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ME/CFS: A disease at war with itself
We can all agree that ME/CFS is a nasty disease, particularly in its severe form, but there are abundant nasty diseases in the world. What is unique and particularly confounding about our disease is that so much controversy surrounds it, and not only surrounds it, but invades it too.
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Prevalence of DSM-IV Personality Disorders in Patients with Chronic Fatigue Syndrome: A Controlled S

Discussion in 'Latest ME/CFS Research' started by Bob, Oct 18, 2012.

  1. Bob

    Bob

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    I don't think this has been posted yet.

    Prevalence of DSM-IV Personality Disorders in Patients with Chronic Fatigue Syndrome: A Controlled Study
    Kempke S, Van Den Eede F, Schotte C, Claes S, Van Wambeke P, Van Houdenhove B, Luyten P.
    Int J Behav Med. 2012 Oct 13
    DOI: 10.1007/s12529-012-9273-y

    Abstract:
    http://www.ncbi.nlm.nih.gov/pubmed/23065435

    Full paper (PDF):
    http://www.springerlink.com/content/3757145868126x61/fulltext.pdf


    Abstract

    BACKGROUND:
    It is not yet clear whether chronic fatigue syndrome (CFS) is associated with elevated levels of personality disorders.

    PURPOSE:
    This study aims to determine the prevalence of DSM-IV axis II personality disorders among patients with CFS.

    METHODS:
    We examined the prevalence of personality disorders in a sample of 92 female CFS patients and in two well-matched control groups, i.e., normal community individuals (N = 92) and psychiatric patients (N = 92). Participants completed the assessment of DSM-IV personality disorders questionnaire (ADP-IV), which yields a categorical and dimensional evaluation of personality disorder features.

    RESULTS:
    The prevalence of personality disorders in CFS patients (16.3 %) was significantly lower than in psychiatric patients (58.7 %) and was similar to that in the community sample (16.3 %). Similar results were found for dimensional and pseudodimensional scores, except for the Depressive (DE) and Obsessive-Compulsive Personality Disorder (O-C) subscales. Patients with CFS had significantly higher levels of DE features compared to normal controls and similar dimensional scores on the O-C scale compared to psychiatric controls.

    CONCLUSIONS:
    Although the CFS sample was characterized by depressive and obsessive-compulsive personality features, this study provides no evidence for the assumption that these patients generally show a higher prevalence of axis II pathology. Given the conflicting findings in this area, future studies using multiple measures to assess personality disorders in CFS are needed to substantiate these findings.
    jeffrez likes this.
  2. Bob

    Bob

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    "The prevalence of personality disorders in CFS patients (16.3 %) was significantly lower than in psychiatric patients (58.7 %) and was similar to that in the community sample (16.3 %)."

    Not a surprise, but it could be useful research evidence.
    rosie26, merylg, SOC and 1 other person like this.
  3. Nielk

    Nielk

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    Thanks Bob.

    It's nice for a change to see such results but, I can't help it to think that why do they even bother starting such studies to begin with?
    Do they perform similar studies for all biological illnesses?

    In a way I feel like we aremarked "insane" until proven "sane".
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  4. Bob

    Bob

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    Yes Nielk, I agree. It is insulting and ignorant to do this sort of study.

    The same applies to the PACE & FINE Trials.
    They proved what we already know: That CBT & GET don't treat CFS/ME.
    beaker, justy, merylg and 1 other person like this.
  5. Valentijn

    Valentijn Activity Level: 3

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    Looks like we're a little less paranoid and narcissistic than average folk :D Actually I'm surprised about the paranoia results, given the poor treatment we get :p

    And on Obsessive Compulsive, CFS patients were halfway between normal and psychiatric levels. And for Depressive we're quite a bit closer to the normals than to the psychiatric patients.

    I wonder if OCPD, depression, or self-critical perfectionism can be caused by CBT.
    rosie26, leela, ukxmrv and 2 others like this.
  6. Esther12

    Esther12 Senior Member

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    The full paper is really funny, as are most papers on this topic. The medicalisation of personality combined with CFS creates a quacktastic splurge of nuttery.

    Anyone know of any recent stuff on homosexuality and personality? My search seemed to reveal a real drop off in interest in this topic in the eighties... around the time it was recognised that bigotry towards gay people was not acceptable - then it started to be the personalities of homophobes that was studied. I fear that those working in this field for CFS have a good few years ahead of them yet.

