Increased levels of fatigue and perfectionism are found in patients with functional dysphonia

Fatigue and poor health, anxiety and depression (physiological, affective and cognitive factors) may have a major impact on patients with functional dysphonia (FD), leading to time off work, reduced activity, and social withdrawal, all of which could further perpetuate and/or cause anxiety, low mood, fatigue and reduced voice use, according to new research published in the June 2011 issue of Otolaryngology – Head and Neck Surgery.

Functional dysphonia (FD) is a voice disorder in which an abnormal voice exists with no vocal pathology, either structural or neurogenic. According to study results, the current literature on dysphonia has a tendency to paint a rather homogenous picture of distress plus repression as the main pathogenic factor in vocal dysfunction.

"The primary aim of the study was to investigate whether FD patients did experience fatigue in addition to their voice problems, and to ascertain if, as in other fatigued populations, this was also associated with perfectionism," said study author James O'Hara, FRCS. "Our hypothesis was that FD patients would have higher levels of fatigue and perfectionism than matched healthy controls in a cross sectional survey."

The majority of the patient population included patients with functional dysphonia from the Freeman Hospital in the United Kingdom. An 11- point fatigue questionnaire, previously validated on a normal population, was analyzed, with a score above 4 on the bimodal system implying substantial fatigue. A 35-point perfectionism questionnaire was also completed and analyzed for "healthy" and "unhealthy" perfectionist traits.

There were 75 cases and 62 controls. The mean fatigue score in patients with functional dysphonia was 17.0 and 14.4 for the controls. Using the bimodal scoring system, the mean fatigue scores in functional dysphonia (5.10) and controls (3.01) were also significantly different. The mean perfectionism scores were 98.9 for patients with functional dysphonia and 91.2 for controls.

The evidence in the study suggests that patients with functional dysphonia are both more fatigued and perfectionist than healthy controls. Author James O'Hara, FRCS, writes, "Understanding how these factors play into the illness experience of people with this condition can help us improve our understanding of how FD develops and how we can practically improve the treatment of those affected by it."