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“I’m So Tired”: Fatigue as a Persistent Physical Symptom among Working People Experiencing Exhaustion Disorder, 2021, Broddadóttir et al

Discussion in 'Psychosomatic research - ME/CFS and Long Covid' started by Andy, Aug 28, 2021.

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  1. Andy

    Andy Committee Member

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    Abstract

    Fatigue is widespread in the population, particularly among working people. Exhaustion disorder (ED), a clinical manifestation of burnout, is common, but, after treatment, about one-third still experience fatigue and other physical symptoms. We propose that in some instances, fatigue as a persistent physical symptom (PPS) might be a more appropriate formulation of ED patients’ fatigue problems, and we suggest that ED patients who meet fatigue PPS criteria will differ from other ED patients in terms of psychological distress, non-fatigue PPSs and functional impairment.

    Questionnaires were sent to 10,956 members of a trade union of which 2479 (22.6%) responded. Of 1090 participants who met criteria for ED, 106 (9.7%) met criteria for fatigue as a PPS. Participants who met fatigue PPS criteria scored on average higher on measures of depression, anxiety and functional impairment and were more likely to have clinically significant scores. Moreover, they had 27 times higher odds of meeting other PPS subtypes and reported more non-fatigue PPS subtypes, suggesting a more complex health problem. Specific evidence-based interventions are available for both ED and PPSs, and therefore, it is crucial to accurately formulate the fatigue problem reported by patients to provide appropriate treatment.

    Open access, https://www.mdpi.com/1660-4601/18/16/8657/htm
     
  2. rvallee

    rvallee Senior Member (Voting Rights)

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    Uh, what treatment? These people are so damn weird.
     
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  3. alktipping

    alktipping Senior Member (Voting Rights)

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    shouldn't medical professionals know the difference between fatigue caused by overworking particularly in stressful environments and fatigue caused by ongoing health issues . there are many chronic conditions cancer ibs ra just of the top of my head that cause ongoing lasting fatigue.
     
  4. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    Also MS, MND, CVA, head injury, etc, etc. Chronic fatigue is one of the most ubiquitous symptoms, so it is pretty useless by itself as a diagnostic tool, and is largely irrelevant if you are looking to find specific treatments for individual conditions. Some conditions can be treated and presumably the fatigue will go away, but others have no identified treatment so all you can do is seek to manage the symptoms.

    It is rather like mild word finding problems that occur in various early stage dementias, CVA, ME, various mental health conditions, including depression, etc. It may direct you towards further investigations, but by itself gives you little idea of what you are dealing with and little or no indication of appropriate intervention or management strategies unless you know what the underlying condition is.

    Focusing on fatigue without identifying the underlying cause is rather like trying to treat a brain tumour with aspirin.
     
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  5. Snowdrop

    Snowdrop Senior Member (Voting Rights)

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    While perusing another thread here I linked to one of the tweets posted there. As I followed various threads I came upon this (which I think is spot on):

    By Darren Brown: @darrenabrown

    Tired: A term that describes a feeling of reduced energy expected following an amount of activity. Being tired is easily resolved with rest or sleep. Example: Driving many hours to your location. When you arrive you feel tired. Nothing rest won't solve.

    Fatigue: A term that describes a feeling of reduced energy not expected following activities usually tolerated. Fatigue is not eased with rest or sleep & persists for long periods. Example: You’ve been unwell with an infection & you can’t shake off the exhaustion for weeks.

    PESE: A term that describes worsening of any symptoms following previously tolerated physical, cognitive & social exertion. PESE is not eased with rest or sleep & persists for long periods. Example: Living with #LongCOVID, doing simple tasks flares up many symptoms
    for days. *I'd add or longer.

    Anyway, I think it's a good place to start. And important. This all 'fatigue' is the same thing is seriously hampering understanding especially as I read in another thread how people with other chronic conditions get a cfs label and the person thinks they have the same thing as ME when they don't have any of the neurological symptoms just fatigue.

    The constant conflation of fatigue and tiredness and the muddling of fatigue from other chronic illness with ME is a prop helping keep the BPS afloat IMO.
     
  6. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    I think it is more than that. This deliberated conflating of diverse conditions is empire building on behalf of their miraculous interventions of behavioural modification and psychotherapy, ie exercise and CBT. By going for ever expanding patient groupings such as the pseudo diagnosis of MUS it brings ever more patients under the misnamed BPS umbrella.
     
