Anonymous
Not logged in
Talk
Contributions
Create account
Log in
Search
Editing
Boudewijn Van Houdenhove
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
Namespaces
Page
Discussion
More
More
Page actions
Read
Edit
Edit source
History
Warning:
You are not logged in. Your IP address will be publicly visible if you make any edits. If you
log in
or
create an account
, your edits will be attributed to your username, along with other benefits.
Anti-spam check. Do
not
fill this in!
'''Boudewijn Van Houdenhove''', M.D., Ph.D., is a retired [[Belgium|Belgian]] professor of psychiatry at the University of Leuven.<ref>{{Cite web | url = https://www.kuleuven.be/wieiswie/en/person/00013007 | title = KU Leuven who's who - Boudewijn Van Houdenhove | website = kuleuven.be | access-date = 2019-09-14}}</ref><ref name=":19" /> During his career he took a special interest in [[chronic fatigue syndrome]] (CFS) and [[fibromyalgia]] (FM), which he considers both<ref name=":7" /> to be [[stress]]-related, [[Psychosomatic illness|psychosomatic]] disorders.<ref>[https://drive.google.com/file/d/0BxnVj9ZqRgk0Smw3emlUS21lbUU/view Altijd moe. Interview Boudewijn van Houdenhove with P-magazine], May 2012. </ref><ref>{{Cite web | url = https://www.boek-durf.be/boek/399544-MCMMGFACVO-ziek-zonder-ziekte/ | title = Ziek zonder ziekte | website = boek-durf.be|language=nl-NL | access-date = 2019-09-14}}</ref> According to Van Houdenhove [[Chronic fatigue syndrome|CFS]] is characterized by a long period of stress and overactivity which leads to a crash of the [[Hypothalamic-pituitary-adrenal axis]] (HPA) and a subsequent lack of resilience.<ref>Van Houdenhove B, Van Den Eede F, Luyten P. Does hypothalamic-pituitary-adrenal axis hypofunction in chronic fatigue syndrome reflect a 'crash' in the stress system? Med Hypotheses. 2009 Jun;72(6):701-5. [[Doi:|doi]]:[https://doi.org/10.1016/j.mehy.2008.11.044 10.1016/j.mehy.2008.11.044]. [[PubMed Identifier|PMID]] [[pubmed:19237251|19237251]]</ref> Although Van Houdenhove is considered to be one of the most influential voices in the debate on [[ME/CFS]] in [[Belgium]]<ref name=":19">{{Cite web | url = https://www.gezondheid.be/index.cfm?fuseaction=art&art_id=489 | title = Over CVS: Moe in tijden van stress {{!}} gezondheid.be | website = gezondheid.be | access-date = 2019-09-14}}</ref>, his views have been criticized by patients for ‘blaming the victim’<ref name=":8" /><ref name=":5" /> and emphazising psychosocial factors.<ref name=":9" /><ref name=":10" /><ref name=":0" /> Van Houdenhove serves on the editorial board of the journal, [[Fatigue: Biomedicine, Health & Behavior]], published on behalf of the [[IACFS/ME]].<ref>{{Cite web | url = https://www.tandfonline.com/action/journalInformation?show=editorialBoard&journalCode=rftg20& | title = Fatigue: Biomedicine, Health & Behavior | website = tandfonline.com | access-date = 2019-11-01}}</ref> == Background == === Liaison psychiatry === Boudewijn van Houdenhove was a forerunner of psychosomatic medicine in Belgium in the 1980s and 1990s.<ref>Jannes, S. 2010. Psychosomatische hoogvliegers in de Lage Landen. Een historiek van het psychosomatische gedachtegoed. In: Van Houdenhove, B., Luyten P., Vandenberghe, J. (eds). [https://books.google.be/books?id=Faj8ZwEACAAJ&dq=luisteren+naar+het+lichaam+het+dualisme+voorbij&hl=nl&sa=X&ved=0ahUKEwiiwsqyl4DcAhULLlAKHZF2AHcQ6AEIKDAA Luisteren naar het lichaam. Het dualisme voorbij]. Tielt: Lannoo</ref> As a liaison psychiatrist he specialized in the interface between general medicine and psychiatry. Early in his career, he argued that the role of psychiatrists could be more than consultative.<ref name=":11" /> According to Van Houdenhove psychiatrists could play an important coordinating role, for example in the multidsicplinay aprpoach offered to patients with chronic pain. He wrote that: <blockquote> "Liaison psychiatrists can 'emancipate' themselves in this way by stepping out of their - often frustrating, because purely advisory - role and putting into practice their own biopsychosocial diagnostic and therapeutic policy."<ref name=":11">Van Houdenhove B. [http://www.tijdschriftvoorpsychiatrie.nl/assets/articles/articles_649pdf.pdf Moet de pijn weg... of kan men ermee leren omgaan? Bedenkingen bij het concept ‘pijnkliniek’ en de rol van de psychiater in de diagnostiek en de behandeling van chronische pijn.] Tijdschrift voor Psychiatrie 1997;39(10): 802-808.</ref> </blockquote> Inspired by the work of Freud and Lacan<ref>Van Houdenhove I. (Sep 30, 2010). [http://www.tijdschriftvoorpsychiatrie.nl/assets/articles/articles_649pdf.pdf Het emeritusexamen: Jan Van Damme, Boudewijn Van Houdenhove en Guido Langouche]. Campuskrant.</ref>, Van Houdenhove started studying patients with unexplained chronic pain from a psychodynamic point of view. His impression was that these patients premorbid life history is characterized by hyperactivity.<ref>{{Cite journal | last = Van Houdenhove | first = B. | date = 1986 | title = Prevalence and psychodynamic interpretation of premorbid hyperactivity in patients with chronic pain | url =https://www.ncbi.nlm.nih.gov/pubmed/3588817 | journal = Psychotherapy and Psychosomatics | volume = 45 | issue = 4 | pages = 195–200|doi=10.1159/000287948|issn=0033-3190|pmid=3588817}}</ref> He speculates this to be "symptomatic of underlying, frequently interrelated psychodynamic factors, such as unfulfilled (but overcompensated) dependency needs, excessive bodily narcissism, ‘phallic’ rivalry (in women patients) and masochistic or obsessional traits."<ref>Van Houdenhove B, Stans L, Verstraeten D. [https://www.sciencedirect.com/science/article/pii/0304395987901849 Is there a link between ‘pain-proneness’ and ‘action-proneness’?] Pain 1987; 29: 113–117.</ref> === Complex regional pain syndrome === An unexplained disorder Van Houdenhove focused on at the begining of his career, was '''reflex sympathetic dystrophy''' (RSD)<ref>{{Cite journal | last = Bruehl | first = S. | last2 = Husfeldt | first2 = B. | last3 = Lubenow | first3 = T.R. | last4 = Nath | first4 = H. | last5 = Ivankovich | first5 = A.D. | date = Sep 1996 | title = Psychological differences between reflex sympathetic dystrophy and non-RSD chronic pain patients |url =https://www.ncbi.nlm.nih.gov/pubmed/8895237 | journal = Pain | volume = 67 | issue = 1 | pages = 107–114|doi=10.1016/0304-3959(96)81973-7|issn=0304-3959|pmid=8895237|pmc=|quote=|access-date=|via=}}</ref><ref>{{Cite journal | last = Van Houdenhove | first = B. | last2 = Vasquez | first2 = G. | date = Sep 1993 | title = Is there a relationship between reflex sympathetic dystrophy and helplessness? Case reports and a hypothesis |url =https://www.ncbi.nlm.nih.gov/pubmed/8307346 | journal = General Hospital Psychiatry | volume = 15 | issue = 5 | pages = 325–329|issn=0163-8343|pmid=8307346|doi=|pmc=|quote=|via=}}</ref> also known as [[complex regional pain syndrome]] (CRPS). In these patients a portion of the body (an arm, hand, leg or foot) becomes chronically impaired, usually after an injury. The cause remains unknown to this day.