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

Summary & key facts

This open-access article reviews evidence about Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and argues that calling it a psychosomatic illness does not match current scientific findings and harms patients. The authors list repeated physical findings in ME/CFS (for example lower brain blood flow, problems with blood vessel function, reduced oxygen supply, and abnormal responses to even small efforts). They note ME/CFS is a clinical diagnosis without a single lab test, affected an estimated 0.2–0.5% of people before COVID-19, and that mislabeling it as psychological leads to delayed diagnosis, wrong treatments, stigma, and obstacles to research.

Key facts:

• ME/CFS has been classified by the World Health Organization as a neurological disease since 1969.
• The core symptom is post-exertional malaise (PEM): a marked worsening of symptoms after minor physical, mental, or emotional effort, usually immediately or up to 12–48 hours later.
• Before the COVID-19 pandemic, ME/CFS affected an estimated 0.2–0.5% of the general population.
• Researchers have repeatedly reported objective physical abnormalities in ME/CFS, including significant reductions in cerebral blood flow, endothelial dysfunction, reduced systemic oxygen supply, lower peak oxygen consumption on exertion, in
• There are no broadly validated biomarkers yet, so ME/CFS remains a clinical diagnosis; tests such as a 2-day cardiopulmonary exercise test or hand-grip strength testing can help but do not replace clinical judgment.
• Many cases of ME/CFS begin after an infection (examples given include glandular fever, influenza, and COVID-19), and Long COVID includes a subgroup that meets ME/CFS criteria.
• A prospective study cited by the authors found that psychological factors did not predict who would develop ME/CFS, and the authors report that 90% of patients are told at least once by health professionals that their symptoms are psychosom
• The authors say that treatments and theories based on a psychosomatic model (for example, cognitive–behavioral therapy combined with graded exercise therapy) conflict with evidence about abnormal reactions to exertion and with the widely re

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

Conditions & symptoms

Chronic Pain Sleep disorder Chronic pain Difficulty focusing Lack of energy or motivation Poor sleep