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

[Esther12]

But the sad fact is that it doesn’t 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 doesn’t matter that it’s calumny of the first order against a whole group of people, you can bet they will do it.

This is such an irritating thing about so much of the CFS psychological research. Researchers are able to hide their own beliefs behind references to the work of others; arguments aren't based on the evidence, but on claims made in peer-reviewed papers; in fact, arguments are rarely put foreward at all: the cowardly circularity of it creates a sheen of respectability for those who only read a couple of papers, but there's nothing more there than the prejudices of a group of researchers that we had started with 30 years ago.

 

[CBS]

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?

They will help a great deal. Thanks for pointing out a critical issue in assessment and validation.

Shane

 

[xrayspex]

Mya--way back you asked for feedback on yr letter......just one thing I noticed is you mean to write "introverted" in your 2nd paragraph and you wrote "extroverted".

 

[jane doe]

5 factor personality test

http://users.wmin.ac.uk/~buchant/wwwffi/

 

[judderwocky]

I almost didn't post this because I'm so unsocial. LOL. I couldn't help but google Personality Disorder Test and I would LOVE to now how Reees would answer these questions. Here they are, the thought of his answers makes me laugh and feel better.
Do you find yourself unaffected by criticism?
Do you often see things in black and white terms? In other words, something either is or it isn't, with no gray area inbetween?
Have other people accused you of being cruel to animals or people?
Do you often get stuck on the details while missing the larger picture?
Do others accuse you of being rigid or stubborn?

Do others see you as being cold and distant?
Do you tend to choose jobs that are below your skill level?
Do you tend to lie a lot?
Do you have a difficult time relating to others?
Do you find yourself exaggerating your achievements to win the respect of others?
Have others accused you of being arrogant?
Are you often critical of weakness in others?
Are you often uninterested in the feelings of others?
Do you sometimes profit at the expense of others, without being bothered by the pain or damage you may cause them?
Do you frequently reassure yourself that you are deserving of praise?

This is the funniest thing I've read in a while. THANKS.

 

[judderwocky]

This is such an irritating thing about so much of the CFS psychological research. Researchers are able to hide their own beliefs behind references to the work of others; arguments aren't based on the evidence, but on claims made in peer-reviewed papers; in fact, arguments are rarely put foreward at all: the cowardly circularity of it creates a sheen of respectability for those who only read a couple of papers, but there's nothing more there than the prejudices of a group of researchers that we had started with 30 years ago.

The entire discipline of psychology is really just one long taxonomy listing... just a long series of references to other references.

 

[katiemoomoo]

I cant believe they are even trying this.. I agree its gotta be the last breath. BYE

 

[oceanblue]

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.

Thanks, ixchelkali, that's a brilliiantly-made point. But also one that competent and rigorous researchers would have considered (so, no surprises that they didn't).

 

[katiemoomoo]

I agree its still SICK what there doing or trying to do

This is such an irritating thing about so much of the CFS psychological research. Researchers are able to hide their own beliefs behind references to the work of others; arguments aren't based on the evidence, but on claims made in peer-reviewed papers; in fact, arguments are rarely put foreward at all: the cowardly circularity of it creates a sheen of respectability for those who only read a couple of papers, but there's nothing more there than the prejudices of a group of researchers that we had started with 30 years ago.

Neuro Endocrinol Lett. 2009;30(3):284-99.

A review on cognitive behavorial therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS): CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS.
Twisk FN, Maes M.

ME-de-patinten Foundation, Limmen, the Netherlands. frank.twisk@hetnet.nl

Abstract
Benign Myalgic Encephalomyelitis (ME) / Chronic Fatigue Syndrome (CFS) is a debilitating disease which, despite numerous biological abnormalities has remained highly controversial. Notwithstanding the medical pathogenesis of ME/CFS, the (bio)psychosocial model is adopted by many governmental organizations and medical profes-sio-nals to legitimize the combination of Cognitive Behavioral Therapy (CBT) and Graded Exercise Therapy (GET) for ME/CFS. Justified by this model CBT and GET aim at eliminating presumed psychogenic and socially induced maintaining factors and reversing deconditioning, respectively. In this review we invalidate the (bio)psychosocial model for ME/CFS and demonstrate that the success claim for CBT/GET to treat ME/CFS is unjust. CBT/GET is not only hardly more effective than non-interventions or standard medical care, but many patients report that the therapy had affected them adversely, the majority of them even reporting substantial deterioration. Moreover, this review shows that exertion and thus GET most likely have a negative impact on many ME/CFS patients. Exertion induces post-exertional malaise with a decreased physical performan-ce/aerobic capacity, increased muscoskeletal pain, neurocognitive impairment, "fatigue", and weakness, and a long lasting "recovery" time. This can be explained by findings that exertion may amplify pre-existing pa-thophysiological abnormalities underpinning ME/CFS, such as inflammation, immune dysfunction, oxidative and nitrosative stress, channelopathy, defec-tive stress response mechanisms and a hypoactive hypothalamic-pituitary-adrenal axis. We conclude that it is unethical to treat patients with ME/CFS with ineffective, non-evidence-based and potentially harmful "rehabilitation therapies", such as CBT/GET.

