Dysautonomias are disorders of the autonomic nervous system.

The autonomic nervous system regulates many body functions unconsciously, continuously, and dynamically, in everybody, throughout all the stages of life. In dysautonomias, changes in functions of one or more components of the autonomic nervous system adversely affect health. 

Dysautonomias range from occasional annoying sensations in otherwise healthy people to progressive, debilitating diseases. They occur in all age groups. Some are established diseases, with changes in body tissues that a pathologist can see. Some are functional disorders, with chemical or biological changes that a clinical investigator can measure. Some are mysterious and controversial, because of a lack of accepted objective tests and treatments. Some are rare and others common, but all involve more than one body function, and all have an impact on the sense of well-being.

All involve multiple disciplines in medicine—cardiology, neurology, endocrinology, physical medicine, psychiatry. Predictably, relatively few cardiologists, neurologists, endocrinologists, rehabilitation medicine specialists, or psychiatrists feel comfortable in diagnosing dysautonomias or managing the patients.

Three factors make the field of dysautonomias difficult—for patients, families, caregivers, physicians, students, and researchers. 

First, the disorders involve multiple disciplines of medicine. Specialists certified in programs in single disciplines often cannot serve dysautonomia patients. Medical and graduate school curricula rarely contain coursework on dysautonomias, and because of the multi-disciplinary nature of dysautonomias, when it comes to research, peer-review committees tend to view grant applications about dysautonomias as somewhat foreign or of secondary importance. For these reasons, clinical and basic training and scientific knowledge about dysautonomias have lagged behind.

Second, dysautonomias are disorders of integration. Many factors determine levels of pulse rate, blood pressure, body metabolism, pain, fatigue, and the sense of psychological well-being. These factors interact with each other. They are regulated as parts of complex feedback loops, which change over time, depending on development, experiences of life, and aging. Further complicating the picture, patients with dysautonomias often are treated with multiple drugs, which not only can interact with each other but also with the disorders. Scientific theories taking into account this complexity have also lagged behind.

Third, dysautonomias are “mind-body” disorders, which goes against a distinction between mental and physical body processes. We do not classify dysautonomias or the patients suffering with them as “psychiatric” or “medical.”  

If a clinician cannot identify the cause of a patient’s symptoms, this ignorance should not lead to dismissing the patient as having a psychiatric rather than a “real” problem. 

Dysautonomias: A Handbook for Patients

David S. Goldstein, MD PhD Senior Investigator National Institute of Neurological Disorders and Stroke National Institutes of Health