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== Research == ===CFS following Epstein Barr Virus (EBV) Infection === In a large longitudinal study, White and colleagues followed up on 108 persons with Epstein Barr Virus (EBV-) infection, 83 patients with glandular not caused by EBV and 54 subjects with an ordinary upper respiratory tract infection (URTI).<ref name="WhiteThomas1998">{{Cite journal | last = White | first = P. D. | last2 = Thomas | first2 = J.M. | last3 = Amess | first3 = J. | last4 = Crawford | first4 = D.H. | last5 = Grover | first5 = S.A. | last6 = Kangro | first6 = H.O. | last7 = Clare | first7 = A.W. | date = Dec 1998| title = Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever |url =https://www.ncbi.nlm.nih.gov/pubmed/9926075|journal=The British Journal of Psychiatry: The Journal of Mental Science|volume=173 | pages = 475–481|doi=10.1192/bjp.173.6.475|issn=0007-1250|pmid=9926075}}</ref> These patients were followed up for more than six months to assess symptoms and disability. The results suggested that a distinct fatigue syndrome existed after glandular fever whose constituent symptoms were reliable over time.<ref name="WhiteThomas1995">{{Cite journal | last = White | first = P. D. | last2 = Thomas | first2 = J.M. | last3 = Amess | first3 = J. | last4 = Grover | first4 = S.A. | last5 = Kangro | first5 = H.O. | last6 = Clare | first6 = A.W. | date = Sep 1995| title = The existence of a fatigue syndrome after glandular fever |url =https://www.ncbi.nlm.nih.gov/pubmed/8588009|journal=Psychological Medicine|volume=25|issue=5 | pages = 907–916|issn=0033-2917|pmid=8588009}}</ref> The prevalence of CFS according to the Fukuda definition was 10%, six months after EBV-infection compared to 0% following an ordinary URTI.<ref name="WhiteThomas1998" /> No psychiatric disorder was significantly more prevalent six months following EBV-infection than before.<ref name="WhiteThomas1998" /> According to White et al. “The validity of the fatigue syndrome was supported, separate from psychiatric disorders in general and depressive disorders in particular.”<ref name="ClareAmess1995">{{Cite journal | last = Clare | first = A. W. | last2 = Amess | first2 = J. | last3 = Thomas | first3 = J.M. | last4 = Kangro | first4 = H.O. | last5 = Grover | first5 = S.A. | last6 = White | first6 = P. D. | date = Sep 1995| title = The validity and reliability of the fatigue syndrome that follows glandular fever |url =https://www.cambridge.org/core/journals/psychological-medicine/article/validity-and-reliability-of-the-fatigue-syndrome-that-follows-glandular-fever/E86878CFD22D70A59CF4E6AA1802885E|journal=Psychological Medicine|language=en|volume=25|issue=5 | pages = 917–924|doi=10.1017/S0033291700037405|issn=1469-8978}}</ref> Using data from the General Practice Research Database (GPRD), White and colleagues reported that significantly more fatigue symptoms were reported in the months following EBV-infection compared to tonsillitis and influenza.<ref>{{Cite journal | last = Petersen | first = I. | last2 = Thomas | first2 = J.M. | last3 = Hamilton | first3 = W.T. | last4 = White | first4 = P. D. | date = Jan 2006| title = Risk and predictors of fatigue after infectious mononucleosis in a large primary-care cohort|url=https://www.ncbi.nlm.nih.gov/pubmed/16330509|journal=QJM: monthly journal of the Association of Physicians|volume=99|issue=1 | pages = 49–55|doi=10.1093/qjmed/hci149|issn=1460-2725|pmid=16330509}}</ref> White is also a member of The International Collaborative on Fatigue Following Infection (COFFI)<ref>{{Cite journal | last = Katz | first = Ben Z | author-link = Ben Katz | last2 = Collin | first2 = Simon M | authorlink2 = Simon Collin | last3 = Murphy | first3 = Gabrielle | author-link3 = Gabrielle Murphy | last4 = Moss-Morris | first4 = Rona | author-link4 = Rona Moss-Morris | last5 = Wyller | first5 = Vegard Bruun | author-link5 = Vegard