Invest in ME Conference 12: First Class in Every Way
OverTheHills wraps up our series of articles on this year's 12th Invest in ME International Conference (IIMEC12) in London with some reflections on her experience as a patient attending the conference for the first time.
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What makes CFS different from somatoform disorder

Discussion in 'General ME/CFS Discussion' started by bostjan01, Feb 7, 2018.

  1. femtosecond99

    femtosecond99 Senior Member

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    It is very well established that psychological stress causes significant alterations to the immune system, and that pain has a psychological aspect.
     
  2. femtosecond99

    femtosecond99 Senior Member

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    I suspect you won't accept any evidence. However it is very well established that stress causes bowel movements and diarrhea. This is very easy to demonstrate in the lab. You can probably even test it on yourself. Anyway, there's not really any doubt about this. By definition, IBS-D is an abnormal number of bowel movements, so therefore if you are under stress and that stress is sufficient to cause diarrhea, then IBS-D can be caused by stress. There are likely other factors at work as well, and IBS could be caused by a range of different things, but stress is definitely one of them. If you look at the major reviews on IBS, they say the same thing.
     
  3. femtosecond99

    femtosecond99 Senior Member

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    It was VO2max I was referring to, which didn't replicate earlier studies. Although you're right that peak workload did reduce in all 3 trials on day 2 (although only by 13%, which I don't think is sufficient to explain PEM). I used to think the repeat CPET might be a good biomarker, but now I'm not so sure. It certainly has promise, but we probably need some larger trials.
     
  4. Cinders66

    Cinders66 Senior Member

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    Pain has psychological aspect Really? According to you I gues. I dont think so. Let me tell you a story. My cousin had an FM/ME diagnosis with crippling pain being a key feature. Her GP pushed her to see a psychiatrist for her pain, she refused as saw no psychological relevance, the GP obsessed with the fact that she still lived at home and didn't socialise, the GP dismissed her terrible period pain as just another manifestation too. As it turns out she had endometriosis and is so scarred she can't have kids, her diagnosis was changed eventually to lupus and guess what, with that "respectable, proveable illness" all suggestion of seeing psychiatrists and blaming her illness on her abnormal social circumstances ended. She's now mananaged by an immunologist I think. When they find a cure for that autoimmune illness her pain will disappear. If stress exacerbates pain it really is just a secondary thing.

    Stress can affect the immune system and trigger IBS and exacerbate many physical illnessss /conditions - yes. So Stress is causing the NK T cell etc dysfunction in ME, unlikeky. So Stress is causing the immune FLARE - sore throats, aching etc during PEM in ME after physical exertion like taking a walk or shower or in my case moving in bed, nah. So Stress is causing illness like IBS - no it just irritates an already malfunctioning system. How about listening to pwME who will say stress exacerbates things and may have helped to develop the illness to start with but is not in the main a key perpetuator because generally people who are sick believe it or not try to take care of themselves .
     
  5. Joh

    Joh Inactivist

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    Can you please give your sources for these claims?
     
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  6. unicorn7

    unicorn7 Senior Member

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    Somatoform disorder doesn't exist.

    Psychological stress, just like every other stressor, plays a role in the development of literally every disease, from cancer to diabetes to infections. There are about hundreds of factors (diet, genes, stressors, infections, environment etc. etc.) that, all together, make you ill or not. The fact that psychological stress is one of those factors to put a dent in your immune system and make you just a little more vulnerable for an illnesss, doesn't say is plays a role in maintaining disease.

    The problem these days is that statistical preventative research is being extrapolated as being the same as curative medicine.
    Just because you have a smaller risk on getting disease when you eat a healthy diet, move throughout the day and keep your stress down, that doesn't say that you will never get a disease if you do that, or your disease is caused by one of those factors or that you can cure disease by having a healthy lifestyle and meditating all day.
     
  7. femtosecond99

    femtosecond99 Senior Member

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    Which particular one? This is all very well established stuff, so I didn't think it was necessary to post references, but I'm happy to post some if you're genuinely interested and not aware of this science.
     
  8. andyguitar

    andyguitar Senior Member

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    All depends what you mean by 'Psychological'. To my fairly simple mind everything is physical in origin. If not how could it exist?
     
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  9. alex3619

    alex3619 Senior Member

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    Let me break the argument that IBS-D is an example of a pychosomatic disorder down into pieces.


    "It's pretty well established that headaches, back/muscle pain, and IBS can be caused by psychological stress, for example."

    What is the mechanism? Do not say cortisol, as I will shortly show why that is most likely wrong.