PMID: 19855350 [PubMed - indexed for MEDLINE

 

[Esther12]

5 factor personality test

http://users.wmin.ac.uk/~buchant/wwwffi/

Thanks for that (and welcome to the forum).

It will be helpful to give people an idea of the sort of test being done, but we really need access to the exact test used and information about how it's scored.

They often have questions like 'Do you feel full of energy' or 'Do you enjoy being in a group of large people' which are used to indicate personality traits and preferences amongst healthy individuals. Testing CFS patients using these sorts of questions and then pretending the abnormal results are indicative of personality disorders is, imo, not a very sensible thing to do.

 

[Tammie]

This is what was PM'd to me.....if it has already been posted, I apologize - I have not been able to read all the way through this thread yet bc I keep getting sick if I stay online too long (I am at page 10 of this so far)
I would put the person's name who sent it to me (to give credit where it is due) but I think from what was said on the PM, that person does not necessarily want his/her name attached to it (if I am wrong, you know who you are, feel free to take credit - I really appreciate that you sent this, thoguh it was not the article I was looking for, it does help)

"http://www.ncbi.nlm.nih.gov/pubmed/19073288

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

Chronic fatigue syndrome and DSM-IV personality disorders.
Courjaret J, Schotte CK, Wijnants H, Moorkens G, Cosyns P.

Department of Psychiatry, University Hospital Antwerp, Edegem, Belgium. kim.courjaret@uza.be

Abstract
OBJECTIVE: Personality is an important factor in the research of the chronic fatigue syndrome (CFS). Although some studies report a high rate of personality disorders--around the 40% level--in samples of patients with CFS, the generalizability of these findings can be questioned. The present study evaluates the prevalence of Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) personality disorders in a sample of female CFS patients and in two control groups. METHOD: The ADP-IV questionnaire (Assessment of DSM Personality Disorders IV) was used to assess the DSM-IV-TR personality disorders at a dimensional and categorical level in a sample of 50 female CFS patients and in two matched control samples of Flemish civilians (n=50) and psychiatric patients (n=50). RESULTS: The results indicate a striking lack of statistical significant differences between the CFS sample and the Flemish control group at the level of dimensional Trait scores, number of criteria, and prevalence rates of personality disorder diagnoses. Unsurprisingly, higher scores at these levels were obtained within the psychiatric sample. The prevalence of an Axis II disorder was 12% in the Flemish and CFS samples, whereas the psychiatric sample obtained a prevalence of 54%. CONCLUSION: The prominent absence of any significant difference in personality disorder characteristics between the female Flemish general population and the CFS samples seems to suggest only a minor etiological role for personality pathology, as defined by the DSM-IV Axis II, within CFS.

PMID: 19073288 [PubMed - indexed for MEDLINE]
Also MERUK summarizes it in their 'Breakthrough' magazine, p.12-13
http://issuu.com/meruk/docs/breakthrough_spring2009

and on their website-
http://www.meresearch.org.uk/informa...s/rsmtalk.html

A second example concerns ‘personality’ and its apparent role in the illness, with some reports claiming rates of personality disorders as high as 40% among patients — some of these claimed personality disorders go under exotic, rather enthralling names, such as alexithymia (emotional deficiency), action-proneness, learned helplessness, and histrionic states. However, Belgian investigators (8) recently evaluated the prevalence of ‘DSM-IV-TR personality disorders’ in a sample of 50 women with ME/CFS and, importantly, in two matched control samples.

The results showed a striking similarity between the ME/CFS sample and the Flemish healthy control group on various measures, including the prevalence rates of an Axis II disorder (defined as “underlying pervasive or personality conditions, as well as mental retardation”) which were 12% in both the healthy Flemish and ME/CFS groups compared with 54% in the psychiatric sample. As the researchers say, “The results of the present study are unambiguous and straightforward… a person diagnosed with CFS is as (un)likely to have a personality disorder as a subject without CFS.”

 

[Tammie]

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

Oh, I didn't take your post to mean that you didn't agree.....just addidn a little to what had already been said.....sorry if it came out wrong

 

[Tammie]

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.)

Had a funny thought about this.......personality disorders by definition are a stable pattern starting in adolescence or early adulthood, and what is quoted above says that basically "normal personalities" change over time and in different situations......so in other words, people with personality disorders are more stable than people with so-called normal persoanlities! (Yeah, I know that's not really what is meant, and in this case, changing personlities could be adaptable personalities, so that could be a good thing......just sharing my weird thoughts on the off chance someone else might find them amusing, too.......cause this subject is so infuriorating, a little humor could help) ; )

 

[Esther12]

To be fair to them, in their paper they do admit to most of the reasons their study is rubbish.

But why not do it better in the first place? All these problems were so utterly predicatable and leave us with results so meaningless that their only use is to give form to the researchers prejudices.

