Is there a psychiatric disorder?

One of the thornier problems in the diagnosis of ME/CFS is whether the patient has ME/CFS or a psychiatric disorder. In some cases, there can be a genuine need to make a differential diagnosis between ME/CFS and a psychiatric disorder. Here the most important diagnostic step to differentiate primary from secondary (post-illness) onset is the patient's history. If not carefully and thoroughly done, the physician may miss what is a simple but very imporant differentiation. Taking an adequate history requires more than a few minutes!

In cases where ME/CFS is already established, there can be difficult, sometimes very difficult, emotional problems coping with and living with this illness. There can be definite secondary depression or anxiety secondary to having to deal with the very real problems caused by the illness.

A properly trained mental health professional who is knowledgeable about ME/CFS can be supportive and additionally help a patient figure out ways to cope with the illness. In cases in which the patient becomes severely depressed or even suicidal, then such mental health care becomes imperative, and a physician would be negligent in not making a referral.

However, there is all too often a psychiatric referral for differential diagnosis that is made out of ignorance or for biased reasons. If the PCP is making the referral because of some real question in his/her mind of whether the illness is ME/CFS or psychiatric, the patient must carefully consider the PCP's reasoning and explanation for the referral.

If there is some genuine doubt that the patient is not physically ill or that the primary cause for physical symptoms is psychological (a rarity of cases), then proper differential diagnosis would call for a psychiatric consult—but only to a psychiatrist or psychologist who is well informed about ME/CFS.

All too often referrals to psychiatrists and other mental health professionals result in blatant misdiagnoses that can become a harmful and counter-productive problem that will take much effort to rectify. If the patient finds a psychiatric consult to be unhelpful or "psychologically-biased" concerning physical symptoms, then the patient should leave.

Make sure to see a mental health professional who is properly informed about ME/CFS. An example of such an instance might be that a patient is applying for Social Security disability and the PCP has indicated some concern that the patient suffers from depression rather than ME/CFS. Then, a properly educated mental health professional would set the record straight that the patient does in fact have ME/CFS.

For more information about the differential diagnosis of ME/CFS vs. psychiatric disorder, see our Differential Diagnosis section.