Eleanor Stein MD FRCP(C)
Psychiatrist, The Burke Institute
Suite G100 Holy Cross Centre
2210 - 2nd St. SW
How to differentiate CFS from psychiatric disorder
A recent publication in the Australian Medical Journal concluded that 6/10 patients presenting to general practitioners have a mental illness (somatization disorder) based on questionnaire self report data of physical symptoms. These somatic symptoms are assumed to be without physical cause though this hypothesis is never tested or validated. It is a mistake to use screening instruments such as the Beck Depression Inventory, the General Health Questionnaire or the SPHERE to diagnose mental illness in persons with undiagnosed somatic complaints including those with CFS because of the unstated, unproven and incorrect assumption that the somatic complaints are of psychological origin.
This paper specifies the clinical differences between CFS and the two most common psychiatric disorders: anxiety and depression. A clinical psychiatric diagnosis rests upon the patient demonstrating the core psychiatric manifestations of depression (eg. anhedonia) or anxiety (eg. unrealistic fear) whereas a diagnosis of CFS requires the presence of 4 or 8 physical symptoms (eg. pain, sore throat) in addition to fatigue. A referenced handout summarizing the research literature differentiating between CFS and depression will be presented.
Depressive and anxious reactions to having a serious, chronic, unpredictable disorder lacking social legitimacy are common among CFS patients. A comorbid psychiatric diagnosis should only be considered if the psychiatric symptoms predated the onset of CFS, if the symptoms are generalized beyond health and quality of life issues affected by CFS or if the symptoms are so severe that they prevent a patient from participating in treatment. Management of the common psychological reactions to CFS and of comorbid psychiatric diagnoses will be discussed.
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