CFS and ME - Psychological or Physical?

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Clarification - CFS versus ME

  • Chronic fatigue syndrome [‘CFS’] is characterised by poor energy delivery mechanisms.
  • Myalgic-encephalitis [‘ME’] is characterised by poor energy delivery mechanisms AND inflammation.

Poor energy delivery is caused by poor diet and gut function, poor breathing, poor sleep, mitochondrial failure, and poor adrenal and thyroid function.
Inflammation occurs when the immune system is activated. The immune system is activated in allergy, chronic infection and auto-immunity.
In both CFS and ME there may also be an emotional hole in the energy bucket.
Please see Overview of CFS/ME protocol for more detail on these various components.


The central cause and lesion in CFS and ME is mitochondrial failure - see CFS - The Central Cause: Mitochondrial Failure.

CFS and ME are physical disorders.


This seemed such a stupid question that I never bothered to consider it. I estimate I must have now (2023) seen well over 10,000 patients with CFS and ME and it is clear that both CFS and ME are physical disorders. It is only when patients have been ill for several months or years and have been told by their physicians that nothing is wrong, that they get secondary psychological problems. The only place where CFS and ME do not exist is in the brains of small-minded doctors.

The reason the "physical or psychological" debate continues is because the usual tests for pathology come up showing normal results. GPs find ill patients, do the usual screening tests which come up normal and feel that this allows them to turn round to patients and conclude there is nothing physically wrong. If, however, the screening tests included SPECT scans; sensitive tests of the hypothalamic-pituitary-adrenal axis; T cell subsets; biopsies to look at mitochondrial abnormalities; mitochondrial function tests, antioxidant status and tests of xenobiotic loads; enterovirus sequences in muscle and brain; trace element levels, vitamins, essential fatty acids and amino acid profiles, then lots of abnormalities would be found. Doctors would diagnose serious metabolic and hormone problems and patients would be taken more seriously.

With any illness there is a psychological component, but with CFS and ME this is secondary to a physical illness. I am always amazed at how well adjusted my CFS patients are and depression is not a common feature. The difference is that CFS sufferers want to do things, but if they do they feel ill. With depression, patients don't want to do anything, but if you push them to exercise, they actually feel better. In contrast to CFS, in depression one sees early morning wakening. I suspect this is why the "stimulating" antidepressive drugs seem to make CFS worse - they increase the desire without improving the performance and therefore worsen the frustration.

This is why psychological interventions do not effect a cure

The new NICE Guideline, after reviewing hundreds of medical papers, have finally endorsed this view, especially with regard to Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy (GET)

The committee wanted to highlight that cognitive behavioural therapy (CBT) has sometimes been assumed to be a cure for ME/CFS. However, it should only be offered to support people who live with ME/CFS to manage their symptoms, improve their functioning and reduce the distress associated with having a chronic illness. [NICE, NG206,Box 5]

And also that:

CBT for people with ME/CFS: (1)aims to improve their quality of life, including functioning, and reduce the distress associated with having a chronic illness (2) does not assume people have 'abnormal' illness beliefs and behaviours as an underlying cause of their ME/CFS, but recognises that thoughts, feelings, behaviours and physiology interact with each other. [NICE NG206, 1.12.32]

The Guideline went further on Graded Exercise Therapy (GET) and stated that:

Do not offer people with ME/CFS:....any programme ...that uses fixed incremental increases in physical activity or exercise, for example, graded exercise therapy [NICE NG206, 1.11.14]

Reference - NICE Guideline NG206 - "Recommendations"

GET can cause serious harm to CFS and ME sufferers

Evidence of harm caused by GET was submitted as part of the NICE [NG206] review of ME/CFS guidance –

Fifty-one percent of survey respondents (range 28-82%, n=4338, 8 surveys) reported that GET worsened their health

[So, in one of the 8 studies reviewed an astonishing 82% of patients reported a worsening of health following GET.]

...graded exercise therapy brings about large negative responses in patients (54%–74%)  

But well delivered psychological interventions can help...

If there are "Emotional Hole" issues, please do not ignore them as dealing with them can help to make life more bearable. Please see:

Also, consider counselling or other psychotherapy, where you feel this would be helpful. See:

Look for a practitioner who REALLY understands CFS and ME - you will find some great (especially Experienced Patient) practitioners here - Natural Health Worldwide

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