BMJ 1994;308:1297-1301 (14 May)

Letters

Chronic fatigue syndrome Role of psychological factors overemphasised

EDITOR, - In concluding that psychological factors are more important than immunological ones in determining the long term outcome of myalgic encephalomyelitis or the chronic fatigue syndrome Andrew Wilson and colleagues seem overconfident of the validity of their findings.1 Although the use of self rated measures of outcome is necessary, the validity of the investigators' treatment of such data is questionable. For example, the five point self rated global illness outcome was dichotomised such that an original response of "not improved at all" was recorded to "worsened" - a decision the investigators fail to justify. It is also dubious whether patients' recall of their own premorbid psychological state is accurate, given that the average onset was 9.2 years before recall and the finding that memory of an event is affected by subsequent events.2

Further the association of "disease conviction" to lack of improved global outcome at follow up may reflect . . . [Full text of this article]


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Relevant Article

Longitudinal study of outcome of chronic fatigue syndrome
A Wilson, I Hickie, A Lloyd, D Hadzi-Pavlovic, C Boughton, J Dwyer, and D Wakefield
BMJ 1994 308: 756-759. [Abstract] [Full Text]

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