<ref>{{Cite web | url = https://www.mayoclinic.org/diseases-conditions/complex-regional-pain-syndrome/symptoms-causes/syc-20371151 | title = Complex regional pain syndrome - Symptoms and causes | website = Mayo Clinic|language=en | access-date = 2019-09-14}}</ref> Back in the early 1990s Van Houdenhove emphasized the psychosocial elements that come into play in CRPS and controversially claimed these to be not only perpetuating but also precipitating factors<ref name=":12" />: <blockquote>"Our basic assumption is that patients suffering from RSD are at the time of the physical trauma confronted with a dramatic psychological situation that they experience as an existential loss i.e. a loss that fundamentally threatens an important life perspective with which they cannot adequately cope. […] More specifically the patient’s reaction to loss appears to be characterized by helplessness, i.e. a set of cognitive motivational and emotional deficits usually resulting from chronic uncontrollable stress and leading to passive withdrawal, decrease of self-esteem [[anxiety]] and [[depression]] as well [[neuroendocrine system|neuroendocrine]] and [[autonomic nervous system]] changes."<ref name=":12">Van Houdenhove B, Vasquez G, Onghena P, Stans L, Vandeput C, Vermaut G, Vervaeke G, Igodt P, Vertommen H. (1992). [[pubmed:1493341|Etiopathogenesis of reflex sympathetic dystrophy: a review and biopsychosocial hypothesis]]. Clin J Pain. 1992 Dec;8(4):300-6.</ref> </blockquote> Van Houdenhove speculated that this maladaptive coping reaction was related to certain [[Personality traits and patient attitudes in ME/CFS|personality traits]] like narcissism and hysteria.<ref name=":12" /> Although his theory was criticized<ref>Goris. R.J.A. and Van Spaendonck K.P.M. (1991). [https://www.ntvg.nl/system/files/publications/1991105450001a.pdf Conversief of somatisch?] Nederlands Tijdschrift voor Geneeskunde; 135 nr.13.</ref><ref>Van Houdenhove B. (October 1991). [https://www.ntvg.nl/artikelen/conversief-somatisch/ingezonden-mededelingen#1207833 Conversief of somatisch?]</ref> at the time, many aspects of it would return in his view on chronic fatigue syndrome. In 2003 for example Van Houdenhove wrote that the evidence of a relationship between CFS/[[Fibromyalgia|FM]] and complex regional pain syndrome type I deserves further research: <blockquote>"In the three disorders, symptoms and disability may be perpetuated by similar factors, such as [[Sleep dysfunction|disturbed sleep]], comorbid [[anxiety]] and [[depression]], and activity avoidance, resulting in physical [[deconditioning]]."<ref>Van Houdenhove B. Chronic fatigue syndrome, fibromyalgia, and complex regional pain syndrome type I. Psychosomatics. 2003 Mar-Apr;44(2):173-4. [[Digital object identifier|doi]]:[https://www.psychosomaticsjournal.com/article/S0033-3182(03)70314-4/fulltext 10.1176/appi.psy.44.2.173] [[PubMed Identifier|PMID]] [[pubmed:12618538|12618538]]</ref> </blockquote> == Chronic fatigue syndrome == ==="Ill without a disease" === In the 1990s Van Houdenhove expanded his expertise to chronic fatigue syndrome, a disorder in which he saw many similarities with the chronic pain patients he was treating.<ref name=":4" /><ref name=":13" /> In his first book<ref>Van Houdenhove, B. (1998). [https://books.google.be/books?id=Y5V0AAAACAAJ&dq=ziek+zonder+ziekte+van+houdenhove&hl=nl&sa=X Ziek zonder ziekte. Beter begrijpen van psychosomatische klachten]. Tielt: Lannoo.</ref> about the issue, he named CFS "the psychosomatic disease of our time" and claimed CFS patients were "ill without a disease" (in Dutch: "ziek zonder ziekte"). Van Houdenhove also claimed that this was a disease, “ideally suited to rehabilitation."<ref>[http://www.dekamer.be/doc/ccri/pdf/50/ic033.pdf#search=%22vermoeidheidssyndroom%20%2050 Belgische Kamer Van Volksvertegenwoordigers]. Handelingen. Integraal verslag van de openbare vergadering van de commissie voor de Sociale Zaken van 09-11-1999.</ref> As a reporting member for the ‘treatment working group’ of the Superior Health Council in 2001<ref>[http://users.telenet.be/martens-hansen/cfspolitiek/HGR_therapie.html Hoge gezondheidsraad - Syntheseverslag van de werkgroep "therapie"] (12-01-2011).</ref>, he played a vital role in implementing [[cognitive behavioral therapy]] (CBT) and [[graded exercise therapy]] (GET) as the state-sponsored treatments for [[ME/CFS]] in [[Belgium]]. When these therapies failed to show meaningful results<ref>Pardaens K, Haagdorens L, Van Wambeke P, Van den Broeck A, Van Houdenhove B. How relevant are exercise capacity measures for evaluating treatment effects in chronic fatigue syndrome? Results from a prospective, multidisciplinary outcome study. Clin Rehabil. 2006 Jan;20(1):56-66. [[Digital object identifier|doi]]:[http://journals.sagepub.com/doi/10.1191/0269215506cr914oa 10.1191/0269215506cr914oa]. [[PubMed Identifier|PMID]] [[pubmed:16502751|16502751]]</ref>, Van Houdenhove admitted his initial views to be erroneous and too simplistic (translated from Dutch): <blockquote>"When I started to see patients with chronic fatigue symptoms in the early 1990s, I was initially a non-believer. It was hard for me to imagine that the exhaustion of these patients could be so dramatic. Perhaps they - like many [[chronic pain]] patients with whom I had some experience - had become abnormally tired because of the deterioration of their physical condition. I thought practicing a lot would help them to get over it. But in the course of time I went through a metamorphosis. I became a believer. I remember that this change of attitude was encouraged by the contact I had with some patients who had previously been passionate about sports. In their case, there was absolutely no question of severe deconditioning. Nonetheless, they were unable to perform normal efforts and complained of a feeling of sickness, if they tried to force themselves."