Bruun Wyller | last6 = Wensaas | first6 = Knut-Arne | last7 = Hautvast | first7 = Jeannine L.A. | last8 = Bleeker-Rovers | first8 = Chantal P | last9 = Vollmer-Conna | first9 = Ute | authorlink9 = Uté Vollmer-Conna | date = 2018 | title=The International Collaborative on Fatigue Following Infection (COFFI)|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6333416/|journal=Fatigue: biomedicine, health & behavior|volume=6|issue=2|pages=106–121|doi=10.1080/21641846.2018.1426086|issn=2164-1846|pmc=6333416|pmid=30666281|quote=}}</ref> which has been established to study post-infection fatigue and related symptoms by sharing data and samples from cohorts around the world.<ref>{{Cite web|url=https://internationalcoffi.wordpress.com/| title = COFFI|website=COFFI|language=en|access-date=2019-08-19}}</ref> ===Graded exercise therapy (GET) === Peter White helped develop graded exercise therapy (GET) <ref name=":4">{{Cite journal | last = Fulcher | first = K. Y. | last2 = White | first2 = P. D. | date = 1997-06-07| title = Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/9180065|journal=BMJ (Clinical research ed.)|volume=314|issue=7095|pages=1647–1652|doi=10.1136/bmj.314.7095.1647|issn=0959-8138|pmc=2126868|pmid=9180065}}</ref><ref name=":5">{{Cite journal | last = Clark | first = Lucy V. | last2 = White | first2 = Peter D. | date = 2005-06-01| title = The role of deconditioning and therapeutic exercise in chronic fatigue syndrome (CFS)|url=https://doi.org/10.1080/09638230500136308|journal=Journal of Mental Health|volume=14|issue=3|pages=237–252|doi=10.1080/09638230500136308|issn=0963-8237}}</ref>, on the basis that "CFS maintained by both the avoidance of activity and deconditioning."<ref name=":11">{{Cite journal | last = Gallagher | first = A.M. | last2 = Coldrick | first2 = A.R. | last3 = Hedge | first3 = B. | last4 = Weir | first4 = W.R.C. | last5 = White | first5 = P. D. | date = Apr 2005| title = Is the chronic fatigue syndrome an exercise phobia? A case control study|url=https://www.ncbi.nlm.nih.gov/pubmed/15992572|journal=Journal of Psychosomatic Research|volume=58|issue=4|pages=367–373|doi=10.1016/j.jpsychores.2005.02.002|issn=0022-3999|pmid=15992572}}</ref> In of his studies CFS patients were compared to sedentary controls. While both were equally unfit, CFS patients had reduced exercise capacity and perceived greater effort during exercise than sedentary controls.<ref>{{Cite journal | last = Fulcher | first = K. Y. | last2 = White | first2 = P. D. | date = Sep 2000| title = Strength and physiological response to exercise in patients with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/10945803|journal=Journal of Neurology, Neurosurgery, and Psychiatry|volume=69|issue=3|pages=302–307|doi=10.1136/jnnp.69.3.302|issn=0022-3050|pmc=1737090|pmid=10945803}}</ref> With GET patients are instructed to gradually increase their level of physical activity.<ref name=":4" /> Under the guidance of a trained physical therapist, patients are instructed to find a baseline of physical activity they can easily manage, even on bad days.<ref name=":5" /> From there, the amount of exercise is increased time-contingently with the goal of reaching 30 minutes five times a week. When patients reach their goals, the intensity of exercise can be increased for example by going from walking to running or swimming.<ref>Bavinton J, Darbishire L, White PD. PACE. [https://me-pedia.org/images/8/89/PACE-get-therapist-manual.pdf Manual For Therapists. Graded Exercise Therapy. MREC Version 2]. 16 November 2004. </ref> According to White, patients can improve and even recover from CFS by following GET.