Personality Features and Personality Disorders in Chronic Fatigue Syndrome: A Populat

[muffin]

Tammie said: "Actually if I am interpreting what you mean correctly, it is not so random as one might be led to believe......they chose an area of Georgia that was of low socioeconomic status and paid them to particapite if they reported feeling "unwell" for a month or more (so some incentive for one thing that could skew the results)....... & not to stereotype, but people living in the area where this was done are most likely stressed, possibly working more than one low paying job (so tired!), and probably not eating well or exercising a lot, not typically very healthy or mentally healthy, and not able to afford good health care or mental health care (like I said I don't like stereotypes, but these are some things that otehr studies have shown tend to be true of poorer socioeconimc status).....if this were actually random, they would not have limited it to this area of the population"

I looked to see what the demographics for Bibb County, Georgia were. Poor, white and not the type of population that you would work from to get really meaningful data. It was a deliberate way to get that "fatigued net" spread wide and knowing already what the results would be given those demographics. Of course these people would be sick, tired, depressed and have mental issues, drug/booze addictions, etc. The CDC KNEW what they were going to get when they went into Bibb County and they got it. Reeves knows how to play this game and skew the data to work to his favor. You have to really look to see what he and his people are doing and how they spread that net out wide to capture the right types of people that will fulfill their criteria.

--->>> Guess Tina's phone call to the CDC does show that the CDC is looking for fatigued people, not real CFIDS/ME sick with neurological/immune/endocrine/gut/etc damage. Cute twist to CYA them when the positive studies come out on XMRV.

This little game really needs the attention of Congress and others at very high levels and with true power - not Sebelius, she seems worthless.

 

[Dolphin]

Actually if I am interpreting what you mean correctly, it is not so random as one might be led to believe......they chose an area of Georgia that was of low socioeconomic status and paid them to particapite if they reported feeling "unwell" for a month or more (so some incentive for one thing that could skew the results)....... & not to stereotype, but people living in the area where this was done are most likely stressed, possibly working more than one low paying job (so tired!), and probably not eating well or exercising a lot, not typically very healthy or mentally healthy, and not able to afford good health care or mental health care (like I said I don't like stereotypes, but these are some things that otehr studies have shown tend to be true of poorer socioeconimc status).....if this were actually random, they would not have limited it to this area of the population

You could have a point.
But it might not be easy to convince people that the random population sample the CDC chose was that biased. The initial paper is at: http://www.pophealthmetrics.com/content/5/1/5

Population studies have a lot of status.

I hadn't read the paper when I made the initial comment but here is what they say in the text:

Interestingly, the occurrence of
personality disorders in our study was substantially lower
than in these other studies. We believe this is best explained
by the fact that previously published studies enrolled
participants from primary or tertiary care centers,
whereas our study was population-based. Patients recruited
from primary or tertiary care centers may have
more comorbid conditions than subjects recruited from
the community.

 

[Tammie]

I was sent a PM including another related study.....not the one I was originally thinking of (the one I was thinking of may have been by Leonard Jason, but I am not positive).....anyway, I will copy the PM's study here later bc it is also helpful......am too wiped to do so rt now (haven't even made my way all the way through what is on here yet)

thanks to the person who sent me that PM! : )

 

[SOC]

--->>> Guess Tina's phone call to the CDC does show that the CDC is looking for fatigued people, not real CFIDS/ME sick with neurological/immune/endocrine/gut/etc damage. Cute twist to CYA them when the positive studies come out on XMRV.

This little game really needs the attention of Congress and others at very high levels and with true power - not Sebelius, she seems worthless.

Yes, I think this is a place that needs a lot of our attention. Not because the CDC is playing some crazy CYA game, but because some of us may be left behind when the XMRV connection clairifies and they are going to be in even deeper manure than we all are now with the psych lobby.

