How do I know if my fatigue is psychosomatic or physical?

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Heya, I was wondering how I can tell if my fatigue is psychosomatic or physical.

I saw a Reddit discussion yesterday from a Doctors subreddit and it was discussing fybro and CFS and lots of the doctors commenting said it was psychosomatic.

I don’t really know if my issues are psychosomatic or not.

I do kinda feel like they’re physical as I had a physical illness (glandular fever) and then my fatigue got a LOT worse, although it had been building up for a few years before I had glandular fever.

However there seems to be so many people claiming CFS is psychosomatic and I just don’t know really.

I do suffer from mental health issues also and have done for years prior to getting CFS.

However before I was still able to exercise and go walking and listen to music and do lots of things without it triggering fatigue or other symptoms.

I do miss the things that are missing from my life.

Also I read an article yesterday about a woman who psychosomatically went blind after getting some window cleaner in her eyes and recovered after going to a psych ward.

But then on the other hand I have read how dismissing CFS as psychosomatic is routed in sexism (as a lot of sufferers are female) and because the cause isn’t known some doctors don’t believe in it etc

So I am confused really I guess.

I want to get better but I don’t know if I will.

I don’t even know if what I’m facing is real with so many people claiming CFS is psychosomatic.

Any advice or thoughts?
 

Alvin2

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I had listened to an ME researcher a few years back and she had a battery of tests to determine if it was ME or depression. If she ever really got stuck she would simply ask the patient what they would do if they got better. If the answer was pessimism or no answer then the patient likely has depression.

Of course ME can cause depression, people who are slowly turning to vegetables don't feel very hopeful about the future. But most people who are depressed becasue of ME will have goals if they somehow got better.

There are some legitimate psychosomatic reactions but the Freudian crowd lives on believing their own hype.

In general if your low mood is becasue of your physical impediments and you feel hopeless becasue they are getting worse with no end in sight then you likely have a physical impediment that is emotionally getting you down.
 
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I don’t even know if what I’m facing is real with so many people claiming CFS is psychosomatic.

Any advice or thoughts?
They are all largely poorly informed. Most US doctors have no training in our illness. Therefore, they are literally simply responding from a place of near total ignorance with rare exception.

Its possible aspects of your condition are affected by your psychology, but there is considerable rigorous evidence from scientists, from places like Stanford and Harvard what there are very specific measurable issues with folks who have the illness Myalgic Encephalomytelitis.

Chronic Fatigue Syndrome is an older name thats not specific and may include a whole array of folks who might have fatigue for a variety of reasons.
 

gbells

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I saw a Reddit discussion yesterday from a Doctors subreddit and it was discussing fybro and CFS and lots of the doctors commenting said it was psychosomatic.
The criteria for undifferentiated somatoform disorder (psychosomatic pain) fails to consider that to have this disorder the stress must precede the pain. If you had a viral onset and symptoms then became stressed out then it isn't somatoform. That's a good indicator.

However, somatoform disorder is a great diagnosis for getting Social Security Administration disability insurance benefits. If you are diagnosed with it just say thank you as it is an automatic approval (though it doesn't work for private disability well because they limit benefits to two years as a mental issue). My opinion is that a doctor can say I am a carrot if it means I get my SSD disability benefits. But that doesn't mean I'm going to drink Miracle-grow shakes. :woot:
 
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This is an important question, a rabbit hole many of us have spent time in.
A psychosomatic diagnosis is clearly biased, a bias that has been going on for a long time.
The body and mind are not separate. Fatigue is a symptom that triggers you rest and recover, yet we don’t ever recover.
 

wabi-sabi

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I don’t really know if my issues are psychosomatic or not.
After being sick for a long time and not getting any answers it can be easy to start to doubt yourself and think-maybe it is all in my head. That's certainly not helped by the disbelief of many healthcare people who should know better.