<ref>{{Cite journal | last = White | first = P. D. | last2 = Goldsmith | first2 = K. | last3 = Johnson | first3 = A.L. | last4 = Chalder | first4 = T. | last5 = Sharpe | first5 = M. | date = Oct 2013| title = Recovery from chronic fatigue syndrome after treatments given in the PACE trial|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776285/|journal=Psychological Medicine|volume=43|issue=10|pages=2227–2235|doi=10.1017/S0033291713000020|issn=0033-2917|pmc=3776285|pmid=23363640}}</ref> He has argued that “patients can be released from their self-perpetuating cycle of inactivity if the impairments that occur due to inactivity and their physiological deconditioning can be reversed. This can occur if they are willing to gradually exceed their perceived energy limits, and recondition their bodies through GET.”<ref name=":5" /> White has conducted three randomized trials that assessed the effectiveness of GET.<ref name=":4" /><ref name=":19">{{Cite journal | last = Sharpe | first = M. | last2 = Chalder | first2 = T. | last3 = McCrone | first3 = P. | last4 = Wilks | first4 = D. | last5 = O'Dowd | first5 = H. | last6 = Murphy | first6 = M. | last7 = Murphy | first7 = G. | last8 = Angus | first8 = B.J. | last9 = Bavinton | first9 = J. | date = 2011-03-05| title = Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60096-2/abstract|journal=The Lancet|language=English|volume=377|issue=9768 | pages = 823–836|doi=10.1016/S0140-6736(11)60096-2|issn=0140-6736|pmid=21334061}}</ref><ref>{{Cite journal | last = White | first = Peter D. | last2 = Beynon | first2 = Michelle | last3 = Vergara-Williamson | first3 = Mario | last4 = Thomas | first4 = Janice M. | last5 = Pesola | first5 = Francesca | last6 = Clark | first6 = Lucy V. | date = 2017-07-22| title = Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32589-2/abstract|journal=The Lancet|language=English|volume=390|issue=10092|pages=363–373|doi=10.1016/S0140-6736(16)32589-2|issn=0140-6736|pmid=28648402}}</ref> All claimed that CFS patients significantly improved in the GET-group, although the results have been challenged by others.<ref>{{Cite journal | last = Shepherd | first = C. | last2 = Macintyre | first2 = A. | date = 1997-10-11| title = Graded exercise in chronic fatigue syndrome. Patients should have initial period of rest before gradual increase in activity|url=https://www.ncbi.nlm.nih.gov/pubmed/9361549|journal=BMJ (Clinical research ed.)|volume=315|issue=7113 | pages = 947; author reply 948|issn=0959-8138|pmc=2127628|pmid=9361549}}</ref><ref>{{Cite journal | last = Franklin | first = A.J. | date = 1997-10-11| title = Graded exercise in chronic fatigue syndrome. Including patients who rated themselves as a little better would have altered results|url=https://www.ncbi.nlm.nih.gov/pubmed/9361550|journal=BMJ (Clinical research ed.)|volume=315|issue=7113 | pages = 947; author reply 948|issn=0959-8138|pmc=2127632|pmid=9361550}}</ref><ref>{{Cite journal | last = Wood | first = Anna | date = Mar 24, 2018| title = Graded exercise self-help for chronic fatigue syndrome in GETSET|url=https://www.ncbi.nlm.nih.gov/pubmed/29595493|journal=Lancet (London, England)|volume=391|issue=10126|pages=1161–1162|doi=10.1016/S0140-6736(18)30619-6|issn=1474-547X|pmid=29595493}}</ref><ref>{{Cite journal | last = Crawford | first = Joan S. | date = Mar 24, 2018| title = Graded exercise self-help for chronic fatigue syndrome in GETSET|url=https://www.ncbi.nlm.nih.gov/pubmed/29595492|journal=Lancet (London, England)|volume=391|issue=10126|pages=1160|doi=10.1016/S0140-6736(18)30621-4|issn=1474-547X|pmid=29595492}}</ref> A review by Vink & Vink-Niese indicated that patients rarely improve on objective outcomes following GET.