Myalgic encephalomyelitis/chronic fatigue syndrome and the biopsychosocial model: a review of patient harm and distress in the medical encounter

Abstract

The biopsychosocial framework currently applied to ME/CFS is too narrow in focus and fails to adequately incorporate the patient narrative. Misdiagnosis, conflict, and harm are observable outcomes where doctors' and patients' perspectives remain incongruent. Biopsychosocial practices should be scrutinized for potential harms. Clinicians should consider adopting alternative patient-centred approaches. Implications for rehabilitation Patients with ME/CFS may report or experience one or more of the modalities of harms and distress identified in this review. It is important health and rehabilitation professionals seek to avoid and minimize harms when treating or assisting ME/CFS patients. There are conflicting models of ME/CFS; we highlight two divergent models, a biopsychosocial model and a biomedical model that is preferred by patients. The 'biopsychosocial framework' applied in clinical practice promotes treatments such as cognitive behavioral therapy and exercise therapy, however, the evidence for their success is contested and many patients reject the notion their illness is perpetuated by dysfunctional beliefs, personality traits, or behaviors. Health professionals may avoid conflict and harm causation in ME/CFS by adopting more concordant 'patient-centred' approaches that give greater prominence to the patient narrative and experience of illness.

Glial Activation and Expression of the Serotonin Transporter in Chronic Fatigue Syndrome

“…CFS, also often described as myalgic encephalomyelitis, is characterized not only by severe and prolonged fatigue drastically impairing life quality, and much more attention has been paid in the past year than ever ( 1 – 6 ). CFS is observed even in children and adolescents ( 7 ).…”

Treating medically unexplained symptoms via improving access to psychological therapy (IAPT): major limitations identified

“…Additionally, IAPT therapists do not need to be clinical psychologists, thus are unlikely to be able to assess ongoing or emergent mental health complaints. The IAPT treatment model is likely to lead to considerable distress for many patients with MUS complaints that endure post-IAPT, or who reject such treatments as inappropriate for them [64]. Will these patients be returned to GP care, when GPs were unable to help them overcome their MUS complaint in the first instance?…”

“…The CB model IAPT therapists are being trained to employ may benefit some patients with MUS, particularly any suffering depression and anxiety. However, many MUS patients may not benefit and are likely to experience anger and frustration at being referred for psychotherapy [64]. IAPT therapists will have to manage this conflict.…”

Rethinking the Standard of Care for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

“…One unfortunate consequence of the model is that ME/CFS has come to be viewed, not as a biologically based illness, but rather as a psychological ailment that is reversible with behavioral therapies. 29,30 This model stands in stark contrast to the harsh reality of this disabling condition and the significant evidence of neurological, immunological, autonomic, and energy metabolism impairment, as reviewed in an influential 2015 Institute of Medicine report. 31 The appropriate use of CBT, which may be selectively indicated in a number of chronic diseases, such as cancer, is intended to promote patients' ability to cope with their illnesses in order to improve quality of life, e.g., Daniels.…”

“…32 CBT is not viewed as a cure for these illnesses, nor is it used to convince patients that they are either psychologically ill or simply not ill as has been done in ME/CFS, cf. Geraghty et al 29 Thus, the use of CBT as a curative intervention for chronic fatigue syndrome deviates from the treatment's intended purpose.…”