CFS - Psychological or Physical?
This seemed such a stupid question that I never bothered to consider it. I estimate I must have now (2010) seen over 10,000 patients with CFS and it is clear that CFS is primarily a physical disorder. It is only when patients have been ill for several months and been told by their physicians that nothing is wrong that they get secondary psychological problems. The only place where CFS does not exist is in the brains of small-minded doctors.
The reason the "physical or psychological" debate continues is because the usual tests for pathology come up showing normal results. GPs find ill patients, do the usual screening tests which come up normal and feel this allows them to turn round to patients and conclude there is nothing physically wrong. If, however, the screening tests included SPECT scans; sensitive tests of the hypothalamic-pituitary-adrenal axis; T cell subsets; biopsies to look at mitochondrial abnormalities; mitochondrial function tests, antioxidant status and tests of xenobiotic loads; enterovirus sequences in muscle and brain; trace element levels, vitamins, essential fatty acids and amino acid profiles, then lots of abnormalities would be found. Doctors would diagnose serious metabolic and hormone problems and patients would be taken more seriously.
With any illness there is a psychological component, but with CFS this is secondary to a physical illness. I am always amazed how well adjusted are my CFS patients and depression is not a common feature. The difference is that CFS sufferers want to do things, but if they do they feel ill. With depression, patients don't want to do anything, but if you push them to exercise, they actually feel better. In contrast to CFS, in depression one sees early morning wakening. I suspect this is why the "stimulating" antidepressive drugs seem to make CFS worse - they increase the desire without improving the performance and therefore worsen the frustration.
The recent news (end 2009) that 90% of CFS patients test positive for the XMRV virus compared to 3% of controls clearly puts CFS into the physical camp.
- Recommended reading: Hans Selye "The Stress of Life", McGraw-Hill Book Co, first published 1956, ISBN 0-07-056212-1
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