<ref>{{Cite journal | last = Vink | first = Mark | last2 = Vink-Niese | first2 = Alexandra | date = Jul 2018| title = Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review|url=https://www.ncbi.nlm.nih.gov/pubmed/30305916|journal=Health Psychology Open|volume=5|issue=2|pages=2055102918805187|doi=10.1177/2055102918805187|issn=2055-1029|pmc=6176540|pmid=30305916}}</ref> White has acknowledged that “GET does not work by improving physical fitness”<ref name=":6">{{Cite journal | last = Cheshire | first = Anna | last2 = Ridge | first2 = Damien | last3 = Clark | first3 = Lucy | last4 = White | first4 = Peter | date = 2018-10-16| title = Guided graded Exercise Self-help for chronic fatigue syndrome: patient experiences and perceptions|url=https://www.ncbi.nlm.nih.gov/pubmed/30325677|journal=Disability and Rehabilitation|pages=1–10|doi=10.1080/09638288.2018.1499822|issn=1464-5165|pmid=30325677}}</ref> but argued that it may work by improving exercise tolerance or reducing fear avoidance.<ref name=":6" /> The use of GET has been controversial in the ME/CFS community. In several surveys, patients indicated to have been harmed by this treatment.<ref>Kindlon, T. [https://iacfsme.org/PDFS/Reporting-of-Harms-Associated-with-GET-and-CBT-in.aspx Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.] ''Bulletin of the IACFS/ME''. 2011;19(2):59-111.</ref> White has said that reports of harm are merely examples of GET being wrongly applied, for example when patients are told to go to the gym to exercise without any guidance<ref>{{Cite journal | last = Clark | first = Lucy V. | last2 = White | first2 = Peter D. | date = Nov 2008| title = Chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/19242631|journal=Journal of Rehabilitation Medicine|volume=40|issue=10 | pages = 882–883; author reply 883–885|doi=10.2340/16501977-0261|issn=1651-2081|pmid=19242631}}</ref> - an explanation that has been contested.<ref>{{Cite journal | last = Kirke | first = Karen D. | date = Aug 2017| title = PACE investigators' response is misleading regarding patient survey results|url=https://www.ncbi.nlm.nih.gov/pubmed/28805528|journal=Journal of Health Psychology|volume=22|issue=9|pages=1168–1176|doi=10.1177/1359105317703787|issn=1461-7277|pmid=28805528}}</ref> White has acknowledged however that “It is an apparent paradox that graded exercise programmes are prescribed for patients with CFS/ME, when post-exertional malaise is a feature, which requires explanation.”<ref name=":6" /> === Risk factors and prognosis of CFS === Using data from the 1958 British birth cohort White was able to study premorbid risk factors for (self-reported) CFS/ME. The study could not confirm a connection with activity levels in child- or adulthood. Female gender, premorbid psychopathology, childhood gastrointestinal symptoms and parental reports of many colds increased the risk of self-reported CFS/ME in later life.<ref>{{Cite journal | last = White | first = Peter D. | last2 = Hotopf | first2 = Matthew | last3 = Stansfeld | first3 = Stephen A. | last4 = Goodwin | first4 = Laura | last5 = Clark | first5 = Charlotte | date = Oct 2011| title = Premorbid risk markers for chronic fatigue syndrome in the 1958 British birth cohort|url=https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/premorbid-risk-markers-for-chronic-fatigue-syndrome-in-the-1958-british-birth-cohort/13FD27D7ABC50DB975C43717CF465CCF|journal=The British Journal of Psychiatry|language=en|volume=199|issue=4|pages=323–329|doi=10.1192/bjp.bp.110.083956|issn=0007-1250}}</ref> There was also an association with parental physical abuse, although this factor was assessed retrospectively.<ref>{{Cite web|url=https://forums.phoenixrising.me/threads/premorbid-risk-markers-for-chronic-fatigue-syndrome-in-the-1958-british-birth-cohort.13090/| title = Premorbid risk markers for chronic fatigue syndrome in the 1958 British birth cohort | website = Phoenix Rising ME / CFS Forums|language=en-US|access-date=2019-08-19}}</ref> Using data from the General Practice Research Database (GPRD), White and colleagues were able to report that viral infections were a risk marker for CFS, while gastroenteritis put persons at greater risk for irritable bowel syndrome.