<ref name=":13">Van Houdenhove, B. (2009) [https://books.google.be/books/about/Herwin_je_veerkracht.html?id=yDauPwAACAAJ&redir_esc=y Herwin je veerkracht. Omgaan met chronische vermoeidheid en pijn]. Tielt: Lannoo.</ref> </blockquote> === The swith hypothesis === Van Houdenhove now believes effort intolerance<ref>{{Cite journal | last = Van Houdenhove | first = Boudewijn | date = 2006 | title = What is the aim of cognitive behaviour therapy in patients with chronic fatigue syndrome? | url = https://www.ncbi.nlm.nih.gov/pubmed/17053343 | journal = Psychotherapy and Psychosomatics | volume = 75 | issue = 6 | pages = 396–397|doi=10.1159/000095448|issn=0033-3190|pmid=17053343}}</ref> to be the main characteristic of ME/CFS.<ref name=":13" /> He suspects that this is caused by a dysregulation of the stress system. Van Houdenhove has argued that when a normal person experiences acute stress, the [[Hypothalamic-pituitary-adrenal axis|HPA axis]] gets activated and the body produces of [[hormone]]s like [[cortisol]], which instigates a state of arousal.<ref name=":7" /> When this state persists for too long and stress becomes chronic, Van Houdenhove speculates this to result in a [[crash]]<ref name=":14" /> after which the body is no longer able to produce enough [[cortisol]], as is often seen in ME/CFS patients.<ref>{{Cite journal | last = Jerjes | first = W.K. | last2 = Cleare | first2 = A.J. | last3 = Wessely | first3 = S. | last4 = Wood | first4 = P.J. | last5 = Taylor | first5 = N.F. | date = 2005-08-01 | title = Diurnal patterns of salivary cortisol and cortisone output in chronic fatigue syndrome | url =http://www.sciencedirect.com/science/article/pii/S0165032705000881 | journal = Journal of Affective Disorders | volume = 87 | issue = 2 | pages = 299–304|doi=10.1016/j.jad.2005.03.013|issn=0165-0327}}</ref> Because cortisol has immunosuppressive properties, this switch from HPA axis hyper- to hypofunction is thought to be accompanied by an overactivation of the [[immune system]] and excessive production of [[cytokine]]s.<ref name=":14" /> According to Van Houdenhove, this induces sickness behavior that could account for the fatigue experienced by ME/CFS patients. The final result is a lack of resilience, which he sees as the main characteristic of ME/CFS.<ref name=":14">Van Houdenhove B, Van Den Eede F, Luyten P. Does hypothalamic-pituitary-adrenal axis hypofunction in chronic fatigue syndrome reflect a 'crash' in the stress system? Med Hypotheses. 2009 Jun;72(6):701-5. [[Doi:|doi]]:[https://doi.org/10.1016/j.mehy.2008.11.044 10.1016/j.mehy.2008.11.044]. [[PubMed Identifier|PMID]] [[pubmed:19237251|19237251]]</ref> === Perfectionism and overactivity === According to Van Houdenhove ME/CFS patients partly create their own stress, for example by being too [[personality traits and patient attitudes in ME/CFS|perfectionistic]].<ref>{{Cite journal | last = Luyten | first = Patrick | last2 = Van Houdenhove | first2 = Boudewijn | last3 = Cosyns | first3 = Nele | last4 = Van den Broeck | first4 = Anne-Lies | date = 2006-05-01 | title = Are patients with chronic fatigue syndrome perfectionistic—or were they? A case-control study | url = http://www.sciencedirect.com/science/article/pii/S0191886906000043 | journal = Personality and Individual Differences | volume = 40 | issue = 7 | pages = 1473–1483|doi=10.1016/j.paid.2005.10.023|issn=0191-8869}}</ref><ref name=":15">Van Houdenove B, Neerinckx E. (1998). [http://www.tijdschriftvoorpsychiatrie.nl/assets/articles/articles_510pdf.pdf Overzichtsartikel De ziel uit het lijf... Verhoogt een overactieve levensstijl de vatbaarheid voor het chronische-vermoeidheidssyndroom?] Tijdschrift voor Psychiatrie 40 (4).</ref> In one of his first major studies into the disease, he showed that ME/CFS patients were more "action-prone", meaning naturally more active, than healthy controls or people with anxiety disorders, and at a similar level to people with chronic musculoskeletal pain.<ref name=":6">{{Cite journal | last = Van Houdenhove | first = B. | author-link = Boudewijn Van Houdenhove | last2 = Onghena | first2 = P. | author-link2 = Patrick Onghena | last3 = Neerinckx | first3 = E. | author-link3 = Eddy Neerinckx | last4 = Hellin | first4 = J. | author-link4 = J Hellin | author-link5 = | date = Jul 1995 | title = Does high 'action-proneness' make people more vulnerable to chronic fatigue syndrome? A controlled psychometric study | url = https://www.ncbi.nlm.nih.gov/pubmed/7490698 | journal = Journal of Psychosomatic Research | volume = 39 | issue = 5 | pages = 633–640|issn=0022-3999|pmid=7490698|quote=|via=}}</ref> Van Houdenhoe argued that these patients weren't [[Stigma and discrimination|lazy]] or too sedentary as is sometimes claimed by proponents of the [[deconditioning]] hypothesis, instead they were overactive.<ref name=":15" /> According to Van Houdenhove, they showed the same 'ergomania' he had previously seen in his unexplained [[chronic pain]] patients.<ref name=":16" /> === Victimization === Van Houdenhove wondered why ME/CFS patients were in a continuous state of overdrive before falling ill, as his research indicated. He argued that this behavior acted as a "stabilizing factor in the psychic economy". He wrote: <blockquote>"In our clinical practice, we often hear from CFS/FM patients that—before they got ill—they never could sit still, they were always busy to avoid becoming nervous, or they needed physical workout to chase away negative thoughts or feelings."<ref name=":1">Van Houdenhove B. [http://www.uppitysciencechick.com/van_houdenhove_pain-fatigue-overactivity.pdf Letter to the Editor. Premorbid "overactive" lifestyle and stress-related pain/fatigue syndromes.] Journal of Psychosomatic Research 2005;58:389-390.</ref> </blockquote> In another study by Van Houdenhove and colleagues, ME/CFS patients reported more emotional and physical [[trauma#abuse|abuse]] than controls with [[multiple sclerosis]] (MS) or [[rheumatoid arthritis]] (RA).<ref name=":17" /> A considerable subgroup experienced lifelong victimization.<ref name=":17">Van Houdenhove B, Neerinckx E, Lysens R, Vertommen H, Van Houdenhove L, Onghena P, Westhovens R, D'Hooghe MB. Victimization in chronic fatigue syndrome and fibromyalgia in tertiary care: a controlled study on prevalence and characteristics. Psychosomatics. 