 

[Dolphin]

Tammie said: "Actually if I am interpreting what you mean correctly, it is not so random as one might be led to believe......they chose an area of Georgia that was of low socioeconomic status and paid them to particapite if they reported feeling "unwell" for a month or more (so some incentive for one thing that could skew the results)....... & not to stereotype, but people living in the area where this was done are most likely stressed, possibly working more than one low paying job (so tired!), and probably not eating well or exercising a lot, not typically very healthy or mentally healthy, and not able to afford good health care or mental health care (like I said I don't like stereotypes, but these are some things that otehr studies have shown tend to be true of poorer socioeconimc status).....if this were actually random, they would not have limited it to this area of the population"

I looked to see what the demographics for Bibb County, Georgia were. Poor, white and not the type of population that you would work from to get really meaningful data. It was a deliberate way to get that "fatigued net" spread wide and knowing already what the results would be given those demographics. Of course these people would be sick, tired, depressed and have mental issues, drug/booze addictions, etc. The CDC KNEW what they were going to get when they went into Bibb County and they got it. Reeves knows how to play this game and skew the data to work to his favor. You have to really look to see what he and his people are doing and how they spread that net out wide to capture the right types of people that will fulfill their criteria.

--->>> Guess Tina's phone call to the CDC does show that the CDC is looking for fatigued people, not real CFIDS/ME sick with neurological/immune/endocrine/gut/etc damage. Cute twist to CYA them when the positive studies come out on XMRV.

This little game really needs the attention of Congress and others at very high levels and with true power - not Sebelius, she seems worthless.

The registry is taken from Bibb County http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0609D&L=CO-CURE&P=R1431&I=-3&m=15635 , http://www.ihealthbeat.org/Articles...y-of-Chronic-Fatigue-Syndrome-Treatments.aspx , http://replay.waybackmachine.org/20090501224651/http://www.cdc.gov/cfs/Spotlight_Registry.html or http://liveweb.waybackmachine.org/h...anager1_wp743118060_wp708981496πd=711&pt=wiki

This is not a registry study but an earlier study.
The details of where people are taken from are at: http://www.pophealthmetrics.com/content/5/1/5

 

[Tammie]

one more quick note re personality disorders.....

by definition they have to have had an onset in adolescence or early adulthood.....so the question is if their survey and questionnaire were measuring current personality or if they were looking at people's youth and early adulthood, too

 

[anciendaze]

If you check for criticism of the Eysenck Personality Questionnaire used in this study, independent of CFS, you should have no trouble discovering controversy. This whole study is a matter of supporting opinions with reference to other opinions, which are also short of validation. Add in interpretations of citations not supported by the original authors and you have a typical paper study based on the safe assumption most readers will not spend the time to check. This is characteristic of groups who simply generate paper and judge results by weight.

 

[Dolphin]

If you check for criticism of the Eysenck Personality Questionnaire used in this study, independent of CFS, you should have no trouble discovering controversy. This whole study is a matter of supporting opinions with reference to other opinions, which are also short of validation. Add in interpretations of citations not supported by the original authors and you have a typical paper study based on the safe assumption most readers will not spend the time to check. This is characteristic of groups who simply generate paper and judge results by weight.

The questionnaire used was:
Hyler SE: Personality Diagnostic Questionnaire-4+ (PDQ-4+). New York, New York State Psychiatric Institute, 1994.

I have no idea whether the same criticisms apply.

 

[Stone]

I think the most deplorable thing about this is that they compared CFS patients to NORMAL people. What would the results be had they compared CFS people to OTHER PEOPLE WITH CHRONIC SERIOUS ILLNESSES? What would CFS patients look like next to people undergoing chemotherapy? What about people with active AIDS? How about end-stage renal disease, advanced multiple sclerosis, congestive heart failure or lupus or rheumatoid arthritis? Just exactly what would you expect people to be like who are largely bedbound, can't think, can't participate much in interpersonal relationships, social activities, congregational worship, or their own self care much of the time? Not that I'm saying that CFS patients really do have the disorders they say they're finding, but even if they did, what else would you expect? I'm amazed, frankly, at how many of us have NOT lost our effing minds with all this, and it's a testament to our strength that we are as 'together' as we are.

