I'm pretty sure that was the fault of the standard psychiatric diagnostic processes, where "physical symptoms wot I don't understand" = "crazy patient". But generally I agree - as long as PEM is a core symptom, it's not necessary to require a list of other symptoms.
One study found that 64 percent of patients with major depressive disorder experienced PEM, but the authors did not describe how PEM was assessed (Zhang et al., 2010). As mentioned earlier, these prevalence estimates may vary depending on how PEM was defined and queried for, and thus need to be interpreted with caution.
Isn't this kind of moot with the 2 day CPET test that proves disability?
The first thing I looked for when I got the IOM report was the algorithm they used to determine diagnosis, for which they gave a flowchart. The remarkable thing about that flowchart is that there were no actions taken to confirm a test, except waiting 6 months if onset was recent. Given the intake label based on reported fatigue, this doesn't sound very different from what went on in the "bad old days" of "CFS".
I think a simplified version might be constructed which had only one diamond containing the question "Feel like treating this patient?" The "yes" alternative would have the action "consider another diagnosis". The "no" alternative would dump them into a diagnostic wastebasket.
This outcome is not an accident, nor is it the result of malevolence on the part of committee members. The unstated parts of the charge to the committee must have been that they could not required any increase in diagnostic or treatment costs without unusually strong evidence. Another implicit assumption was that the committee should not criticize the institutions funding the committee. In fact, if you look at the recommendation for how to implement these recommendations you will see references to the high regard the public has for HHS and the CDC in particular. You would never guess that these institutions had the power to set diagnostic and research criteria 30 years ago, and produced three consecutive definitions which are now all considered incorrect, inadequate and positively harmful. We do not even have the common bureaucratic admission that anonymous "mistakes were made."
Should I ask a busy and pragmatic medical doctor to read a 300+ page document which ends up telling him all he can do is offer symptomatic relief in any case? You can be sure he/she will not thank me, and that there will not be very careful consideration of diagnostic criteria afterward. If he can't spend any money on diagnosis or treatment, beyond what is currently done for amelioration of symptoms, why should he/she bother?