However before I was still able to exercise and go walking and listen to music and do lots of things without it triggering fatigue or other symptoms.
For me, this is your best indicator of what is mental health versus physical health. Exercise helps people with depression. Exercise hurts people with ME/CFS, even though both diseases come with a symptoms of fatigue. It's perfectly possible to have both a mental illness and ME/CFS. Really, it's hard not to get anxiety or depression when you have such an awful disease.

One other option is to get treatment for the mental health stuff (you'd mentioned that in the past and I wasn't sure if it was current or not). If some stuff gets better with mental health treatment, then you know which of your symptoms are mental compared to physical, since mental health treatments won't make ME/CFS better, but will help the psych stuff.

Also, depression (and most mental health issues) are not a psychosomatic illness either.
 
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For me, this is your best indicator of what is mental health versus physical health. Exercise helps people with depression. Exercise hurts people with ME/CFS, even though both diseases come with a symptoms of fatigue. It's perfectly possible to have both a mental illness and ME/CFS. Really, it's hard not to get anxiety or depression when you have such an awful disease.

One other option is to get treatment for the mental health stuff (you'd mentioned that in the past and I wasn't sure if it was current or not). If some stuff gets better with mental health treatment, then you know which of your symptoms are mental compared to physical, since mental health treatments won't make ME/CFS better, but will help the psych stuff.

Also, depression (and most mental health issues) are not a psychosomatic illness either.
I have benefited from **self directed/paced** GET, but my step count has gone down. I don’t think we have the final word on this.
I am quite sure that thinking of anything as either mental or physical is wrong. Our consciousness is a biological function evolved to keep us healthier. I think depression is a closely related condition like IBS, Fibro, Pots, etc. My thought is that it is a milder form of ME. The consensus criteria to me are disabling standards, when you need to accommodate or eliminate work. I think ME is more of a malfunction than a disease, it’s the same feeling as recovering from a flu but you never recover.
 

Hip

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I saw a Reddit discussion yesterday from a Doctors subreddit and it was discussing fybro and CFS and lots of the doctors commenting said it was psychosomatic.
ME/CFS community members as well as researchers have spent decades fighting the notion that ME/CFS is an "all in the mind" psychosomatic or somatoform condition. There is long history of this sort of activism.

One of the reasons there has been so little biomedical research in to ME/CFS is because once you portray a condition as "all in the mind", biomedical scientists have no interest in it.

There was a drive by disability insurance companies in the 1980s to make people believe ME/CFS was "all in the mind", as this would mean these companies do not have to pay long-term disability support for ME/CFS patients, which saves these insurance companies billions.

The disability insurance companies teamed up with a group of psychiatrists (called the Wessely school in the UK), in order to try to recast ME/CFS as an "all in the mind" condition. It's one of the most unethical events in the history of medical science.
 

livinglighter

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I am not an expert, but I recently had a medical consultation with a neuroimmunologist and they did not say ME/CFS is all in the mind at all. Sounded like the problem is dysregulation at cellular levels. Psychiatrists (called the Wessely school in the UK) want to claim it is all in the mind due to their relationships with insurance companies, the DWP (UK government social security agency).

The condition is likely to involve neuropsychiatry as it involves the brain, which is how it gets muddled as an overall psychiatric illness by theorists claiming it as so.
 
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pattismith

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I am not an expert, but I recently had a medical consultation with a neuroimmunologist and they did not say ME/CFS is all in the mind at all. Sounded like the problem is dysregulation at cellular levels. Psychiatrists (called the Wessely school in the UK) want to claim it is all in the mind due to their relationships with insurance companies, the DWP (UK government social security agency).

The condition is likely to involve neuropsychiatry as it involves the brain, which is how it gets muddled as an overall psychiatric illness by theorists claiming it as so.
I am happy to read that neuroimmunologists just exist somewhere on earth,
they are the only doctors that may have the knowledge to understand our disease.

An immunologist in France said something interesting that correlates with what I understand about ME/CFS and long covid patients:

There is several types of patients with symptomatic covid:

-The ones that make severe form. They usually have strong innate immunity which is involved in their high inflammatory response.

-The ones that have mild/moderate covid.
These ones have weaker innate immunity (any defect in the complement system for example).