And WTF is Reeves still doing messing with CFS anyway? Isn't he supposed to be doing something else? Oh yes, now I remember. Didn't they put him in charge of psychological surveillance of something or another? I see now what those rats have done. Amazing how they're putting our tax dollars to work. Excuse me, I gotta throw up now.

 

[SOC]

And WTF is Reeves still doing messing with CFS anyway? Isn't he supposed to be doing something else? Oh yes, now I remember. Didn't they put him in charge of psychological surveillance of something or another? I see now what those rats have done. Amazing how they're putting our tax dollars to work. Excuse me, I gotta throw up now.

Reeves is in charge of (psychiatric illness)/CFS, not ME/CFS. ME is a different illness from CFS according to the CDC and they're not studying it. They are studying "CFS" which is a psychiatric illness, apparently.

They're going to keeping pitching out this psychiatric BS in order to reinforce their position that they've always studied CFS (a psychiatric illness) not ME (a neurological illness). CFS patients who are XMRV+ must all be ME patients who were misdiagnosed as CFS patients.

Drs Petersen, Lapp, Cheney, Klimas, Lerner, etc, etc are going to love this latest CDC game.

 

[Stone]

Oh goodie, I can't wait to hear their reactions. Something to look forward to. I hope they rip the CDC a new one, but alas, I don't really expect it. It's okay if they don't respond though, since it's really a wasted effort. You can't fix stupid. The good doctors' time is probably better spent doing what they do best. God bless them.

 

[anciendaze]

The questionnaire used was:
Hyler SE: Personality Diagnostic Questionnaire-4+ (PDQ-4+). New York, New York State Psychiatric Institute, 1994.

I have no idea whether the same criticisms apply.

Did anyone else see a reference to Eysenck, or did I imagine that? In any case, the whole field of personality theory is hugely controversial. The areas of general agreement extend only about as far as in common pop psychology. Typically, there are only about four either/or determinations or crude scales for things like introversion/extroversion, giving 16 combinations.

Other studies based on personality regularly turn up discomfitting results for believers. I remember one which tried to tie depressive personality to unrealistic perception of social opinion. Turned out the depressives who were not actually depressed at the time were spot on. The normals all had unrealistic beliefs that others thought highly of them. Other studies have shown depressives far more accurate at predicting negative outcomes. Normal, socially-well-adjusted people tend to reach conclusions like: "we've been launching these things for years and those O-rings have never caused a serious problem", or "just stick enough goop in that well, and it will stay quiet; expensive equipment is more a problem than a solution."

 

[SOC]

Oh goodie, I can't wait to hear their reactions. Something to look forward to. I hope they rip the CDC a new one, but alas, I don't really expect it. It's okay if they don't respond though, since it's really a wasted effort. You can't fix stupid. The good doctors' time is probably better spent doing what they do best. God bless them.

My only concern re: our good docs is that the CDC is saying, quite plainly I think, that any doctor who diagnosed patients with CFS when those patients are not psychiatric patients, misdiagnosed them. That is, that most of our good docs misdiagnosed a majority of their patient population. That's got to be a hard pill to swallow... and it reduces their credibility in the eyes of those not familiar with the naming controversy.

 

[Dolphin]

Oh goodie, I can't wait to hear their reactions. Something to look forward to. I hope they rip the CDC a new one, but alas, I don't really expect it. It's okay if they don't respond though, since it's really a wasted effort. You can't fix stupid. The good doctors' time is probably better spent doing what they do best. God bless them.

I very much doubt one will see a formal response from them. Few physicians anywhere have written letters to journals in the last 10 years anyway.

 

[CBS]

Note: if people want everything (or most things) challenged point-by-point, there could be need for more than one letter. It might be hard to get everything into one letter.

I had the same thought. My plan was to address the misrepresentation of the work that the authors cite and to state that their conclusions about personality being causative fall apart (are actually contradicted by their own citations) if you reference the cited papers appropriately.