    I was just reading this on aversion therapy for homosexuality: http://www.bmj.com/highwire/filestream/242730/field_highwire_article_pdf/0/594 It touches upon the high rate of personality disorders they found there (presumably prior to the aversion therapy... at least this round of it anyway).

    I expect that the bastards responsible were left to retire in comfort, and that's not something I'm entirely happy about.
    justy likes this.
  7. Valentijn

    Valentijn Activity Level: 3

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    Oh man, that's what we need to be cured ... electric shocks every time we see a photo of a couch :D
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  8. Bob

    Bob

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    The depression and OCD results are meaningless if there's no comparison with other chronic debilitating neurological illnesses, as a control group. (I haven't read the full paper, so I'm just assuming they didn't make that comparison.)
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  9. Esther12

    Esther12 Senior Member

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    Yeah - there always seem to be confounding factors with these things. Also - the increase in these 'personality disorders' reported was pretty minimal.

    There were weird things about this paper, eg: all the CFS patients were female. I thought the paper was silly enough to be barely worth thinking about... but it also wouldn't surprise me if we find it gets repeatedly cited as evidence of the problematic personalities clinicians have to put up with from those CFS patients.
    justy and merylg like this.
  10. Esther12

    Esther12 Senior Member

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    I really think that they could be induced by the sort of psychosocial management many CFS patients have had to put up with.
    ukxmrv likes this.
  11. Valentijn

    Valentijn Activity Level: 3

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    Yeah, they only compared CFS patients to healthy controls and psychiatric controls.
    merylg and Bob like this.
  12. SOC

    SOC Moderator and Senior Member

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    We all know that depression can be the result of chronic illness, so no surprise there. I wonder how OCD is evaluated? I'm thinking about those of us who have been given various incorrect psychiatric labels because of behaviors we engage in in order to function -- keeping a close eye on our heart rates, drinking lots of water, limiting what we eat, etc. I wonder if this apparent increase in OCD isn't also mislabeled functional coping mechanisms.
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  13. Bob

    Bob

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    Yes, it could potentially be related to coping with a chronic illness.
    Or it could be directly related to the neurology of ME.
    That's why it's meaningless without a control group with a similar illness.
    rosie26, alex3619, Sing and 1 other person like this.
  14. SOC

    SOC Moderator and Senior Member

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    Agreed. I can't figure out why they are using healthy people as a control group instead of other chronically ill people. Ignoring a major confounding factor is poor experimental design.
    merylg and Bob like this.
  15. Valentijn

    Valentijn Activity Level: 3

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    Well it is a study done by psychologists. The group of psychiatric patients was probably their version of a group of people with a similar illness to CFS :p
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  16. Esther12

    Esther12 Senior Member

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    Coincidentally (or maybe not), I've just stumbled upon this piece from Peter Tatchell which discusses Isaac Marks's use of aversion therapy. Isaac Marks was a co-author on this early Wessely CBT RCT for CFS:

    Cognitive behavior therapy for chronic fatigue syndrome: A randomized controlled trial.
    Deale, Alicia; Chalder, Trudie; Marks, Isaac; Wessely, Simon
    The American Journal of Psychiatry, Vol 154(3), Mar 1997, 408-414.


    This description of Mark's approach does rather remind me a the biopsychosocial approach to the 'management' of the sick:

    http://www.petertatchell.net/lgbt_rights/psychiatry/dentist.htm

    He was a founding member of BABCP (British Association for Behavioural and Cognitive Psychotherapies), which Chalder now chairs.

    Reading some of this old psychology of homosexuality stuff... it's really disgusting. A lot of the people involved went on to continue to be respected as researchers into this century.
    justy and Bob like this.
  17. Esther12

    Esther12 Senior Member

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    This seemed to have some lessons for CFS too (edit: I removed quote tags to make it easier to read - I really found this interesting):

