, precipitate and perpetuate functional dysphonia and to assess the evidence for these models. Recent findings Recent studies have identified evidence of genetic susceptibility, occupational susceptibility, a history of sexual and/or physical abuse and perfectionism as being predisposing factors. Precipitants include life events, frequency of vocal use and infections. General fatigue is identified as being a potential perpetuating factor. A recent novel theoretical model of functional dysphonia is reported, which proposes deficits in emotional processing as the core process in voice loss. Summary Current research confirms that functional dysphonia is associated with multiple psychosocial factors. However, these findings are shown to be true of other medically unexplained symptoms in which vocal problems are absent. It is argued that, whilst intuitively appealing, there is insufficient evidence to support the popular notion that the loss of voice is the consequence of unexpressed emotion. Keywords cognitive behavioural therapy, conversion, functional dysphonia, medically unexplained symptoms, psychogenic dysphonia Curr Opin Otolaryngol Head Neck Surg 19:150–154 ß 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 1068-9508 1068-9508 ß 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI:10.1097/MOO.0b013e328346494d