    Sensory and cognitive stimuli might indeed cause various hormonal and neurological responses, and from there immunological ones. Congratulations on a biological explanation. It does not prove psychogenic causation. It can easily be explained by biology all the way. That is the problem with many of these explanations, they are too vague and quickly move from mind to biology without any established scientific basis.

    "I suspect you won't accept any evidence." I am happy to consider scientific evidence, that is evidence that is from sound scientific methodology, and sound analysis and reasoning is applied to it. Sadly in this area of medicine, and claimed medical research, it seems lacking far too often. Like any scientific argument it would then be subject to attempts at refutation, which is a normal part of science.

    "However it is very well established that stress causes bowel movements and diarrhea."
    "There are likely other factors at work as well, and IBS could be caused by a range of different things, but stress is definitely one of them. If you look at the major reviews on IBS, they say the same thing."

    I have trouble finding ANY reviews that say this definitively, they are all careful to say might be or possibly or could be. A few do count psychological causation as a possibility, not an established fact. Please cite a source that is available online for the claim about reviews, and another for specific research (not a review) on IBS-D. There is also a difference between exacerbation and causation. For example, its thought likely that cognitive, emotional and physical stressors might induce post exertional malaise in Myalgic Encephalomyelitis. This does not mean they are the cause. Its the underlying mechanism that is important.

    The almost universal claims are about the impact of diet, with regular questions raised about the immune system and dysbiosis.

    I suspect you might well find an association with cortisol and IBS-D, plus other disroders claimed to be psychogenic. These disorders involve pain and other stimuli. A cortisol response might well be a result of the problems, not a cause. Causation needs to be seperately established.

    When I see these kinds of arguments I notice the same pattern -

    1. Vague claims, like talking about stress without discussing mechanisms.

    2. Irrelevant claims, as if a cortisol response is involved then unless the causative direction can be established it must be treated as association only.

    3. Claims beyond the evidence. Many of the arguments are hypothetically possible, and sometimes are referenced as possibilities in the literature, but cannot be said to be proven. In any case the notion of something being scientifically proven is nineteenth century science. That is the century before last. All science needs to be established in a way that is potentially refutable .. if it cannot potentially be refuted it is nonscience, aka unfalsifiable, aka pseudoscience.


    The Cortisol Claim

    Now if the stress response is due to cortisol, and if cortisol is shown to be associated with IBS-D or some other disorder, does this mean we can reasonably infer causation?

    Let me first make a caveat that other responses are involved in stress, its not all cortisol, with adrenaline as an example, but my point is that we have to be specific, so here I debunk a cortisol claim.

    There is a classic high cortisol problem in Cushing's, whether the syndrome or disease version. Irritable bowel or diarrhea are not typical symptoms. If cortisol were by itself causative then Cushing's patients would have these issues at least at a substantially increased frequency. Now this says nothing about cortisol plus other factor, a problem similar to the issue that depression is clearly not due to serotonin deficiency, but that does not disprove serotonin plus some other factors in combination are not responsible.

    Let me remind everyone again ... arguments about cortisol are about biology, not psychology. If the link is thought goes to cortisol goes to IBS-D then its highly speculative at best. At worst its wrong. If they want to prove a causal chain then they can do the science.


    Mind-Body Dualism

    My perspective on most claims that excuse this kind of reasoning based on the argument that emphasising biology is a case of dualism is typically a dualistic argument itself. If they want to argue a monistic claim then suddenly there is no need for mind at all. There is the brain, and what it does. Biological explanations do not need the notion of mind. Its dualistic explanations that require the notion of mind. I am here excluding the (to me very weird) ideas that its all mind, that physical reality is a figment.


    Association or Causation?

    This issue needs to be addressed with many of these arguments. I find it plausible, for example, that many patients with many of these symptoms will have elevated cortisol. That does not prove cortisol causes the problem. It might be that causation is the other way around, or a little of both directions, or other factors are involved.

    If there are that many papers that show the existence of psychosomatic disorders, please name some! Even one! In every case I have investigated there are potentially other explanations, all biological. The issue that we do not know to a high certainty what the causes are do not prove psychogenic causation, at best they only raise it as an hypothesis.

    This is the psychogenic fallacy/inference as defined by Sykes. I have a blog on this if anyone is interested.

    Typically the arguments fail due to one or more of three reasons ... poor scientific methodology, poor evidence, or poor reasoning. Imprecise language, lack of quality references, and hyperbolic claims seem good indicators that there is a problem with the argument.

    There is work at the NIMH in the USA to try to establish an evidence based psychiatric classification. I hope they succeed, and the sooner the better.

