COMMENTARY

Chronic Fatigue Syndrome: Right Name, Real Treatments

Peter D. White, MD

Disclosures

March 12, 2015

In This Article

A recent Medscape article, "Chronic Fatigue Syndrome: Wrong Name, Real Illness," suggested that "chronic fatigue syndrome" (CFS)—which the Institute of Medicine recently recommended renaming "systemic exertion intolerance disease (SEID)" —was the wrong name for this illness, and that it was a "real illness." Any doctor who looks after patients with CFS will have no problem regarding CFS as "real."

The weight of research supports the separate existence of a CFS, particularly after certain infections.[1] Calling it "myalgic encephalomyelitis" (ME) would be an error, because the evidence that CFS is an inflammatory condition of the central nervous system is limited.[2] Diagnostic labels matter, and an inaccurate description of an implied yet absent pathology can be as disabling as much as a label of a syndrome for which effective treatments exist can be enabling.[3]

It would be unfortunate to stigmatize one group of patients to legitimize another. Patients who suffer from illnesses without a current biological marker are as genuinely unwell as those with an illness for which the marker is known. The aforementioned article stated "...those with CFS are often labeled as malingerers, depressed, or at least partially psychosomatic. But for the scientists and clinicians in the field, the phenomenon is as real as diabetes or atherosclerosis." I am sure that the author did not mean to imply that depression was not real, but that is a possible interpretation of this quotation. No healthcare professional reading this article would doubt that depressive illness is as real as (and can be as disabling as) diabetes mellitus—or even CFS.

The recent article also suggests that it is straightforward to sort out those with depressive illness from those with CFS, as implied in the advice to simply ask a patient, "What would you be doing if you weren't ill?" Depressed patients typically won't have an answer, whereas ME/CFS patients will often respond with a laundry list of dreams deferred." The reality is less simple, and a clinician may need all of his or her skills and time to decide which diagnosis is most likely, because depressive illness is a commonly missed or comorbid diagnosis in those referred for assessment.[4]

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