2001 Jan-Feb;42(1):21-8. [[doi:]][https://doi.org/10.1176/appi.psy.42.1.21 10.1176/appi.psy.42.1.21] [[PubMed Identifier|PMID]] [[pubmed:11161117|11161117]]</ref> Van Houdenhove uses this to support his claim that ME/CFS patients are often perfectionistic and in need of external validation. <blockquote>"This case report illustrates the multifactorial etiology of CFS. Mr. A’s severe abuse history and his premorbid overactive lifestyle may be considered important vulnerability factors. Based on a deep-rooted lack of self-esteem, this man was driven to work hard and take part in sports to a fanatic degree (bodybuilding and karate) as a means of compensation for feelings of emptiness, worthlessness, and insufficiency."<ref>Cuykx V, Van Houdenhove B, Neerinckx E. [[pubmed:9854653|Childhood abuse, personality disorder and chronic fatigue syndrome.]] Gen Hosp Psychiatry. 1998 Nov;20(6):382-4.</ref></blockquote> When their outlet of overactivity becomes hampered, persons like Mr. A are susceptible to developing ME/CFS: <blockquote>"What happens, then, when a protracted illness or physical injury makes further (over)activity impossible? Such events may seriously threaten the patient’s psychobiological equilibrium and precipitate a dysregulation of the stress system."<ref name=":1" /> </blockquote> === A lumper standpoint === According to Houdenhove the mechanism described above is not unique to ME/CFS. He argues that low cortisol levels for example have also been reported in other stress-related disorders like atypical depression, fibromyalgia, [[post-traumatic stress disorder]] (PTSD) and [[burnout]].<ref name=":18" /> Van Houdenhove sees a lot of similarity between these conditions, stating for example: <blockquote> "Could it be that the over-ambitious athlete complains about 'overtraining', the over-committed social worker about 'burnout', and the over-burdened modern woman who feels obliged to combine three 'fulltime' jobs (household, professional career and educator of children).., about ME?"<ref name=":18">Van Houdenhove B, Onghena P, Neerinckx E, Hellin J. [[pubmed:7490698|Does high 'action-proneness' make people more vulnerable to chronic fatigue syndrome?]] A controlled psychometric study. J Psychosom Res. 1995 Jul;39(5):633-40.</ref> </blockquote> Van Houdenhove confesses that he is a lumper, not a splitter i.e. he thinks fibromyalgia (FM) and ME/CFS should be regarded and treated as one disease.<ref name=":7" /> In line with Simon Wessely he thinks the splitting of many so called functional somatic syndromes represents an artifact of specialized modern medicine.<ref name=":7" /> In 2007 he proposed to rename FM and ME/CFS into "stress intolerance and pain hypersensitivity (SIPH) syndromes".<ref>Van Houdenhove B, Luyten P. [https://www.ingentaconnect.com/contentone/ben/crr/2007/00000003/00000004/art00009?crawler=true Fibromyalgia and Related Syndromes Characterised by Stress Intolerance and Pain Hypersensitivity: Do We Need a New Nosology?] Current Rheumatology Reviews. 2007Nov; 3(4): 304-308. </ref> === ME/CFS; a symptom of a sick society? === Inspired by historian [[Edward Shorter]], Van Houdenhove emphasizes how culture shapes the way we define illnesses.<ref name=":2" /> For example, in a letter to The Lancet, he explained the curious situation in his home country, Belgium: <blockquote>"French-speaking Belgian colleagues have repeatedly confirmed that the chronic fatigue syndrome (CFS) has not yet become a hyped illness, as it is in Flanders (as well as in the Netherlands and the UK). In Flanders, for example, there are currently four CFS/ME self-help groups, whereas none exists in Wallonia. The Flemish press, has regularly reported the disorder for 10 years (eg, describing patients’ experiences about disbelief and incomprehension, or about so-called research breakthroughs), but the Walloon press has shown interest only in the past few years. Walloons are more oriented— culturally as well as scientifically—to France, whereas Flemish people are on the same wavelength as countries with Anglo-Saxon culture and science. Consequently, Walloon and Flemish patients and doctors use different labels to communicate about distress and ill health."<ref name=":2">Van Houdenhove B. [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)05002-9/fulltext Does myalgic encephalomyelitis exist?] Lancet. 2001 Jun 9; 357 (9271): 1889.</ref> </blockquote> Van Houdenhove speculates the prevalence of ME/CFS to be on the rise because of consumerism and the high social demands modern society places on the individual. In this respect he ponders if ME/CFS should be regarded as a "symptom of a sick society".<ref name=":3">Van Houdenhove B, Vanthuyne S, Neerinckx E, Vanden Wyngaert M. [https://www.tvg.be/article/moet-het-chronische-vermoeidheidsyndroom-erkend-worden Moet het chronische-vermoeidheidssyndroom erkend worden?] Tijdschrift voor Geneeskunde. 1999; 55: 1732. </ref> === Listening to the patient === According to Van Houdenhove the whole controversy around ME/CFS can be explained by doctors and researchers not listening to the story of the patient.<ref name=":20" /> If they did, they would know that this isn’t merely a matter of [[deconditioning]] and [[illness beliefs |unhelpful cognitions]]. Only if one listens closely to the life history of patients, is it possible to grasp the many complex dimensions this illness has. Psychologists who rely solely on questionnaires will often miss the underlying factors (childhood abuse, maladaptive perfectionism, overactivity etc.) that help explain why a person got ill. According to Van Houdenhove this is the main reason why the effectiveness of CBT in ME/CFS has been so disappointing.<ref name=":20" /> He has argued that herapists should expand their scope: <blockquote> "[…] when the patient’s story is left out of the therapeutic project, the risk of nonresponse or relapse might be substantial as soon as he or she is confronted with unresolved intrapsychic conflicts or ongoing psychosocial (e.g. interpersonal) problems. This surely does not imply that all CFS patients should engage in formal psychodynamic or interpersonal therapy. It does, however, suggest that [[Cognitive behavioral therapy |cognitive – behavioural]] therapists should— besides their traditional focus on illness maintaining and reinforcing factors— broaden their scope to include predisposing and initiating psychosocial factors as well."<ref name=":20">Van Houdenhove B. [https://www.jpsychores.com/article/S0022-3999(01)00297-5/pdf Listening to CFS: why we should pay more attention to the story of the patient]. J Psychosom Res. 2002 Jun;52(6):495-9. [[PubMed Identifier|PMID]] [[pubmed:12069874|12069874]]</ref> </blockquote> === Adaptation instead of recovery === When analyzing the results of the multidisciplinary center for CFS at the University of Leuven, Van Houdenhove and colleagues found that among all factors of the cognitive-behavioral model, only severity of [[depression]] before treatment was significantly associated with post-treatment fatigue.