    My prediction is that the more we learn about the brain, the more the notion of mind will become irrelevant. There is no doubt the brain has an impact on biology, its a biological control system, but we still do not really understand the details of brain function. We do have an overview, and are learning more year by year, but its a long difficult road. We are still learning about rather gross anatomy, with at least two new discoveries in the last couple of years.

    So the future of psychiatry is a psychology/neurology hybrid, and most issues will probably fall squarely into one camp or the other. We might not really need psychiatry as its currently practised.
     
    Last edited: Mar 6, 2018
  10. Galixie

    Galixie

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    I was diagnosed using tests that are conventional. It just took a long time and some piecing together of info by more than one person to get there. First I had a naturopath who suspected I was having a reactivation of an old virus, so she tested me for EBV and CMV. I came back with high positive antibodies to EBV. I was tested for EBV three more times over the course of a year and all my results kept coming back high (antiviral medicine didn't make a dent in my results). No one told me that this might be CFS, so I wasn't thinking along those lines at all when I went to see a hematologist and happened to mention the EBV test results. The hematologist didn't think it was possible to have a chronic viral infection, and so he decided to test me again himself by rerunning the antibody tests as well as doing a viral load test. It was a couple of years later by this point and, lo and behold, my antibodies were still coming back high. The viral load test came back negative though. This result was so puzzling to him that he asked a virologist. The virologist basically went, "That's weird, but there's nothing that can be done." And that is how I was diagnosed with CFS using conventional tests.

    I laugh at the idea about US doctors. The hematologist who ended up diagnosing me was unapologetic when he read me the email correspondence he had with the virologist where he implied that I was probably a hypochondriac. If my lab results hadn't turned out the way they did, I'm certain he would have just told me it was all in my head and sent me on my way. Even knowing there is an actual issue, he still wanted to wash his hands of me because it wasn't in his wheelhouse of expertise.

    The assumption that the patient is imagining things is not limited to any particular type of doctor or ailment either. I recently had an appointment with a doctor and told her about a benign polyp that I knew I had (from a previous doctor mentioning it to me) and she truly didn't believe it was there until she saw it for herself. Why would I lie about that? Where does this 'it's all imaginary until proven otherwise' mentality come from?
     
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  11. blueberry

    blueberry

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  12. nanonug

    nanonug Senior Member

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    IBS-D was thought to be caused by stress. So was gastritis, by the way. Now we know that gastritis is usually caused by Helicobacter Pylori. "I don't know what it is therefore it's in the mind" is a statement of ignorance, arrogance and intellectual dishonesty.

    IBS-D is an autoimmune disease of the small intestine as shown by Pimentel. Ref: https://www.ncbi.nlm.nih.gov/pubmed/28451914

    There is even a blood test to diagnose IBS-D/M, called IBSDetex:
    https://www.questdiagnostics.com/ho...t-info/chronic-disease/ibs/ibsdetex-test.html
     
    Last edited: Mar 6, 2018
  13. alex3619

    alex3619 Senior Member

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    Why of course. Its not all in the mind. Its caused by snarks, boojums or frumious bandersnatch! Alice would be proud of these people. They live in Wonderland!
     
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  14. Dmitri

    Dmitri Senior Member

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    And not to mention maliciousness. A psychological diagnosis discourages any further testing which puts the patient in danger. Then there are those who die from diseases that doctors failed to diagnose while being labeled a hypochondriac: " http://www.news.com.au/lifestyle/he...e/news-story/ebbdb2774f51d3d662e8d13a29b4c4fb

    I was diagnosed with "somatoform pain disorder" a year ago, oddly enough it was by one of the neurologists on dinet's recommended list.
     
  15. Alexi

    Alexi

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    Is functional neurological disorder the new “bucket “ diagnosis ?
     
  16. nanonug

    nanonug Senior Member

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    More interesting to me is the question: what is a non-functional disorder? A non-functional machine is a machine who doesn't work. Is a non-functional disorder, therefore, a disorder who doesn't actually disorder anything? Hmm, I'm confused...
     
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  17. Alexi

    Alexi

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    Neurosymptoms.org

    I was directed to this website by my neurologist. He said he believes all my symptoms are genuine and caused by brain incorrectly reading and sending signals. Treatment : learn to live with it.

    Hmm....what do you think ?
     
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  18. Gijs

    Gijs Senior Member

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    Did he meassure these signals? And which signals did he meassure? Mmm, i don't think so. He says nonsense.
     
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  19. Alexi

    Alexi

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    Yes I had nerve conduction and EMG single probe studies to eliminate myasthenia gravis and ms. I’m confused ‍♀️
     
  20. andyguitar

    andyguitar Senior Member

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    Yeah sounds like a load of cobblers to me.
     
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