Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and the Biopsychosocial Model: A Review of Patient Harm and Distress in the Medical Encounter

Research output: Contribution to journalArticle


Objective: Despite the growing evidence of physiological and cellular abnormalities in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, there has been a strong impetus to tackle the illness utilising a biopsychosocial model. However, many sufferers of this disabling condition report distress and dissatisfaction following medical encounters. This review seeks to account for this discord.
Methods: A narrative review methodology is employed to synthesise the evidence for potential iatrogenesis.
Results: We identify seven potential modalities of iatrogenesis or harm reported by patients:
1.difficulties in reaching an acceptable diagnosis;
2.misdiagnosis, including of other medical and psychological conditions;
3.difficulties in accessing the sick role, medical care and social support;
4.high levels of patient dissatisfaction with the quality of medical care;
5.negative responses to controversial therapies (cognitive behavioural therapy and graded exercise therapy);
6.challenges to the patient narrative and experience;
7.psychological harm (individual and collective distress).
Conclusion: The biopsychosocial framework currently applied to Myalgic Encephalomyelitis/Chronic Fatigue Syndrome is too narrow in focus and fails to adequately incorporate the patient narrative. Misdiagnosis, conflict and harm are observable outcomes where doctors’ and patients’ perspectives remain incongruent. Biopsychosocial practices should be scrutinised for potential harms. Clinicians should consider adopting alternative patient-centred approaches.

Bibliographical metadata

Original languageEnglish
JournalDisability and Rehabilitation
Early online date21 Jun 2018
Publication statusPublished - 2018