 

[CBS]

I think the most deplorable thing about this is that they compared CFS patients to NORMAL people. What would the results be had they compared CFS people to OTHER PEOPLE WITH CHRONIC SERIOUS ILLNESSES? What would CFS patients look like next to people undergoing chemotherapy? What about people with active AIDS? How about end-stage renal disease, advanced multiple sclerosis, congestive heart failure or lupus or rheumatoid arthritis? Just exactly what would you expect people to be like who are largely bedbound, can't think, can't participate much in interpersonal relationships, social activities, congregational worship, or their own self care much of the time?

This is exactly my point in an earlier post. The CDC authors actually cite studies that did compare CFS to MS and the CFS patients were no different than MS patients on the very measures the CDC is claiming proof of personality being causative for CFS. What the CDC left out of this article is that the studies they cite included MS patients.

Think study of cancer patients and cardiac patients with both showing higher levels of anxiety and lower levels of activity compared to healthy people. Then writing up a study of cancer patients and stating that their anxiety and inactivity was causative for cancer (with no mention whatsoever that the study you cited as supporting your hypothesis also included cardiac patients).

 

[Enid]

I've posted before this is outrageous - being quite simple I would have thought "personality disorder" meant murderers, rapists, convictions of anything to do harm or perhaps grand ideas (voices told me) . The criteria listed are so mundane. Who has not thought from time to time gosh I wish they would go away, I'm so tired. And the questions cunningly designed to elicit agreement from those already so ill (dangerous). When can we get this pseudoscience out of ME/CFS. We've a Weasel and cohorts here in the UK. despite international pathology findings.

 

[ixchelkali]

Well, besides the fact that Merck does not list it as an actual disorder, the CDC "study" stated clearly that they took the personality disorders mentioned from the DSM and as I said, it's NOT in there!....and they also clearly stated that the instruments they used to measure these disorders were based on the DSM, so again if they are not in the DSM, then the instruments could NOT measure this at all.

I was agreeing with you. Just pointing out that Merck also agrees that "depressive personality" is not a personality disorder.

 

[Sean]

There is no mention whatsoever of this study in the paper.
CFS isn't really that active an area in terms of the number of studies that are published. This paper appeared on PubMed Nov 2008. I think it should have been mentioned.

Chronic fatigue syndrome and DSM-IV personality disorders

J Psychosom Res. 2009 Jan;66(1):13-20. Epub 2008 Nov 22.

Courjaret J, Schotte CK, Wijnants H, Moorkens G, Cosyns P.

Failure to acknowledge and take into account this paper is getting dangerously close to scientific misconduct.

In any case, the whole field of personality theory is hugely controversial.

It sure is.

Other studies based on personality regularly turn up discomfitting results for believers. I remember one which tried to tie depressive personality to unrealistic perception of social opinion. Turned out the depressives who were not actually depressed at the time were spot on. The normals all had unrealistic beliefs that others thought highly of them. Other studies have shown depressives far more accurate at predicting negative outcomes."

That is a very important point. IIRC, one of the main splits in the debate over personality is whether personality types (to the extent they can be reliably measured) have any value in indicating pathology, or are just natural variations, each with their own pros and cons. In highly social and complex species, like humans, it is impossible for any one individual to possess all the skills and traits needed to cope with the complex and dynamic environment we live in. It takes a range of behavourial strategies for the group to succeed.

There is also the equally serious question of how stable personalities are in changing social/external circumstances. IIRC, there was a study released not too long ago that found they were not stable, and that (surprise, surprise) people's response patterns changed with external circumstance, in a way that was not predictable by conventional personality type. (Don't quote me on this, didn't pay much attention to it at the time. But I think that is correct.)

 

[ixchelkali]

Criterion Contamination


Here are a couple of studies dealing with criterion contamination in the use of psychological testing instruments with seriously ill patients, in this case rheumatoid arthritis. Maybe they will help?