<ref>Kempke S, Goossens L, Luyten P, Bekaert P, Van Houdenhove B, Van Wambeke P. Predictors of outcome in a multi-component treatment program for chronic fatigue syndrome. J Affect Disord. 2010 Oct;126(1-2):174-9. [[doi:]][https://www.jad-journal.com/article/S0165-0327(10)00099-6/fulltext 10.1016/j.jad.2010.01.073] [[PubMed Identifier|PMID]] [[pubmed:20167377|20167377]]</ref> As Van Houdenhove noticed, this wasn’t the only time findings contradicted the [[cognitive behavioral therapy]] (CBT) paradigm: <blockquote> "[…] in [[Cognitive behavioral therapy|CBT]]-oriented literature concerned with CFS, different treatment goals can be discerned. Some authors suggest that the therapist should mainly incite patients to diminish their somatic focus and correct inappropriate physical attributions. However, the usefulness of this goal is doubtful since the majority of patients with CFS and the largely overlapping fibromyalgia syndrome (FM) seems to accept a combined psychological/somatic causation of their illness. According to other authors, the therapist should in the first place tackle the patients’ activity avoidance or irregular activity patterns (outburst of activity followed by prolonged periods of rest), and stimulate them to engage in a graded exercise program in order to fight physical deconditioning. However, most CFS patients do not show kinesiophobia and loss of exercise capacity does not seem to play a major role in the pathophysiology of CFS."<ref name=":21">Van Houdenhove B. What is the aim of cognitive behaviour therapy in patients with chronic fatigue syndrome? Psychother Psychosom. 2006;75(6):396-7. [[doi:]][https://doi.org/10.1159/000095448 10.1159/000095448] [[PubMed Identifier|PMID]] [[pubmed:17053343|17053343]] </ref> </blockquote> Van Houdenhove criticizes his Dutch colleague [[Gijs Bleijenberg]] for arguing that full recovery should be the main goal of CBT. Based on years of experience working in ME/CFS clinic, Van Houdenhove does not see this as a realistic objective.<ref name=":21" /> Instead he suggests clinicians should recognize the lasting vulnerability of ME/CFS patients. He advises ME/CFS patients that: <blockquote>"…they should accept their ailment and functional limitations and work through the painful grieving process resulting from the fact that CFS means giving up many important things in life. Second, they should realistically adapt to their effort intolerance by learning to carefully pace activities in order to avoid post-exertional malaise reflecting abnormal immune activation. In many patients, this implies abandoning their previous ‘overactive’ lifestyles, which may be rooted in [[personality traits and patient attitudes in ME/CFS|narcissistic, perfectionistic or counter-dependent tendencies]]."<ref name=":21" /> </blockquote> Despite these criticisms, Van Houdenhove continues to promote [[graded exercise therapy]] (GET) and CBT as an essential part of the treatment of ME/CFS patients.<ref>Finoulst M, Vankrunkelsven P, Van Houdenhove B. [https://www.tvg.be/article/cvs-me-en-fibromyalgie-waar-staan-we CVS, ME en fibromyalgie: waar staan we?] Tijdschrift voor Geneeskunde. 2018; 74: 666.</ref> == Criticism == === By researchers === ====Too much stress? ==== Boudewijn Van Houdenhove's approach to ME/CFS has been questioned by researchers and patient advocates. A recurring criticism is that his emphasis on stress in the etiopathogenesis of ME/CFS is not supported by sufficient evidence. Harvard professor and renowned ME/CFS expert [[Anthony Komaroff]] for example commented: <blockquote> "Van Houdenhove and colleagues would have to concede, however, that many patients with chronic fatigue syndrome do not report unusual stressors in the months before the onset of their illness and do not have evidence of hypothalamic dysfunction. Available data do not support the hypothesis that stress leading to hypothalamic dysfunction explains all cases of chronic fatigue syndrome. It must be more complicated than that."<ref>Komaroff AL. [[pubmed:11126311|The biology of chronic fatigue syndrome]]. Am J Med. 2000 Feb;108(2):169-71.</ref> </blockquote> Neurologist [[Benjamin Natelson]] essentially made the same remark: <blockquote>"While we also occasionally find patients whose history of fatigue precedes their getting a flu-like illness from which they are unable to recover, our own careful approach certainly does find appreciable numbers of patients who were perfectly well until succumbing to a sudden flu-like illness."<ref name=":0">Natelson B. [https://muse.jhu.edu/article/46036 Reply to Dr. Van Houdenhove.] Hum Biol. 2003 Jun;75(3): 413.</ref></blockquote> Others pointed out that even if stress is a factor in the development of ME/CFS, this doesn’t necessary mean much, since stress plays a role in almost every disease. As the De Meirleir & De Becker wrote: <blockquote>"It is clear that stress can influence the course of disease adversely as in cancer for example but do we treat stress instead of the biological correlates in cancer patients?"<ref>Van Houdenhove B, Vanthuyne S, Neerinckx E. [[pubmed:11023437|Chronic fatigue syndrome.]] Am J Med. 2000 Aug 15;109(3):257-9.</ref></blockquote> ==== Not a sound scientific method ==== Another criticism states that Van Houdenhove uses antidotal evidence rather than research, e.g., using 'the story of the patient' and case examples to put forward his own preconceptions about the illness. As Natelson wrote: <blockquote>"While we as clinicians depend heavily on narration to inform us about the patient and the patient’s illness story, we believe that the evidence-based approach is the only way the medical field can solve the problem of illness cause."<ref name=":0" /></blockquote> [[Frank Twisk|Twisk]] & [[Michael Maes|Maes]] wrote about Van Houdenhove and colleagues: <blockquote>"[…] the authors neglect the fact that there is a considerable gap between their philosophical point of view which they erroneously call evidence-based and numerous scientific papers which show that ME/CFS is a medical disorder with a biological pathophysiology."<ref>Maes M, Twisk FN. Treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a multisystem disease, should target the pathophysiological aberrations (inflammatory and oxidative and nitrosative stress pathways), not the psychosocial "barriers" for a new equilibrium. Patient Educ Couns. 