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  7. Sean

    Sean Moderator Staff Member

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    One might even describe it as naked empire building par excellence.
     
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  8. Simbindi

    Simbindi Senior Member (Voting Rights)

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    Given that most GPs have no idea how to accurately diagnose ME/CFS, I think this has happened increasingly over the years. That's why PEM/PESE needs to be the core symptom, so that a diagnosis of ME/CFS is recognised as more than a 'waste basket' diagnosis' as well as preventing harm from inappropriate treatments. I've had neurological and immunological symptoms from the very start of my illness. When I describe my symptoms (rather than state my diagnosis) to a lay person they always assume I have MS.
     
  9. chrisb

    chrisb Senior Member (Voting Rights)

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    This is where we came in. I remember attending a MEA meeting in Bradford in the early 1990's. They had Peter Behan and Darrel Ho-Yen speaking-unless I am conflating separate meetings. PB scoffed at people who said they were exhausted and self diagnosed with ME, despite commuting for an hour each way, working 8 or 9 hours, going out in the evening, and getting little sleep. Of course they were b....y tired what do they expect. But it had nothing to do with PVFS, as he termed the condition.
     
  10. Mithriel

    Mithriel Senior Member (Voting Rights)

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    I think PVFS was a name imposed on ME about then as they had previously termed it ME. probably they thought it would lead to wider acceptance, like the awful myalgic encephalopathy, as if it the was the name that made the BPS the way they are!

    Right from the start Wessely stated that all fatigue was the same, there was just a spectrum of severity. The patients and ME researchers and doctors complained but even then they were drowned out - a clue that there were powerful influences behind the BPS right from the start.
     
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  11. Invisible Woman

    Invisible Woman Senior Member (Voting Rights)

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    And if he was genuinely interested he's had ample time to investigate further and attempt to prove that.

    All fatigue is the same is simply a convenient hypothesis. Something that can be used to cut to the chase to the treatment......the treatment that doesn't work.

    I simply cannot understand why other specialities haven't (to the best of my knowledge) counteracted this claim. Oncology, endocrinology, haematology etc are all used to seeing different types of fatigue that require different treatment.

    Even within endocrinology there are various very different conditions which have fatigue as a symptom.
     
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  12. chrisb

    chrisb Senior Member (Voting Rights)

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    No. Its all the same isn't it. All biopsychosocial.
     
  13. Mithriel

    Mithriel Senior Member (Voting Rights)

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    This is simply because no one in these fields bothers with his work. It is totally irrelevant to them.

    At one time there was a big thing made about CBT being used successfully for heart disease, cancer and so on with the implication that people with ME were whiners who would not take their medicine. Ellen Goudschmitt contacted some of the organizations for these diseases and they had no idea what she was talking about.

    A researcher in the US who found significant abnormalities in some people with Gulf War Syndrome was interviewed by the New Scientist. They asked her how this fit with the views of Simon Wessely and she said "Simon who?"

    He was only influential in certain spheres.

    Now it is different as he has status and they are using the success they have had curing Chronic Fatigue Syndrome - the name could have been designed for this when you think about it, who would think ME applied to cancer - to get it used for other diseases.
     
  14. Joan Crawford

    Joan Crawford Senior Member (Voting Rights)

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    Yes they should.
     
  15. Sean

    Sean Moderator Staff Member

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    Yes, but critical ones. He has a very good nose for relevant nexus of power.
     
  16. Mithriel

    Mithriel Senior Member (Voting Rights)

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    Critical for us certainly. I think the insurance industry does not care about the likes of cancer and heart diseases because they have no loopholes there to avoid payment, the public would not allow it.

    Medicine and science have seen ME and post viral disease as a side issue, at least until covid, so they have let this worm into the heart of medicine.

    A group being left to their own devices because no one else cared has caused disaster in a lot of areas (too political for this forum) with the bits seen as unimportant turning out to be world changing.
     
  17. Wonko

    Wonko Senior Member (Voting Rights)

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    If significant numbers of people, who are not 'ill', are suffering exhaustion and fatigue, and this is viewed as 'normal', then why is this 'normal'?

    Should not something be done about it, or would this impact the profits of those causing it too much to be worth bothering about.

    The people who are apparently happy for this to continue if it increases their profits, and others who are happy for people to be worked to exhaustion simply to survive.
     

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