From Fatigue: Biomedicine, Health & Behavior, 24 May 2013.
Chronic fatigue syndrome/fibromyalgia: a ‘stress-adaptation' model
Boudewijn Van Houdenhove(a,*), Patrick Luyten(b,c) & Stefan Kempke(b)
a. Faculty of Medicine, Universty of Leuven, Leuven, Belgium
b. Faculty of Psychology and Educational Sciences, Universty of Leuven, Leuven, Belgium
c. Research Department of Clinical, Educational and Health Psychology, University College, London, UK
* Corresponding author, Email: boudewijn.vanhoudenhove@med.leuven.ac.be
Abstract
BACKGROUND
A symptom cluster consisting of ‘medically-unexplained' chronic fatigue, effort intolerance and widespread pain is a complex and still poorly understood condition.
PURPOSE
To demonstrate the theoretical and clinical value of a biopsychosocially-oriented ‘stress-adaptation' model for this multi-symptom illness.
METHODS
Clinical observation and review of the relevant literature.
RESULTS
Symptoms and functional limitations of these patients may reflect a loss of normal physical, mental and emotional adaptability, primarily based on stress system dysregulation.
CONCLUSIONS
The proposed stress-adaptation model may facilitate diagnosis, defy dualistic causal thinking, and offer tailor-made treatment options to help patients find a better balance in their lives
From Primary Health Care Research and Development, 23 May 2013 (epub ahead of print).
Diagnosis and management of chronic fatigue syndrome/myalgic encephalitis in black and minority ethnic people: a qualitative study.
Bayliss K, Riste L, Fisher L, Wearden A, Peters S, Lovell K, Chew-Graham C.
Research Associate, Institute of Population Health, University of Manchester, Manchester, UK.
Abstract
Aim This study aims to explore the possible reasons for the lower levels of diagnosis of chronic fatigue syndrome/myalgic encephalitis (CFS/ME) in the black and minority ethnic (BME) population, and the implications for management.
BACKGROUND
Population studies suggest CFS/ME is more common in people from BME communities compared with the White British population. However, the diagnosis is made less frequently in BME groups.
METHODS
Semi-structured qualitative interviews were conducted with 35 key stakeholders in NW England. Interviews were analysed using open explorative thematic coding.
FINDINGS
There are barriers at every stage to the diagnosis and management of CFS/ME in people from BME groups. This begins with a lack of awareness of CFS/ME among BME respondents. Religious beliefs and the expectation of roles in the family and community mean that some people in BME groups may choose to manage their symptoms outside primary care using alternative therapies, prayer or spiritual healing.
When accessing primary care, all participants recognised the possible influence of language barriers in reducing the likelihood of a diagnosis of CFS/ME. Stereotypical beliefs, including labels such as ‘lazy' or ‘work shy' were also believed to act as a barrier to diagnosis.
Patients highlighted the importance of an on-going relationship with the general practitioner (GP), but perceived a high turnover of GPs in inner city practices, which undermined the holistic approach necessary to achieve a diagnosis.
CONCLUSION
Training is required for health professionals to challenge inaccurate assumptions about CFS/ME in BME groups. The focus on the individual in UK primary care may not be appropriate for this group due to the role played by the family and community in how symptoms can be presented and managed.
Culturally sensitive, educational resources for patients are also needed to explain symptoms and legitimise consultation.