2010 Jul;80(1):148-9; author reply 147. [[doi:]][https://linkinghub.elsevier.com/retrieve/pii/S0738399110000510 10.1016/j.pec.2010.02.017.] [[PubMed Identifier|PMID]] [[pubmed:20303231|20303231]]</ref> </blockquote> ==== Recall and selection bias ==== Natelson also questioned the means by which Van Houdenhove and colleagues profile ME/CFS patients as being perfectionistic, action prone or [[trauma |abused during childhood years]]: <blockquote>"Self-reported data are open to substantial recall bias. For example, a number of studies have linked abuse in childhood as reported to have occurred by adults with fibromyalgia( e.g. Walker et al. 1997). However Raphael et al.(2000) have recently shown that rates of widespread pain do not differ in people with documented abuse in childhood compared to nonabused samples."<ref name=":0" /> </blockquote> [[Gijs Bleijenberg]] made the argument that Van Houdenhove' method suffers from selection bias: because he is known as a doctor who treats ME/CFS from a psychiatric point of view, he might see more patients with more comorbid psychological problems than are present in the general population. Bleijenberg wrote (Translated from Dutch): <blockquote>"The percentage of patients with psychopathological problems underlying or related to CFS complaints reported by them – 75% -, is very different from the percentages mentioned in the literature. […] We know from presentations at conferences that other CFS patients end up in the group of Van Houdenhove et al. than for example, in Nijmegen. The average scores in research with questionnaires for psychological or psychopathological problems are considerably higher in his group; they are comparable to scores of psychiatric patients. The scores in our group are comparable to those of other patients who visit the hospital because of physical complaints. If the patients of Van Houdenhove et al. were to be compared to a control group with equal scores for psychological or psychopathological problems, it would almost certainly be concluded that the presence of traumatic childhood experiences is not characteristic for patients with CFS."<ref name=":22">Bleijenberg G and Van der Meer J.W.M. (1997) [https://www.ntvg.nl/artikelen/moe-met-drie%C3%ABntwintig-oes/ingezonden-mededelingen Onderschrift.]</ref></blockquote> Bleijenberg also criticizes Van Houdenhove for using [[antidepressant]]s in the treatment of ME/CFS, as this is not evidence based.<ref name=":22" /> === By patient advocates === ==== The biological basis of the disease being neglected ==== Though some<ref>Matthyssen K. (2001, March 22). [http://www.gopress.be/Public/bibnet-article.php?issueDate=2001-03-22&publicationId=10&articleOriginalId=degazetvanantwerpenrug365315ed1022032001-00000&language=dut "Waar mogen wij nog rusten?"] Gazet Van Antwerpen. </ref> have emphasized that Van Houdenhove treated his patients with empathy and compassion, most patient organizations and advocates in Belgium have criticized his approach to ME/CFS. In the 1990s members of patient group ‘Samen Sterk’ wrote that (translated from Dutch): <blockquote>"Although Professor van Houdenhove is apparently concerned about CFS patients, one increasingly gets the feeling that his interviews in the popular press are an advertising stunt for his field of expertise and the psychosomatic rehabilitation department of the UZ Pellenberg."<ref name=":4">Van Houdenhove B. 2001. [https://books.google.be/books?id=eS7ZED-n8AUC&printsec=frontcover&dq=moe+in+tijden+van+stress&hl=nl&sa=X&ved=0ahUKEwjxyPOxpIDcAhULJ1AKHS1TC2wQ6AEIKDAA#v=onepage&q=moe%20in%20tijden%20van%20stress&f=false Moe in tijden van stress. Luisteren naar het chronischevermoeidheidssyndroom.] Tielt: Lannoo, pp 71-72.</ref></blockquote> In 2002, patient advocate and published researcher Anna Wood decried the fact Van Houdenhove was appointed to lead the ME/CFS reference center at the University of Leuven: <blockquote>"How unfortunate that professor Boudewijn Van Houdenhove is linked to the K.U. Leuven that he gets publicity rather than someone else.[…] With the gross imbalance of research efforts and money being out into the psychological side of CFS, patients with this disease will have to wait extra-long before there is any progress into understanding the processes, finding the cause and ultimately a cure for their disease."<ref name=":9">Wood A. (2002 May 30). Forum: Chronische vermoeidheid. Campuskrant. Retrieved from: https://nieuws.kuleuven.be/nl/campuskrant/0102/13/forum--chronische-vermoeidheid</ref></blockquote> Even those who welcome a more holistic approach to ME/CFS like Stefan Pasture of the [https://sites.google.com/site/cvsevenwicht/ CVS-Society] and [http://www.sonjan.be/lichtwerker/helewaut-marie Marie Helewaut] of patient organization Anamkara<ref>Debusschere B. (2002 April 9). Polarisering onder cvs-patiënten en artsen. De Morgen. Retrieved from: http://www.gopress.be/Public/bibnet-article.php?issueDate=2002-04-09&publicationId=1&articleOriginalId=demorgenpersgroep09-cvskader9042002-00000&language=dut</ref> have criticized Van Houdenhove for treating the disease exclusively from a psychiatric angle. Stefan Pasture for example wrote (translated from Dutch): <blockquote>"One of the few who can express how CFS patients feel is Prof. Van Houdenhove. But that's precisely why I don't understand why his ME/CFS reference centre pays so little attention to the physical side of the disease. Van Houdenhove does refer to neurobiological dysfunctions in his book, but the reference centre does no attempt to map them out. Of course, acceptance of the disease and learning how to deal with it are crucial. However, this must not result in the biological basis of the disease being neglected."<ref>Van Houdenhove, B., Luyten P., Vandenberghe, J. (eds). 2010. [https://books.google.be/books?id=Faj8ZwEACAAJ&dq=luisteren+naar+het+lichaam+het+dualisme+voorbij&hl=nl&sa=X&ved=0ahUKEwjt4KzspoDcAhXMaVAKHQhiCHYQ6AEIKDAA Luisteren naar het lichaam. Het dualisme voorbij.] Tielt: Lannoo.</ref></blockquote> ====A narrative of ME/CFS that conflicts with how patients experience it ==== In a notable television debate in 2006, Van Houdenhove was heavily criticized by ME/CFS patient and former singer/radio host Luk Saffloer for constructing a narrative of ME/CFS that conflicts with how most patients experience it.