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Independents' Day

Chronic fatigue syndrome and somatoform disorders, contrary views

Dr Christopher Bass's recent article on somatoform disorders, and in particular his inclusion of chronic fatigue syndrome and fibromyalgia within this grouping, has provoked a strong response from sufferers of the condition.

Dr Christopher Bass's recent article on somatoform disorders, and in particular his inclusion of chronic fatigue syndrome and fibromyalgia within this grouping, has provoked a strong response from sufferers of the condition.

There is a highly vocal ME/CFS lobby which strongly opposes the categorisation of the condition as a psychiatric/mental disorder, arguing strongly that it is primarily caused by physical components.

Rather than add their extensive comments as feedback to Dr Bass's article, which rather than stimulating debate we felt would somewhat drown it out, we reproduce them here for you to consider. What's your view? Has there been too little focus on the physical aspects of CFS and Fibromyalgia?

Or are those with these conditions being overly sensitive to a diagnosis that it's a psychiatric disorder, with the historic stigma this brings that 'it's all in the mind' and that the sufferer is 'weak'.

May we also stress that, as pulsetoday is a site for GPs and other health professionals, it is people from these groups whose views we seek.

Antidepressant drugs maybe helping CFS patients but will not help ME/Lyme disease sufferers. And for CBT, GET, PACE etc for ME/Lyme it is just a waste of time. How can drugs be prescribed when doctors dont know what is making us ill. We have biomedical research to show just what is going on but doctors and government will not accept it! Is this because it may show that contaminated polio vaccines and germ warfare may be involved?
Jacqui Butterworth

Misdiagnosis wears a new name, a diagnosis of imagined illness in the patient saves the doctor's day! Unfortunately iatrogenic harm will be on the increase if doctors are diverted from properly investigating patients because of the increase in reporting of so-called somatoform disorders by psychiatrists with unsubstantiated 'illness beliefs' about serious medical conditions.

Chronic fatigue syndrome is one of two things: the renaming of multi-systemic disease Myalgic Encephalomyelitis, a serious infectious disease of the CNS classified by the WHO as a neurological disease since 1969; or as a result of the unfortunate renaming and loose criteria a mixed group of undiagnosed patients who do need proper investigation of the underlying cause of their illness. There are guidelines for diagnosing and treating ME/CFS including diagnostic tests for neurological, immune, cardiac abnormalities and viral etiology if doctors care to look for them, there are over 4,000 published studies of the serious abnormalities found in this disease, autopsies proving that there is inflammation of the brain and spinal cord and historical records of outbreaks dating back to the 1930s, and other serious diseases including cancer have been uncovered in patients who were dismissed under the unfortunate CFS label. The proposed 'psychological' causes for CFS as outlined in this article have been disproven and the sensitivity to drugs is a sign of the disease, the body's loss of homeostasis and ability to detoxify properly.

Fibromyalgia is a similar disease recognised by the WHO which often overlaps with other diseases that don't have a single biomarker like M.E. or Lupus, and recent research suggests that it is a disease of the CNS with evidence of viral etiology. Bass is simply wrong in stating that Fibromyalgia has been renamed as "chronic widespread pain", that was a rather simplistic view of this disease before much was known about it.

The promotion of these unproven beliefs has no place in medical and scientific discourse, they cause untold harm to patients and loss of respect for the medical profession. Misdiagnosis is a much more serious concern and the medical profession is losing credibility as the everyday stories of misdiagnosis become widespread in the general population.
John Anderson

Dr Bass is sadly misled in believing that patients with Chronic Fatigue Syndrome (now officially named CFS/ME, Chronic Fatigue Syndrome/Myalgic Encephalomyelitis) are 'reasonably comfortable' with the use of the term 'functional' or indeed 'somatoform' to describe their illness. The reality is quite the opposite. He chooses to ignore the thousands of papers evidencing biological abnormalities (rendering questionable the use of the term 'medically unexplained' with reference to this condition) as well as the pressing need for appropriate testing and further biomedical research into ME/CFS.

This is the most disturbingly misleading article refering to CFS that I have read for some considerable time. GPs following Dr Bass's guidance would be doing both themselves and their patients with CFS/ME a gross disservice.

Jacqui Footman, Information and Publicity Officer, South Molton ME Support Group,
It might be useful to attend a few biomedical research conferences about CFS. They are full of objective science and demonstrate that ME/cfs has been shown to be linked to enteroviruses in many cases.

Also, it is a fact that due to lack of investigation, there is a large number of patients who have been misdiagnosed with CFS/ME. They have been found to have: celiac disease, MS, hypothyroidism, IBS, Lupus, cancer and many other extremely physical illnessess.

Johnathan Kerr has identified seven genomic subtypes of CFS/ME.

Remember that in the history of medicine, the following conditions were perceived as psychiatric: epilepsy, brain tumours, parkinson's disease, colitis, M.S.

Things may be medically unexplained at the moment, but that doesn't mean that they will remain so.
Jill cooper

Pulse Team Blog - CFS and fibromyalgia, contrary viewpoints

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