I'm really affronted by the stupidity of it. Is this really the level of thought and effort they think CFS research is worthy of? No doubt they see their own deluded respect for their work and themselves as a terribly healthy way of dealing with their own limitation. No 'all-or-nothing' here - a zen like contentment with their own incompetence reigns at the CDC's CFS department. If only we could be more like them.

 

[oceanblue]

To be fair to them, in their paper they do admit to most of the reasons their study is rubbish.

But why not do it better in the first place? All these problems were so utterly predicatable and leave us with results so meaningless that their only use is to give form to the researchers prejudices.

Very well put.

 

[oceanblue]

Case definition: suspiciously high prevalence

If my calculations are right - and I'd be very grateful to have then checked - then this population study gives an implausibly high CFS prevalence rate of 3.2% or 3,200 per 100,000.

Jason's chicago populaton studies estimated around 400 CFS cases per 100,000. Applying the 3.2% figure to the UK would give around 60 CFS cases per GP and the reality is nothing like that. The UK Department of Health also estimates around 400 cases per 100,000, in line with Jason's finding.

If this is right, then this study isn't looking at CFS/ME, but at a much more widely defined group of fatigues patients.

My estimate was calulated like this:
Total people covered by initial telephone recruiting = 5,623
CFS-like group identified from this = 469
CFS-like group completing clinical assessment = 292 (62%), ie loss of 38%

These 292 would have come from a smaller initial group, 62% of 5,623 = 3,486
CFS cases identified = 113
Prevalence of CFS = 113/3,486 = 3.2%

This study used the CDC's empircal criteria, which have already been much-critcised as being too broad.

So, regardless of all the other flaws, the study is probably not looking at CFS patients that most physicians would recognise.

 

[Dolphin]

If my calculations are right - and I'd be very grateful to have then checked - then this population study gives an implausibly high CFS prevalence rate of 3.2% or 3,200 per 100,000.

Jason's chicago populaton studies estimated around 400 CFS cases per 100,000. Applying the 3.2% figure to the UK would give around 60 CFS cases per GP and the reality is nothing like that. The UK Department of Health also estimates around 400 cases per 100,000, in line with Jason's finding.

If this is right, then this study isn't looking at CFS/ME, but at a much more widely defined group of fatigues patients.

My estimate was calulated like this:
Total people covered by initial telephone recruiting = 5,623
CFS-like group identified from this = 469
CFS-like group completing clinical assessment = 292 (62%), ie loss of 38%

These 292 would have come from a smaller initial group, 62% of 5,623 = 3,486
CFS cases identified = 113
Prevalence of CFS = 113/3,486 = 3.2%

This study used the CDC's empircal criteria, which have already been much-critcised as being too broad.

So, regardless of all the other flaws, the study is probably not looking at CFS patients that most physicians would recognise.

Much as I don't like the empiric criteria, I'll inclined to go with the figure of 2.54% i.e. trust their calculations.

I don't particularly want to re-read the paper again but one has to remember that the final CFS cases didn't just come from CFS-like cases (see Table 2 http://www.pophealthmetrics.com/content/5/1/5 ). Also there is some talk of weightings.

 

[oceanblue]

Thanks for the clarification.

I wasn't sure if they were using the exact same selection as for the original empiric cirteria paper but as they are, a rate of 2.5% of CFS (1 in 40 of the population) suggests that they are not selecting what most physicians - never mind most ME patients - would regard as CFS/ME. The personality findings need to be considered in that sense.

 

[Dolphin]

Thanks for the clarification.

I wasn't sure if they were using the exact same selection as for the original empiric cirteria paper but as they are, a rate of 2.5% of CFS (1 in 40 of the population) suggests that they are not selecting what most physicians - never mind most ME patients - would regard as CFS/ME. The personality findings need to be considered in that sense.

Good points. Yes, these are the 113 that one can see in Table 2 at: http://www.pophealthmetrics.com/content/5/1/5 . They're not the same patients from the original empiric criteria paper - these are the sorts of empiric criteria patients one sees in the general population (the original empiric criteria paper used a lot of people who at one stage satisfied the Fukuda criteria so is a slightly different cohort although used the same definition).

 

[Esther12]

I was curious about the info at the bottom of the abstract that "Part of these analyses have been presented at the 67th Annual Meeting of the American Psychosomatic Society." I found the abstract book for the meeting here: www.psychosomaticmedicine.org/misc/abstracttext2009v2.pdf

Several interesting things stand out. First, the abstract presents data for CFS vs. well individuals. The 264 subjects with insufficient fatigue, including in the article, were not included here. This makes me wonder if that was one of the revisions required by the journal ("Received: August 9, 2009 Accepted after revision: January 5, 2010"). If so, this begs the question of why the authors selected the ISF group instead of the MS group from the 2003 study. Second, I added emphasis for the obvious question we've already asked: are the results of the study indicative of risk factors or the outcome of chronic illness.

Thanks for that. Interesting stuff.