<ref>De zevende dag. VRT. 05-03-2006. Retrieved from: https://www.youtube.com/watch?v=neaNUwqLsoc</ref> Medical journalist and patient advocate [[Marc van Impe]] noted that Van Houdenhove rarely shows up at international conferences of ME/CFS and that he prefers to philosophize instead of conducting proper research into the disease.<ref name=":5">Van Impe M. (2012 March 16). Een aangekondigde mislukking waarbij we ons moesten neerleggen. Retrieved from: http://www.cvsmeliga.be/home/over-cvs-me/referentiecentra-cognitieve-gedragstherapie/een-aangekondigde-mislukking-waarbij-we-ons-moesten-neerleggen</ref> Van Impe also criticizes Van Houdenhove for writing in reports for insurance companies that there is no organic basis for the diagnosis of ME/CFS.<ref name=":5" /><ref>Van Houdenhove B. redactioneel. [http://www.tijdschriftvoorpsychiatrie.nl/assets/articles/articles_391pdf.pdf Uitdagingen van het chronischevermoeidheidssyndroom]. Tijdschrift voor psychiatrie 42 (2000) 11: 791-792.</ref> Van Houdenhove has often been criticized by patients on the online information website [https://www.me-gids.net/index.html ME-Gids.net.] One patient, named Marlène, wrote him an open letter stating (translated from Dutch): <blockquote>"I hope that you will devote your energy […] to treating people with trauma's, fears and so on and leave people like us, who are ill [with a neurological disease much like] MS or Parkinson’s, alone. Stick to your expertise. And if you really want to get involved in ME/CFS, then listen to patients instead of imposing your opinion on them."<ref name=":8">https://www.me-gids.net/module-ME_CVS_docs-viewpub-tid-1-pid-736.html</ref></blockquote> More recently, [http://www.wakeupcallbeweging.be/ The Wake-Up Call Beweging] has criticized Van Houdenhove for downplaying the value of biomedical research into ME/CFS. Gunther De Bock for example wrote (translated from Dutch): <blockquote>"The articles in which BvH [Boudewijn Van Houdenhove] is involved are always drawn up according to a recurring pattern in which he (1) questions the credibility of biomedical researchers, (2) weakens the scientific value of biomedical findings,(3) portrays the criticism of patients as fanatical and/or negligible, (4) highlights the psychosocial causes of CFS, (5) addresses usefulness of CBT and GET, (6) portrays other treatments as dangerous or a scam, (7) emphasizes that there is no diagnostic marker (8) that only the biopsychosocial model is evidence based (9) and that there is and will not be a pill that cures ME/CFS.”<ref name=":10">De Bock G. (2018 may 5). Retrieved from: https://www.facebook.com/Wake-Up-Call-Beweging-action-group-for-MEcfs-fibromyalgia-sufferers-202494729818299/</ref> </blockquote> === Controversy === ==== Membership of a patient organization as an illness-perpetuating factor ==== Boudewijn Van Houdenhove has responded to criticism by patient advocates. In his book ‘[https://books.google.be/books?id=eS7ZED-n8AUC&printsec=frontcover&dq=moe+in+tijden+van+stress&hl=nl&sa=X&ved=0ahUKEwjh4N3Lq4DcAhVDLlAKHd_TDXYQ6AEIKDAA#v=onepage&q=moe%20in%20tijden%20van%20stress&f=false Moe in tijden van stress’ (2001)] he wrote that he felt "surprise, pity and vicarious shame" as he read criticism of patients on the internet. In another of his books, [https://books.google.be/books?id=yDauPwAACAAJ&dq=%E2%80%98Herwin+je+veerkracht%E2%80%99+(2009)&hl=nl&sa=X&ved=0ahUKEwjGw-rbq4DcAhUFYlAKHTDuBYEQ6AEIKDAA ‘Herwin je veerkracht’ (2009)] he referred to the website of patient advocate (and published researcher) [[Frank Twisk]] with the remark (translated from Dutch) “It is suffice to say that most of them do not bother to read what I write […] They just echo each other's prejudices.” And concerning the protest of some ME/CFS patients against a psychiatric approach to their illness, Van Houdenhove noted (translated from Dutch): <blockquote>"The stubbornness with which this happens in some patients sometimes prompts us to think that, if the energy wasted in this fight were used to work on rehabilitation, the process of recovery would probably have come a long way."<ref>Neerinckx E and Van Houdenhove B. [http://www.tijdschriftvoorpsychiatrie.nl/assets/articles/articles_599pdf.pdf Kort signalement Gegijzeld door chronische vermoeidheid...] Tijdschrift voor Psychiatrie 39 (1997) 4: 339-341.</ref> </blockquote>In a 2008 scientific paper on the treatment of ME/CFS, Van Houdenhove wrote that membership of a patient support group could be regarded as a perpetuating factor of the disease.<ref>Van Houdenhove B and Luyten P. Customizing treatment of chronic fatigue syndrome and fibromyalgia: the role of perpetuating factors. Psychosomatics. 2008 Nov-Dec;49(6):470-7. [[doi:]][https://doi.org/10.1176/appi.psy.49.6.470 10.1176/appi.psy.49.6.470] [[PubMed Identifier|PMID]] [[pubmed:19122123|19122123]]</ref> ==== Recovery is an undesirable goal ==== Another controversial statement Van Houdenhove has made, is that for ME/CFS patients, full recovery is not only an unrealistic but also an undesirable goal.<ref name=":13" /> This has to do with Van Houdenhoves view that the premorbid behavior of ME/CFS patients is an important precipitating factor of the disease (translated from Dutch): <blockquote>"Elsewhere we have argued that in many CFS/FM patients - before the outbreak of their disease - the balance between their will and ability had become lost. They perpetrated continuous violence against themselves, whether intentionally or unintentionally. This imbalance was a source of chronic, undermining stress. Sooner or later this had to go wrong..."<ref name=":7">Van Houdenhove, B. (2005). [https://books.google.be/books?id=xuQONxCnpIgC&pg=PA13&dq=in+wankel+evenwicht+boudewijn+van+houdenhove&hl=nl&sa=X&ved=0ahUKEwjgtMv-qYDcAhUJPFAKHb5qBl0Q6AEIKDAA#v=onepage&q=in%20wankel%20evenwicht%20boudewijn%20van%20houdenhove&f=false In wankel evenwicht. Over stress, levensstijl, en welvaartsziekten.] Tielt: Lannoo. p 139-140.</ref> </blockquote> According to Van Houdenhove some ME/CFS patients were "trapped in a narcissistic urge to perform" while others were "a slave of their perfectionism".<ref name=":7" /> This is the reason why there will never be a simple pharmacological cure for ME/CFS. (Translated fom Dutch): <blockquote>"[…], it seems unlikely that CFS/fibromyalgia can be 'cured' completely by pharmacological therapy. Indeed, as discussed above, the course of the condition often depends heavily on secondary physical and psychosocial factors. For many patients with CFS/fibromyalgia, a return to 'former times' is an entirely undesirable goal, given the factors that contributed to the disease."