Biased research on cfs, chronic fatigue syndrome

Professionals and patients are confronted with a vast number of publications on cfs, chronic fatigue syndrome, produced by psychologists and psychiatrist. The fact that these authors have hijacked the subject leads to a serious publication bias.

At the same time they mistake this illness for a psychosomatic condition and forget to consider physical factors as a reason for illness. This bias of perspective leads to serious flaws in their research. Their outcomes should be refuted.

An enlightening example of biased interpretations can be found in this article in Psychological Medicine online.

The role of the partner and relationship satisfaction on treatment outcome in patients with chronic fatigue syndrome

J. Verspaandonka1 c1, M. Coendersa2, G. Bleijenberga1, J. Lobbestaela3 and H. Knoopa1

a1 Expert Centre for Chronic Fatigue, Radboud University Medical Centre, Nijmegen, The Netherlands

a2 Faculty of Social and Behavioural Sciences, Utrecht University, The Netherlands

a3 Faculty of Clinical Psychological Science, Maastricht University, The Netherlands and RINO Zuid, Postdoctoral Education Institute, Eindhoven, The Netherlands


Background Cognitive behaviour therapy (CBT) for chronic fatigue syndrome (CFS) leads to a significant decrease in CFS-related symptoms and disability. The primary objective of this study was to explore whether partners’ solicitous responses and patients’ and partners’ perceived relationship satisfaction had an effect on treatment outcome.

Method The treatment outcome of a cohort of 204 consecutively referred patients treated with CBT was analysed. At baseline, CFS patients completed the Maudsley Marital Questionnaire. The Checklist Individual Strength subscale Fatigue and the Sickness Impact Profile total scores completed by CFS patients post-treatment were used as measures of clinically significant improvement. Partners completed the Family Response Questionnaire, the Maudsley Marital Questionnaire, the Brief Illness Perception Questionnaire, and the Causal Attribution List. Logistic regression analyses were performed with clinically significant improvement in fatigue and disability as dependent variables and scores on questionnaires at baseline as predictors.

Results Solicitous responses of the partner were associated with less clinically significant improvement in fatigue and disability. Partners more often reported solicitous responses when they perceived CFS as a severe condition. Patients’ relationship dissatisfaction was negatively associated with clinically significant improvement in fatigue.

Conclusions Partners’ solicitous responses and illness perceptions at the start of the therapy can negatively affect the outcome of CBT for CFS. We emphasize the importance of addressing this in therapy.

This research aimed at the predictive value of the partners concern and the perceived relationship satisfaction on the results of CBT treatment.
Several models have been developed to explain why the cfs related symptoms and disability did not decrease. In these explanations  behavioral, psychological and social factors were considered. This description leads to a number of questions and remarks:
1. What group of patients do the authors have in mind when they use the name CFS. There are several definitions. The CDC definition these authors used is a non specific definition. Psychiatric and other problems are included in this definition. This means that we have a very heterogenous population, which makes the outcomes very hard to interprete.
2. Who was excluded ? Patients with severe ME were probably not included because they are not able to visit any healthcareprovider.  Yet authors like Bleijenberg and Knoop are very persistant in their opinion that ME and CFS are the same. ME is officially a neurological disease (ICD10). That means we have a bias here.
3. The research suggests causality between partners concern and relationship satisfaction on one side and the outcome of CBT treatment on the other side. What confounders are there that could influence the outcomes of this research? Specifically one could consider the cause of the illness. Apart from behavioral, psychological and social factors, did you consider a physical cause? What did authors do to exclude a physical condition? That would possibly give us a totally different impression of  the supposed causality. The fact that this was a research based on behavioral, psychological and social factors means that this narrow point of view leads to a serious bias.
4. Did the researchers investigate the group of patients who had no decrease of problems? Are there similarities in this group of patients, apart from partners concern and relationship satisfaction,  that could explain why the therapy didn’t work? In this case but also in general, scientific researchers should pay much more attention to the patients who had no effects or adverse effects as a result of treatment. Especially  research on these aspects can lead to new knowledge.In this case the outcome of this research project could have been that the concern of the partner is a very solid indicator that the patient has a severe physical illness. That would be in line with the statement of the IOM (institute of medicine in the US) that ME is a complex, disabling physical illness. The authors of the above study missed this point totally because of their bias in perspective.


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