    Then, in the 1960s we entered the era of modern learning theory and the development of behaviour therapy or behaviour modification. Here the objective was not so much curing illness but modifying behaviour that was in some way unwanted. One of the more successful applications of this approach was the management of phobic anxiety, by means of a graduated exposure, combined with some form of relaxation (e.g. systematic desensitization). Attention was also paid to the possibility of modifying sexual preferences, reducing, for example, fetishism, transvestism or homosexuality, a chapter in this history which is of particular significance to me as, for a few years, I was involved in it. Soon after completing my training in psychiatry, I collaborated with Isaac Marks and Michael Gelder in the treatment of fetishism and transvestism using electrical aversion therapy (Marks et al 1970). Around that time, MacCulloch & Feldman (1967) and McConaghy (1970) reported success, at least in some cases, in reducing homosexual and increasing heterosexual responsiveness by means of aversion therapy. I was interested to see if I could replicate their findings, using what I believed to be a better aversive procedure. I reviewed this literature, including my own research (Bancroft 1974; see Haldeman 1994 for a more recent review), coming to the conclusion that aversive procedures were ineffective, but more positive techniques to gradually increase the capacity for heterosexual response and behaviour without trying to suppress homosexual interest, may have some value in those individual who wanted to change. This, however, was around the peak of the gay rights movement, which will be considered more closely below, and I was attacked for my contribution to 'brain-washing' homosexuals. This was a formative experience, cause me to reflect (Bancroft 1975). At no point had I considered homosexuality to be pathological, but stigmatization of homosexuality was still strong, gay rights had not yet achieved the breakthroughs that were to follow, and there were still many homosexual men (not women) who wanted to escape this stigma and sought help to do so. However, I also came to realize that, by pursuing this behaviour modification, I was unintentionally reinforcing the medical pathologization of homosexuality. I also became aware of a further problem. Since the start of the 20th century when clinicians like Schrenck-Notzing (1895), using hypnosis, and Moll (1911), using what he called 'association therapy', an early version of behaviour therapy, claimed some success in increasing heterosexual interest in homosexual men, there was concern that any evidence of the 'treatability' of homosexuality was evidence that it was acquired and hence sinful. Havelock Ellis (1915) concluded that any one who had changed as a result of such therapy could not have been a true homosexual in the first place. Masters and Johnson (1979), in their book on homosexuality, reported two series of cases: homosexual couples who were having sexual problems and who were given the same treatment as ysed for heterosexual couples, with good effect, and homosexual individual who presented with 'homosexual dissatisfaction' and an opposite sex partner (mostly wife or husband), the majority of whom, as a result of going through a treatment programme, were able to enjoy their heterosexual relations more than previously. They called their treatment 'conversion' or 'reversion' therapy, depending upon whether there had been any previous heterosexual interest. Clearly, as Master & Johnson (1979) emphasized, their sample was 'highly selected' (p. 392) and certainly not representative of homosexual men or women. Nevertheless soon after it was published, following a prosecution of a British politician with a homosexual history, one commentator cited Masters and Johnson's results as evidence that homosexuality was always 'learnt', and it was therefore justified to take steps to prevent it by fostering anti-homosexual values.

    A challenge to the pathology model of homosexuality started to emerge in the 1950s with the work of Evelyn Hooker (1965), who used various psychometric test to compare homosexual to heterosexual men, contrasting with much of the work by psychoanalysts (eg Bieber et al 1962) by recruiting homosexuals who were functioning well in their livers, rather than those seeking clinical help for psychological problems. She found that such 'normal' homosexual men showed a variability that was indistinguishable from heterosexual men in terms of personality characteristics. Her findings were replicated in a series of studies by Siegelman (1972, 1974, 1978), and we will return to this literature in the later section on the personalities of homosexual men and women. It is noteworthy that this research was carried out by psychologists, not psychiatrists, and, according to Minton (2002), gave considerable encouragement to the emerging homophile movement.


    Human Sexuality And Its Problems
    By John Bancroft


    http://books.google.co.uk/books?id=bI-Jau14aLAC&pg=PA256&lpg=PA256&dq=isaac marks homosexuality&source=bl&ots=EahcH42DBn&sig=FcaDNR4JeBD5OC3piJNA353ZQMU&hl=en&sa=X&ei=mKeAUPqeOY3htQao0IDgCw&redir_esc=y#v=onepage&q=isaac marks&f=false

    There's more after that which is interesting too.

    This guy's write up of himself sounds very like CFS quacks too:

    http://www.kinseyinstitute.org/about/bancroft-cv.html
    Last edited: Dec 18, 2013
    justy likes this.
  18. Marco

    Marco Old blackguard

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    Or if 'co-morbid' with ME/CFS, merely different facets of the same underlying pathology?

    Not that I give much credence to psychiatric diagnoses.
  19. Marco

    Marco Old blackguard

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    If this 'insight' had been achieved through therapy, said therapy after at least 5 years would have failed every test of cost effectiveness.

    :)

    OK - its a typo. I can be a little childish at times I admit but the combination of psychiatry and TCM tickles me.


  20. Rand56

    Rand56 Senior Member

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    "Patients with CFS had significantly higher levels of DE<depressive> features compared to normal controls"

    Ya think? DUH. Wow these people doing this study must be brilliant.
    Marlène and merylg like this.

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