<ref>Van Houdenhove B, Luyten P, ke S. [https://www.tvg.be/index.php/article/het-stressadaptatiemodelvan-het-chronischevermoeidheidssyndroomfibromyalgieeen-update Het “stressadaptatiemodel” van het chronischevermoeidheidssyndroom/Fibromyalgie: een update.] Tijdschrift Voor Geneeskunde. 2013;69: 905.</ref></blockquote> ==== Patients should help themselves ==== At Van Houdenhoves clinic, the ME/CFS patient was encouraged to be more self-sufficient. (Translated fom Dutch) "We tell him that he must stop expecting medicine to solve everything, that he must stop doctor-shopping."<ref>VandelooD. (1997 June 3) Psychosomatische afdelingen luiden nieuw tijdperk van hulpverlening in – “Patiënt moet stoppen met dokter-shopping”. Het Belang van Limburg. Retrieved fom: http://www.gopress.be/Public/bibnet-article.php?issueDate=1997-06-03&publicationId=18&articleOriginalId=hetbelangvanlimburgrug902893061997-00000&language=dut</ref>According to Van Houdenhove, ME/CFS patients “can best be helped by helping themselves.”<ref name=":4" /> ==== ME should not be a condemnation of [[disability]] ==== Another controversial intervention by Van Houdenhove occurred at the turning of the millennium when Belgian ME/CFS patients, through lobbying and protests, just about managed to have their disease recognized by the government. At the time, Van Houdenhove published an article, cautioning about these developments.<ref name=":3" /> Though he stressed that the ‘illness’ of these patients (by which he means the subjective feeling of being sick) should always be respected by physicians and society, recognition of an official disease and disability is a more complicated matter. He published an opinion piece in the Belgian newspaper, De Standaard, stating: <blockquote> "Recognition of the authentic feeling of illness and inability of the CFS patient certainly does not have to result in long-term or permanent disability. After all, in many cases the GP can intervene in a timely and adequate manner in order to prevent the patient from falling into a downward spiral."<ref>Van Houdenhove B. (1998 October 25). Chronischvermoeidheidssyndroom erkennen? De Standaard. Retrieved from: http://www.gopress.be/Public/bibnet-article.php?issueDate=1999-10-25&publicationId=2&articleOriginalId=destandaardvumcuscusds25101999-00000&language=dut</ref> </blockquote> According to Van Houdenhove "labels such as CFS and ME should be used in a constructive way, not as a condemnation of disability, but as a point of departure for realistic and pragmatic help."<ref name=":2" /> == Notable studies == [[Category:Clinicians]] [[Category:Belgian clinicians]] * 1995, Does high 'action-proneness' make people more vulnerable to chronic fatigue syndrome?<ref name=":6" /> [[pubmed:7490698|(Abstract)]] * 2001, Premorbid "overactive" lifestyle in chronic fatigue syndrome and fibromyalgia. An etiological factor or proof of good citizenship?<ref name=":16">{{Cite journal | last = Van Houdenhove | first = B. | author-link = Boudewijn Van Houdenhove | last2 = Neerinckx | first2 = E. | author-link2 = Eddy Neerinckx | last3 = Onghena | first3 = P. | author-link3 = Patrick Onghena | last4 = Lysens | first4 = R. | author-link4 = Roeland Lysens | last5 = Vertommen | first5 = H. | author-link5 = Hans Vertommen | date = Oct 2001 | title = Premorbid "overactive" lifestyle in chronic fatigue syndrome and fibromyalgia. An etiological factor or proof of good citizenship? | url = https://www.ncbi.nlm.nih.gov/pubmed/11595245 | journal = Journal of Psychosomatic Research | volume = 51 | issue = 4 | pages = 571–576|issn=0022-3999|pmid=11595245|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pubmed/11595245 (Abstract)] *2013, Prevalence of DSM-IV Personality Disorders in Patients with Chronic Fatigue Syndrome: A Controlled Study<ref name="Kempe2012">{{Cite journal | last = Kempke | first = Stefan | author-link = Stefan Kempke | last2 = Van Den Eede | first2 = Filip | author-link2 = Filip Van Den Eede | last3 = Schotte | first3 = Chris | author-link3 = Chris Schotte | last4 = Claes | first4 = Stephan | author-link4 = Stephan Claes | last5 = Van Wambeke | first5 = Peter | author-link5 = Peter Van Wambeke | last6 = Van Houdenhove | first6 = Boudewijn | author-link6 = Boudewijn Van Houdenhove | last7 = Luyten | first7 = Patrick | author-link8 = Patrick Luyten | date = Jun 1, 2013 | title = Prevalence of DSM-IV Personality Disorders in Patients with Chronic Fatigue Syndrome: A Controlled Study | url = https://doi.org/10.1007/s12529-012-9273-y | journal = International Journal of Behavioral Medicine|language=en | volume = 20 | issue = 2 | pages = 219–228|doi=10.1007/s12529-012-9273-y|issn=1532-7558|quote=|via=}}</ref> [https://link.springer.com/article/10.1007/s12529-012-9273-y (Abstract)] == Books == * ==Letters, blogs and videos == == Online presence == * Twitter * Facebook * Website * YouTube == Learn more == == See also == * [[Stigma and discrimination]] * [[Biopsychosocial model]] * [[Personality traits and patient attitudes in ME/CFS|Personality traits and patient attitudes]] * [[Psychologization]] == References == {{Reflist}} [[Category:Belgium researchers]] [[Category:Researchers]] [[Category:Psychological paradigm proponents]]
Summary:
Please make sure your edits are consistent with
MEpedia's guidelines
.
By saving changes, you agree to the
Terms of use
, and you irrevocably agree to release your contribution under the
CC BY-SA 3.0 License
and the
GFDL
. You agree that a hyperlink or URL is sufficient attribution under the Creative Commons license.
Cancel
Editing help
(opens in new window)
Templates used on this page:
Template:Cite journal
(
edit
)
Template:Cite web
(
edit
)
Template:Main other
(
edit
)
Template:Reflist
(
edit
)
Module:Check for unknown parameters
(
edit
)
Module:Citation/CS1
(
edit
)
Module:Citation/CS1/COinS
(
edit
)
Module:Citation/CS1/Configuration
(
edit
)
Module:Citation/CS1/Date validation
(
edit
)
Module:Citation/CS1/Identifiers
(
edit
)
Module:Citation/CS1/Utilities
(
edit
)
Module:Citation/CS1/Whitelist
(
edit
)
Module:No globals
(
edit
)
This page is a member of a hidden category:
Category:CS1 Nederlands-language sources (nl)
Navigation
Navigation
Skip to content
Main page
Browse
Become an editor
Random page
Popular pages
Abbreviations
Glossary
About MEpedia
Links for editors
Contents
Guidelines
Recent changes
Pages in need
Search
Help
Wiki tools
Wiki tools
Special pages
Page tools
Page tools
User page tools
More
What links here
Related changes
Page information
Page logs