<ref>{{Cite journal | last = White | first = P. D. | last2 = Thomas | first2 = J.M. | last3 = Gallagher | first3 = A.M. | last4 = Hamilton | first4 = W.T. | date = Nov 2009| title = Risk markers for both chronic fatigue and irritable bowel syndromes: a prospective case-control study in primary care|url=https://www.cambridge.org/core/journals/psychological-medicine/article/risk-markers-for-both-chronic-fatigue-and-irritable-bowel-syndromes-a-prospective-casecontrol-study-in-primary-care/FCD39EEB36A3FA20D1FD28D720F779A2|journal=Psychological Medicine|language=en|volume=39|issue=11|pages=1913–1921|doi=10.1017/S0033291709005601|issn=1469-8978}}</ref> Using the GPRD, White estimated the incidence of CFS to be 14.8 per 100,000 people.<ref name=":7">{{Cite journal | last = Collin | first = Simon M. | last2 = Bakken | first2 = Inger J. | last3 = Nazareth | first3 = Irwin | last4 = Crawley | first4 = Esther | last5 = White | first5 = Peter D. | date = Jun 2017| title = Trends in the incidence of chronic fatigue syndrome and fibromyalgia in the UK, 2001-2013: a Clinical Practice Research Datalink study|url=https://www.ncbi.nlm.nih.gov/pubmed/28358988|journal=Journal of the Royal Society of Medicine|volume=110|issue=6|pages=231–244|doi=10.1177/0141076817702530|issn=1758-1095|pmc=5499564|pmid=28358988}}</ref> The data indicated that the incidence of CFS had remained relatively constant during the period 2001-2013, even decreasing a little over time.<ref name=":7" /> White and colleagues also reported that CFS-patients had a 50% increased GP consultation rate in the 10 years before their CFS diagnosis in the GPRD, compared to controls.<ref name=":8">{{Cite journal | last = Collin | first = Simon M. | last2 = Bakken | first2 = Inger J. | last3 = Nazareth | first3 = Irwin | last4 = Crawley | first4 = Esther | last5 = White | first5 = Peter D. | date = 2017-05-05| title = Health care resource use by patients before and after a diagnosis of chronic fatigue syndrome (CFS/ME): a clinical practice research datalink study|url=https://doi.org/10.1186/s12875-017-0635-z|journal=BMC Family Practice|volume=18|issue=1 | pages = 60|doi=10.1186/s12875-017-0635-z|issn=1471-2296|pmc=5420108|pmid=28476151}}</ref> Healthcare consumption peaked in the year of CFS/ME diagnosis but quickly reached levels similar to the period before diagnosis.<ref name=":8" /> === Activated cytokines === In one of his first papers featuring CFS, White speculated that the condition may be the result of activated cytokines such as Interleukin 1.<ref>{{Cite journal | last = Ur | first = E. | last2 = White | first2 = P. D. | last3 = Grossman | first3 = A. | date = 1992| title = Hypothesis: cytokines may be activated to cause depressive illness and chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/1606197|journal=European Archives of Psychiatry and Clinical Neuroscience|volume=241|issue=5|pages=317–322|issn=0940-1334|pmid=1606197}}</ref> He subsequently tested the activation of cytokines in CFS patients before and after performing an exercise test.<ref>{{Cite journal | last = White | first = P. D. | last2 = Nye | first2 = K.E. | last3 = Pinching | first3 = A.J. | last4 = Yap | first4 = T.M. | last5 = Power | first5 = N. | last6 = Vleck | first6 = V. | last7 = Bentley | first7 = D.J. | last8 = Thomas | first8 = J.M. | last9 = Buckland | first9 = M. | date = 2004-01-01| title = Immunological Changes After Both Exercise and Activity in Chronic Fatigue Syndrome|url=https://doi.org/10.1300/J092v12n02_06|journal=Journal of Chronic Fatigue Syndrome|volume=12|issue=2 | pages = 51–66|doi=10.1300/J092v12n02_06|issn=1057-3321}}</ref> In a 2015 review, however, White and colleagues reported that studies on cytokines in CFS are often of poor quality and have conflicting results.<ref name=":9">{{Cite journal | last = Blundell | first = S. | last2 = Ray | first2 = K.K. | last3 = Buckland | first3 = M. | last4 = White | first4 = P. D. | date = Nov 2015 | title = Chronic fatigue syndrome and circulating cytokines: A systematic review|url=https://www.ncbi.nlm.nih.gov/pubmed/26148446|journal=Brain, Behavior, and Immunity|volume=50|pages=186–195|doi=10.1016/j.bbi.2015.07.004|issn=1090-2139|pmid=26148446}}</ref> According to the authors, the only consistent finding has been an increase in transforming growth factor-beta (TGF-β).