Study starts to unravel stigma around chronic fatigue syndrome

A study has thrown crucial new light on the relationship between the mental and physical health of people who suffer from three stigmatizing disorders whose symptoms are not medically explained, including chronic fatigue syndrome (CFS)—also known as myalgic encephalomyelitis (ME).

Francis Creed, a professor emeritus of psychiatry at The University of Manchester, analyzed the data of 120,000 people followed over 2-and-a half years to unpick the mystery around CFS/ME, irritable bowel syndrome and fibromyalgia.

"When people suffering from CFS/ME, IBS and fibromyalgia come into contact with health professionals, negative attitudes can sometimes get in the way of treatment. but by understanding these complex conditions better, the stigma and mystery around them can be eased," he said.

His latest study—published in the journal PLOS ONE—used data from the Dutch Lifelines cohort study to compare people who reported one of the unexplained disorders with people who reported one of three common medical illnesses: diabetes, inflammatory bowel disease and rheumatoid arthritis.

These illnesses lead to symptoms similar to the unexplained conditions: like ME, diabetes causes tiredness; irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) both lead to diarrhea and stomach pain; and like rheumatoid arthritis (RA), fibromyalgia causes debilitating joint and muscle pain.

All participants had a standardized interview to assess their mental health. A cross-sectional examination of the data revealed that the variables most closely associated with mental health problems were similar in all the conditions studied. These included indicators of:

• A tendency to develop mental health problems: previous anxiety and depression, stress and neuroticism.
• A psychological reaction to the illness: severe difficulties arising from health problems including impairment of daily tasks.

A second analysis compared the prevalence of mental health problems before the onset of the six disorders in a longitudinal study. This analysis allowed Professor Creed to see if underlying mental health problems preceded or followed the onset of the conditions.

It revealed the proportion with mental health problems was smaller than might have been expected: there was no evidence of mental health problems in three quarters of the people developing the unexplained disorders.

The findings, in conjunction with previous work published in Frontiers in Psychiatry, suggest that mental health problems play a part in the development of the illness in approximately a quarter of people developing chronic fatigue syndrome or irritable bowel syndrome.

Creed said, "This work provides evidence that for many people, a wide variety of physical and psychological factors are associated with these debilitating conditions."

"These may be other illnesses, such as gastroenteritis, metabolic and thyroid disorders, chronic infections, asthma, allergies, impaired sleep and excessive preoccupation with illness as well as lifestyle issues. stress, anxiety and depressive disorders."

Appreciating this multifactorial pattern, Creed hopes, will enable health professionals to take a more holistic view of medically unexplained disorders, which can cause debilitating and life changing illness.

He added, "Although mental health problems are more common in ME, they only occur in a minority of people early in the course of the illness. The treatment approach should consider a wide range of possible factors just as sound treatment of diabetes and rheumatoid arthritis should include an assessment of mental health as well as the characteristic bodily problems."

"Although there are symptomatic treatments which may help these unexplained disorders, we should aim to understand fully their underlying causes. There are probably several different ways they may develop; a whole range of physical and mental factors are probably involved. Treatment approaches will become more effective as our understanding of the causes improves."

"Thinking about ME and the other illnesses as either 'physical' or 'psychological' in origin is not helpful and this artificial division could make it more difficult for sufferers to get appropriate help. This study might help to change that for the better."