The long covid patients are in this group, especially in a subgroup with something wrong in their adaptative immunity (people that have tendency to allergies or autoimmune disease).

ME/CFS patients are in the same boat, research about long covid will help us a lot in the future I guess.
 

gbells

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I have benefited from **self directed/paced** GET, but my step count has gone down. I don’t think we have the final word on this.
I did GET with a PT starting from light activity. The end result was 20% improvement in physical strength and no improvement in fatigue, concentration or aerobic endurance. I started being unable to do more than two sets of exercises and that it where I ended.

It's a gimmick.
 
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I did GET with a PT starting from light activity. The end result was 20% improvement in physical strength and no improvement in fatigue, concentration or aerobic endurance. I started being unable to do more than two sets of exercises and that it where I ended
It seems we are simply exchanging sets of symptoms.

Forced by necessities to walk more, I got stronger muscle wise, and my lymph improved.

I proceeded to then develop a whole new list of intensified neurological symptoms. Yucky and unfun (tachycardia, intense OI, visually cannot process sensory inputs).

So is that an improvement? It didn't feel like it at the time.
 
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It's like wallpaper-push down on one bubble and another one pops up elsewhere.
exactly.

I see this more and more. I see it better now, when my gut acts up.

My first step is always: Blame the food.

(yet, thats the same food)

So alot is going on, but ultimately, this Spoon Analogy is pretty effective. You've got three today. Use them wisely.

maybe you'll have 10 on Sunday. Don't blow that.
 
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I did GET with a PT starting from light activity. The end result was 20% improvement in physical strength and no improvement in fatigue, concentration or aerobic endurance. I started being unable to do more than two sets of exercises and that it where I ended.

It's a gimmick.
I would totally agree with this. Five years after doing GET which made me so much worse, I hired a personal trainer in August last year to help me start moving again, gentle exercise and sort out my diet as I had seen six months of gradual improvement. I struggled to do five push ups at the start, but after three months got up to twelve pushups, plus was able to do other low-intensity exercises. However - it produced a massive crash in other symptoms, despite losing weight and feeling like I had more energy, so I stopped with the PT. Six months later and I'm struggling with walking and have probably regressed twelve months in my progress.
 

wabi-sabi

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This rather sounds truly physiological than psychosomatic. did you try to analyse your fatigue causes?
In ME/CFS the body simply cannot produce enough energy to meet demands. Subjectively, this produces a sensation of fatigue. So, on a simple level, the reason for the fatigue is an overdrawn energy budget. On a more complicated level, the reason is lack of pacing or energy budgeting. You can use spoon theory or an energy envelope of whatever analogy you prefer, but if you up one area another area must come down in another, because there is only so much energy to go around.

That being said, it's possible that physical exertion is uniquely harmful, moreso than other causes of exertion, like mental or emotional exertion. You'd have to compare the type and severity of a crash you got from each type of exertion.

So, the cause of the fatigue here was the increased exercise of the PT. In a weird sort of way, you can think of it as a sports injury. Even healthy, ultra-atheletes will be injured if they push for too much exercise. The human body has limits, and if you push past you get hurt, no matter how fit you are. In our disease, we get much more "sports injury" for much less activity. The key is to find how much activity you can do without a "sports injury" and to do that much.
 
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So, on a simple level, the reason for the fatigue is an overdrawn energy budget.
I feel like I"m in constant short term cycles of- a bit of energy is followed by. the profound zombie exhaustion, then it can shift again an hour later.

it seems like physical exertion by definition would come with more detox effects from the release of whatever gets stored up in tissues, lymph, etc. it seems like: just thinking- sort of cannot achieve that same type of state.

Last nite was the first time I ever tried to verify- my heart rate after a shower washing my hair. I don't like the shower any more. I avoid it. It got pretty woozy in there, in this hair washing project. I was both standing and doing some: leaning. Please hold me up, shower walls.

My heart rate went WAY up 30 points at least. OK, OI is confirmed.