<ref name=":9" /> A subsequent study by White’s research group showed that TGF-β was the only cytokine significantly increased in CFS patients compared to controls, but that this was considered “a spurious finding due to variation between different assay batches.”<ref name=":10">{{Cite journal | last = Clark | first = L.V. | last2 = Buckland | first2 = M. | last3 = Murphy | first3 = G. | last4 = Taylor | first4 = N. | last5 = Vleck | first5 = V. | last6 = Mein | first6 = C. | last7 = Wozniak | first7 = E. | last8 = Smuk | first8 = M. | last9 = White | first9 = P. D. | date = Dec 2017| title = Cytokine responses to exercise and activity in patients with chronic fatigue syndrome: case-control study|url=https://www.ncbi.nlm.nih.gov/pubmed/28779554|journal=Clinical and Experimental Immunology|volume=190|issue=3|pages=360–371|doi=10.1111/cei.13023|issn=1365-2249|pmc=5680051|pmid=28779554}}</ref> According to the authors, the results suggest that “elevated circulating cytokines are not important in the pathophysiology of CFS” although a role for local release of cytokines in the central nervous system (CNS) was not ruled out.<ref name=":10" /> === Subgrouping: to both 'lump' and 'split' === White has argued that CFS is a heterogeneous label representing more than one separate condition and that this might explain the lack of replication in the field. “If CFS is found to be more than one separate condition", he wrote, “this could explain why no replicated causes have been found associated with the illness, since an association found only in one subgroup would be diluted, and risk being found non‐significant, by mixing the subgroup with others.”<ref name=":12">{{Cite journal | last = White | first = Peter Denton | date = 2019-08-01| title = A perspective on causation of the chronic fatigue syndrome by considering its nosology|url=https://www.ncbi.nlm.nih.gov/pubmed/31373106|journal=Journal of Evaluation in Clinical Practice|doi=10.1111/jep.13240|issn=1365-2753|pmid=31373106}}</ref> White was able to perform subgroup analysis on the data collected during two large epidemiological studies by the Centers for Disease Control and Prevention in the United States. Principal components analysis was conducted on selected CFS patients, patients with idiopathic chronic fatigue and healthy controls from the Wichita, Kansas study.<ref name=":13">{{Cite journal | last = Vollmer-Conna | first = Uté | last2 = Aslakson | first2 = Eric | last3 = White | first3 = Peter D. | date = Apr 2006| title = An empirical delineation of the heterogeneity of chronic unexplained fatigue in women|url=https://www.ncbi.nlm.nih.gov/pubmed/16610946|journal=Pharmacogenomics|volume=7|issue=3|pages=355–364|doi=10.2217/14622416.7.3.355|issn=1462-2416|pmid=16610946}}</ref> The analysis indicated 6 different classes which were mostly based on factors such as obesity, depression, and apnea.<ref name=":13" /><ref>{{Cite journal | last = Aslakson | first = Eric | last2 = Vollmer-Conna | first2 = Uté | last3 = White | first3 = Peter D | date = 2006-04-01| title = The validity of an empirical delineation of heterogeneity in chronic unexplained fatigue|url=https://www.futuremedicine.com/doi/abs/10.2217/14622416.7.3.365|journal=Pharmacogenomics|volume=7|issue=3|pages=365–373|doi=10.2217/14622416.7.3.365|issn=1462-2416}}</ref> Similar groups were found in the analysis of data from the CDC’s prevalence study in Georgia.