I mentioned earlier, and others have pointed out, that answers to some questions that might indicate psychopathology in a healthy person might be entirely appropriate in someone who is sick. Thats called criterion contamination. The instruments that the CDC study used have not been shown to be valid when applied to seriously ill patients, nor were they adjusted to correct for criterion contamination, nor did they have a control group of patients with other disabling diseases. Without that, the results are meaningless.

But the sad fact is that it doesnt matter how invalid the study is, or what is done to discredit it. It has been published, so now others of the psychosocial ilk can cite it, saying It has been demonstrated that a high percentage CFS patients are mentally ill with serious personality disorders. It doesnt matter that its calumny of the first order against a whole group of people, you can bet they will do it.

=======================================

http://www.ncbi.nlm.nih.gov/pubmed/3801070
Arthritis and rheumatism. 1986 Dec;29(12):1456-66.

Elevated MMPI scores for hypochondriasis, depression, and hysteria in patients with rheumatoid arthritis reflect disease rather than psychological status.
Pincus T, Callahan LF, Bradley LA, Vaughn WK, Wolfe F.

Abstract
The Minnesota Multiphasic Personality Inventory (MMPI) scales for Hypochondriasis, Depression, and Hysteria were studied in patients with rheumatoid arthritis (RA). The RA patients showed elevated scores on these scales, and these results are similar to those reported in each of 6 published studies. The elevated MMPI scale scores can be explained largely by 5 "disease-related" MMPI statements which met 2 criteria: they were among 11 of the 117 MMPI statements that two-thirds of rheumatologists predicted would be RA-associated; and RA patients and normal subjects differed significantly in their responses to these statements. The responses of RA patients and normal subjects to most other statements in the MMPI Hypochondriasis, Depression, and Hysteria scales were quite similar. In RA patients, responses to "disease-related" statements were correlated with results of measures of disease activity, which indicates that responses to these MMPI items reflect the severity, as well as the presence, of RA. These findings suggest that new criteria are needed for validation of the MMPI as a clinical tool for the recognition of hypochondriasis, depression, and hysteria in a patient who has RA.

PMID: 3801070 [PubMed - indexed for MEDLINE]

==============================

http://www.ncbi.nlm.nih.gov/pubmed/19962630
Rheumatic diseases clinics of North America. 2009 Nov;35(4):861-4, xi-xii.

Criterion contamination of depression scales in patients with rheumatoid arthritis: the need for interpretation of patient questionnaires (as all clinical measures) in the context of all information about the patient.
Pincus T, Hassett AL, Callahan LF.

Division of Rheumatology, Department of Medicine, NYU Hospital for Joint Diseases, New York University School of Medicine, 301 East 17th Street, Room 1608, New York, NY 10003, USA. tedpincus@gmail.com

Abstract
The validity of information on a patient questionnaire may not necessarily be generalizable to all individuals and situations, and may depend on the context in which a person provides the information. Examples may be seen in responses of people with rheumatoid arthritis on the Minnesota Multiphasic Personality Inventory (MMPI), on the original Beck Depression Inventory (BDI), and on the Centers for Epidemiologic Studies Depression Scale (CES-D). Several reports have indicated tendencies toward hypochondriasis, depression, and/or hysteria on the MMPI, and tendencies toward depression on the original BDI and CES-D. However, these interpretations were based in large part on responses to such statements as "I am in just as good physical health as most of my friends," "I can work about as well as before," and "I could not get going." These responses would suggest psychological concerns in people who have no somatic disease, the type of subjects in whom these scales were validated, but would also appear appropriate for people with rheumatoid arthritis, including those with no psychological problems. Rheumatologists confirmed independently the likelihood that people with rheumatoid arthritis would respond differently from the general population in responding to these and other statements. This phenomenon, known as criterion contamination, would explain much, but not all, of elevations in scores on these scales in patients with rheumatoid arthritis. The BDI was revised in 1996, as the Beck Depression Inventory-II (BDI-II), to eliminate the items reflecting somatic disease.

PMID: 19962630 [PubMed - indexed for MEDLINE]