Physicians' diagnoses of psychiatric disorders for people with chronic fatigue syndrome.

Observed Findings

• Physicians diagnosed psychiatric illness in 64.3% of CFS patients who had at least one disorder present (vs. 50% in controls and 40% in psychiatrically explained group).
• Patients with psychiatrically explained fatigue were more accurate than their physicians at identifying their own mood and anxiety disorders.
• Physicians showed particular difficulty recognizing psychiatric illness in patients whose fatigue was fully explained by psychiatric disorder.
• Relatively little misdiagnosis of psychiatric illness occurred across all groups (high specificity of physician assessment).
• There was substantial discrepancy between physician documentation and objective psychiatric interview diagnoses (SCID).

Inferred Conclusions

• Physicians systematically underrecognize psychiatric illness in ME/CFS populations, though they rarely over-diagnose.
• Patient self-report should be used as a screening tool for psychiatric disorder alongside clinical assessment.
• Physician training may need improvement specifically for recognizing psychiatric comorbidity in patients with medical fatigue syndromes.
• The highest underrecognition occurred in the psychiatrically explained fatigue group, suggesting diagnostic challenge when fatigue is primarily psychiatric.

Remaining Questions