“It is all in your head.” Patients hate to hear that. I am not sure why physicians still say it.
Lots of “real disease” is in your head: multiple sclerosis, strokes, pain, and depression. That does not mean that there is not organic pathology.
The report from the evidence-heavy Institute of Medicine (IOM) validates what so many patients have known all along: Chronic fatigue syndrome is a valid diagnosis.
No, we do not have laboratory or radiologic markers of the disease. Of course, there are not biomarkers of many other diseases, including posttraumatic stress disorder, pain, and depression.
What is tremendously important about this report is that it scientifically validates the experiences of so many patients – patients who previously have been dismissed by their physicians, thereby adding to their misery.
To reiterate the conclusions of the report:
“Myalgic encephalomyelitis/chronic fatigue syndrome – commonly referred to as ME/CFS – is a legitimate, serious, and complex systemic disease that frequently and dramatically limits the activities of affected individuals.” In the report, the IOM developed new diagnostic criteria for the disorder that include five main symptoms. In addition, it recommended that the disorder be renamed “systemic exertion intolerance disease” and be assigned a new code in the International Classification of Diseases, Tenth Edition.
The report goes on to say that between 836,000 and 2.5 million Americans suffer from ME/CFS, and an estimated 84%-91% of people with ME/CFS are not diagnosed. The disease’s symptoms can be treated, even though a cure does not exist. Its cause remains unknown, although in some cases symptoms have been triggered by an infection.
Less than one-third of medical schools include ME/CFS-specific information in the curriculum. Most patients (67%-77%) said that it took more than a year to receive a diagnosis – about 29% of these patients said it took more than 5 years. The direct and indirect economic costs of ME/CFS to society have been estimated at $17 billion to $24 billion annually, $9.1 billion of which has been attributed to lost household and job productivity.
Clearly, it is a disorder that physicians should take seriously. Especially psychiatrists, who know many diseases are “all in the head.”
Dr. Ritchie serves as professor of psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Md., and at Georgetown University in Washington. She retired from the U.S. Army in 2010 after serving for 24 years and holding many leadership positions, including chief of psychiatry.
