Why the Psychosomatic View on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Is Inconsistent with Current Evidence and Harmful to Patients

Summary & key facts

This review says that calling ME/CFS a psychosomatic illness does not fit current scientific evidence and harms patients. ME/CFS has been classed as a neurological disease since 1969. Studies report repeated physical abnormalities in blood flow, vascular function, energy metabolism, and immune markers, and many patients develop ME/CFS after an infection. The authors report that diagnosis remains clinical, that no broadly validated biomarkers exist yet, and that wrong psychosomatic labels lead to missed diagnoses, poor care, and slowed research.

Key facts:

• Since 1969, the World Health Organization’s International Classification of Diseases lists ME/CFS as a neurological disease.
• The defining symptom is post-exertional malaise (PEM): symptoms get much worse after minor physical, mental, or emotional effort, typically immediately or 12–48 hours later.
• Before the COVID-19 pandemic, an estimated 0.2–0.5% of the general population had ME/CFS.
• A significant subgroup of people with Long COVID meet diagnostic criteria for ME/CFS, so the authors say the overall prevalence likely increased after the pandemic.
• There are no broadly validated biomarkers for ME/CFS; it remains a clinical diagnosis, though tests such as a 2-day cardiopulmonary exercise test and hand-grip strength test can help with diagnosis.
• Replicated physical findings in ME/CFS include reduced cerebral blood flow, endothelial dysfunction, reduced systemic oxygen supply, lower peak oxygen consumption, increased ventricular lactate, hypometabolism, and higher levels of autoanti
• Many of these organic abnormalities have been shown to correlate with symptom severity in patients.
• A prospective study cited in the article found that psychological factors did not predict who developed ME/CFS.
• In many cases ME/CFS begins after a viral infection (examples given include glandular fever, influenza, and COVID-19), and infectious triggers are considered proven for a substantial subgroup.
• The article reports that many physicians still view ME/CFS as psychosomatic, and that 90% of patients are told at least once by health professionals that their symptoms are psychosomatic before receiving an ME/CFS diagnosis.

Abstract

Since 1969, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) has been classified as a neurological disease in the International Classification of Diseases by the World Health Organization. Although numerous studies over time have uncovered organic abnormalities in patients with ME/CFS, and the majority of researchers to date classify the disease as organic, many physicians still believe that ME/CFS is a psychosomatic illness. In this article, we show how detrimental this belief is to the care and well-being of affected patients and, as a consequence, how important the education of physicians and the public is to stop misdiagnosis, mistreatment, and stigmatization on the grounds of incorrect psychosomatic attributions about the etiology and clinical course of ME/CFS.

Topics

Fibromyalgia and Chronic Fatigue Syndrome Research Genetic Neurodegenerative Diseases Health, psychology, and well-being

Categories

Health Sciences Medicine Psychiatry and Mental health

Tags

Attribution Chronic fatigue syndrome Clinical psychology Disease Encephalomyelitis Etiology Intensive care medicine Medicine Multiple sclerosis Pathology Psychiatry Psychology Psychosomatic medicine Social psychology