1. There is no good evidence that psychological factors are a major cause of CFIDS, in spite of earlier claims to the contrary. Indeed such spurious claims were a major cause of hobbling clinical and basic research efforts and still cast a pall of doubt. It may be that psychological factors are among the many other stressors that play a part in the onset of CFIDS but they are not the primary cause.
2. It is important to recognize that there are psychiatric symptoms which are primarily biologically caused manifestations of CFIDS and other, often overlapping, symptoms which are secondary reactions to having CFIDS. The latter are the kind of psychological reactions commonly seen in most people, including children, who have any chronic disabling illness, as well as reactions more specific to CFIDS.

a. Among the major primary biologically caused symptoms are acute and chronic anxiety episodes and panic attacks, emotional lability, sleep problems, and depression. There are in addition a variety of cognitive effects, such as memory deficits, attentional difficulties, language comprehension problems etc. which will be discussed by Dr. Robert Sedgewick. SPECT scans, MRI's, EEG's, and neuropsychological tests have been used to pinpoint affected areas of the brain, showing organic involvement of portions of the cerebral cortex as well the limbic system. The limbic system, linking several brain areas is complex, contains areas that are the sites of emotions, and has connections with both the endocrine and immune systems such that there are probable inter-reactive feedback mechanisms. Many of these biologically-based problems may fluctuate in severity often in conjunction with other physical symptoms.

b. Each of the psychological symptoms can be compounded by secondary psychological effects. For example, a teenager who is subject to the myriad of physical symptoms (described by David Bell), told by her physician that its all in her head (wrong), or that there is nothing that can be done (wrong), who struggles with a mysterious illness which can't yet be cured and about which little is known including prognosis, who at times is confused, unable to remember names, words, directions usually familiar and well known, who can't do what she used to be able to do, who wants to do what her peers are doing academically and socially but is hampered by fatigue and unpredictable cognitive resources, is likely to become anxious and depressed. And so would anyone!

B. There are a variety of diagnostic categories that have been confused with the psychological symptoms of CFIDS.

1. These include:

• Major depressive disorder and dysthymia
• School avoidance or school phobia
• Somatoform disorders (somatization, hypochondriasis)
• Malingering

Each of these can be distinguished from the manifestations of CFIDS. See Tables 1, 2, 3, & 4.

Table 1:

Characteristics which differentiate CFIDS from mood disorders:

Table 2:

Characteristics which differentiate CFIDS from anxiety disorders:

Table 3:

Characteristics which differentiate CFIDS from somatoform disorders:

Table 4:

Characteristics which differentiate CFIDS from other psychiatric disorders:

C. There are significant reverberations in the family and school of a child having CFIDS but much can be done to help children manage.

1. In the family:

• Need for acceptance and support, and becoming well-informed
• Impact on the family
• Differentiating normal adolescent issues from CFIDS phenomena
• Pacing, pacing, pacing

2. In the school:

• The importance of diagnosis and becoming informed
• Assessing the child or adolescent's energy level and work capacity
• Arriving at a balance of time in school/home bound instruction

3. Coping with the Sea of Doubt

D. Treatment: Psychiatric medication and psychological management

1. Medication

• For aid with sleep disturbance
• For treatment of associated depression
• For treatment of anxiety
• For energy level assist

2. Supportive therapy for child and family

3. Absolute necessity that helping professionals be well informed