Bransfield, Robert C, Friedman, Kenneth J · Healthcare (Basel, Switzerland) · 2019 · DOI
Doctors often struggle to distinguish between illnesses caused by psychological factors, illnesses where physical symptoms cause psychological effects, true multisystem diseases (affecting many body systems), and situations where medical causes haven't been found yet. This article discusses how using outdated or inaccurate diagnostic labels—like 'all in your head'—can harm patients and delay proper diagnosis. The authors argue that many conditions previously thought to be purely psychological may actually involve the immune system and microbiome, and that doctors need better training to avoid misdiagnosing complex diseases like ME/CFS.
For ME/CFS patients, this article is crucial because ME/CFS is frequently misdiagnosed as a psychiatric condition despite evidence of immune and neurological dysfunction. The editorial validates concerns that patients have about being labeled 'psychosomatic' without adequate investigation, and argues for more rigorous diagnostic standards that consider biological mechanisms including immune and microbiome dysfunction. It provides intellectual support for the view that complex multisystem illnesses require thorough investigation rather than premature psychological attribution.
This editorial does not provide experimental data, controlled trials, or biomarker evidence comparing diagnostic categories. It does not establish what specific biological mechanisms underlie ME/CFS or prove that microbiome-immune dysfunction causes any particular illness. The case-history approach cannot determine causation or quantify how often misdiagnosis occurs in clinical practice.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
Spotted an error in this entry? Report it →