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Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of, and finding treatments for, complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia, long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.
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Technically this is correct. In practice it is not. Typically when someone is diagnosed with a somatoform disorder the physical problems, if any have been identified, are ignored by the doctors, and patients are taught to ignore them. Its also the case that testing for alternative diagnoses is typically stopped. Somatoform is an hypothetical diagnosis with far less credible evidence than ME or CFS.Somatoform (or psychosomatic) doesn't actually mean there are no physical abnormalities...that would be hypochondria.
There are very specific responses known to occur with respect to possible stressors, both experiential and physical stressors. Those responses do NOT give permission to allow an inference of just about any other physical symptom you can think of, that is an irrational jump. Could such broader responses exist? Hypothetically. Have they ever been proven? No.
If you run any list of former presumed psychogenic disorders, since disproven, versus proven psychogenic disorders, you wind up with a ratio of many to zero. They have never proven the existence of such disorders. Its entirely inferential and fallacious reasoning at that. In patient numbers its probably more like hundreds of millions to zero.
Psychogenic diagnoses are unproven and hypothetical constructs. They have no place in either evidence based nor scientific medicine. So if they are not based on evidence, or science, then they are .... ?
Show me ANY definitive paper, properly designed, peer reviewed, and replicated. In particular show me such a paper involving any major disease entity, like IBS, which is really a disease cluster anyway. Show me the proven mechanism. Show me the objective biomedical tests. There is no question that psychological trauma can initiate physiological changes, but thereafter the issue is primarily physical. Stress, even as used here, invokes physiological change. You do not need to invoke much else after that. The problem is that talking about it as a psychiatric disorder leaves a nebulous hypothetical thing called the mind in the equation. I see no reason to believe that mind is anything other than an observable brain function. Taking the nebulous out of the equation helps avoid errors in reasoning. Or you can load everything with so many caveats that you cannot be sure of the reasoning anyway.It's pretty well established that headaches, back/muscle pain, and IBS can be caused by psychological stress, for example.
Yes, stressors can trigger physiological change, but that change is what needs investigating, not the trigger.The fact that psychic stressors have a huge impact on illness doesn't mean it's psycogenic, it just means that psy stressors have an impact on our brain functions, as well as on our immune system
I was told there aren't any tests to show if you have disease or not diagnosis is made only based on symptoms.
Hi, quite so. We have oodles of evidence of abnormal findings, but given such findings are found in other diseases like MS, sepsis, and diabetes, they are not diagnostic. The two day CPET might be diagnostic, but they are cautious about claiming that. The enlarged fasciculus findings from Stanford are being replicated right now. That might be unique, and might be viewable using various brain scans. The second hypometabolic study apparently is showing 77% of the findings in the first study hold up. That is, iirc, a mass spec study, but you need a top end machine and that probably means a first class facility. The tilt table test shows OI in a majority of patients. They are refining cytokine testing ... there appear to be stable subgroups rather than a universally stable finding, though one or two cytokines are still under investigation. Quantitative EEG images often show a host of problems. A sleep study is always warranted in ME. I am by no means listing all of them, only those I consider the most promising, and ignoring some of the newer cutting edge findings for now until I see if the results are replicable.Also, for something to be a disgnostic test, it has to be specific to that disease. For something to be proof of physical abnormalities, other diseases can have that abnormality as well.
That is, iirc, a mass spec study, but you need a top end machine and that probably means a first class facility.
So ultimately what we are seeing is people conflating the lack of a diagnostic test with a lack of objective physical abnormalit
With CFS there are no established biomarkers for CFS (repeat CPET was thought to be one, but the recent MS study didn't replicate the earlier findings). .
There isn't really any difference, other than presumed etiology. Somatoform (or psychosomatic) doesn't actually mean there are no physical abnormalities...that would be hypochondria. There are many well established physical abnormalities/symptoms that we know can be caused by psychological factors, such as modulation of the immune system in response to stressors, release of stomach acid in response to stress, reduction in hippocampus volume after long-term stress, activation and suppression of HPA axis, autonomic nervous system, etc.
With CFS there are no established biomarkers for CFS (repeat CPET was thought to be one, but the recent MS study didn't replicate the earlier findings). There are some abnormalities that are sometimes (or often) found, and these seem to be similar to the ones seen in somatoform disorders. The main ones seem to be related to the stress system: ANS, HPA axis and immune system.
While I agree that doctors shouldn't automatically jump to the psychosomatic conclusion, I think they also shouldn't completely ignore it. Neither is good for patients, and from what I can tell (in the UK at least), most doctors have the balance about right. In the USA they tend to be more on the organic side, ignoring psychological factors.
It's also not true that there has not been any proven psychosomatic illnesses. It's pretty well established that headaches, back/muscle pain, and IBS can be caused by psychological stress, for example. Obviously there are other possible causes of these conditions as well. Even for stomach ulcer, it is thought that stress is a significant factor. Most people with H.Pylori infection don't get ulcers, and studies show that stress is associated with development of peptic ulcers. We know for certain that cortisol causes the release of stomach acid, so it's very plausible that stress is a factor in causing ulcers.
Even for MS, stress seems to be a factor in causing relapses. It's not the only factor, as we know that lack of vitamin D and EBV are risk factors. We do know that stress reactivates EBV, so it's possible that stress causes EBV reactivation, which then infects the brain causing MS symptoms. Or it could be that some of the MS symptoms such as fatigue and depression are partially caused by stress that is unrelated to MS. There seems to be a lot of parallels with MS and severe CFS which is interesting. The diagnosis of MS seems to be pretty hit and miss...the tests seem to have pretty low sensitivity and specificity.
While I agree that doctors shouldn't automatically jump to the psychosomatic conclusion, I think they also shouldn't completely ignore it. Neither is good for patients, and from what I can tell (in the UK at least), most doctors have the balance about right. In the USA they tend to be more on the organic side, ignoring psychological factors.
It's also not true that there has not been any proven psychosomatic illnesses. It's pretty well established that headaches, back/muscle pain, and IBS can be caused by psychological stress, for example. Obviously there are other possible causes of these conditions as well. Even for stomach ulcer, it is thought that stress is a significant factor. Most people with H.Pylori infection don't get ulcers, and studies show that stress is associated with development of peptic ulcers. We know for certain that cortisol causes the release of stomach acid, so it's very plausible that stress is a factor in causing ulcers.
Even for MS, stress seems to be a factor in causing relapses. It's not the only factor, as we know that lack of vitamin D and EBV are risk factors. We do know that stress reactivates EBV, so it's possible that stress causes EBV reactivation, which then infects the brain causing MS symptoms. Or it could be that some of the MS symptoms such as fatigue and depression are partially caused by stress that is unrelated to MS. There seems to be a lot of parallels with MS and severe CFS which is interesting. The diagnosis of MS seems to be pretty hit and miss...the tests seem to have pretty low sensitivity and specificity.
What can I tell uninformed doctor that tells me I have to sort things out in my brain and that my symptoms are just psychological what abnormalities have been found in studies in CFS patients?
What can I tell uninformed doctor that tells me I have to sort things out in my brain and that my symptoms are just psychological what abnormalities have been found in studies in CFS patients?