<ref name=":14">{{Cite journal | last = Aslakson | first = Eric | last2 = Vollmer-Conna | first2 = Uté | last3 = Reeves | first3 = William C. | last4 = White | first4 = Peter D. | date = 2009-10-05| title = Replication of an empirical approach to delineate the heterogeneity of chronic unexplained fatigue|url=https://www.ncbi.nlm.nih.gov/pubmed/19804639|journal=Population Health Metrics|volume=7|pages=17|doi=10.1186/1478-7954-7-17|issn=1478-7954|pmc=2761845|pmid=19804639}}</ref> According to the authors, this replication supported “the broadening of the concept of CFS to include patients with fewer symptoms but similar disability.”<ref name=":14" /> White has recommended that NICE guidelines for the diagnosis of CFS as the most useful as it requires only one additional symptom beyond post‐exertional fatigue.<ref name=":12" /><ref name=":26">[https://www.youtube.com/watch?v=doY1WK1plOQ Psychiatrist Peter White at the Royal Society of Medicine 2008 - Defining CFS/ME.]</ref> White has however been critical of proposals to lump several functional somatic syndromes (FSS) - which in his view includes ME/CFS - into one diagnostic entity.<ref name=":15">{{Cite journal | last = Wessely | first = Simon | last2 = White | first2 = Peter D. | date = Aug 2004| title = There is only one functional somatic syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/15286058|journal=The British Journal of Psychiatry: The Journal of Mental Science|volume=185 | pages = 95–96|doi=10.1192/bjp.185.2.95|issn=0007-1250|pmid=15286058}}</ref><ref name=":16">{{Cite journal | last = White | first = Peter D. | date = May 2010| title = Chronic fatigue syndrome: Is it one discrete syndrome or many? Implications for the "one vs. many" functional somatic syndromes debate|url=https://www.ncbi.nlm.nih.gov/pubmed/20403504|journal=Journal of Psychosomatic Research|volume=68|issue=5 | pages = 455–459|doi=10.1016/j.jpsychores.2010.01.008|issn=1879-1360|pmid=20403504}}</ref><ref>{{Cite journal | last = White | first = Peter D. | date = Jan 2013| title = Functional somatic syndromes may be either "polysyndromic" or "monosyndromic"|url=https://www.ncbi.nlm.nih.gov/pubmed/23272980|journal=Journal of Psychosomatic Research|volume=74|issue=1|pages=2–3|doi=10.1016/j.jpsychores.2012.10.005|issn=1879-1360|pmid=23272980}}</ref> He has argued that there is little overlap between conditions such as fibromyalgia and irritable bowel syndrome, that treatments and risk factors between FSS may differ and that “historically, more progress has been made through splitting illnesses rather than lumping them together.”<ref name=":15" /> According to White “A general functional somatic syndrome can be consistent only with psychogenesis, since it is difficult to conceive of a pathophysiological mechanism that would be common to all functional somatic syndromes.”<ref name=":15" /> As an alternative White proposes to be “over‐inclusive regarding the diagnosis as a first step, while subdividing the condition into likely subgroups as a means of finding valid and reliable associations with potential causes”<ref name=":12" /> He has argued that "the solution to the debate is that we need to both 'lump' and 'split.' We need to study both the similarities between syndromes and their dissimilarities to better understand what we currently call the FSSs."<ref name=":16" /> === Central Sensitization === While White has originally emphasized the role of deconditioning in the pathology of CFS, in recent years he has highlighted the potential role of central sensitization, a suspected hypersensitivity of the central nervous system.<ref name=":17">{{Cite journal | last = Bourke | first = Julius H. | last2 = Langford | first2 = Richard M. | last3 = White | first3 = Peter D. | date = Mar 2015 | title = The common link between functional somatic syndromes may be central sensitisation|url=https://www.ncbi.nlm.nih.gov/pubmed/25598410|journal=Journal of Psychosomatic Research|volume=78|issue=3|pages=228–236|doi=10.1016/j.jpsychores.2015.01.003|issn=1879-1360|pmid=25598410}}</ref> He has argued that central sensitization may form a common link between functional somatic syndromes, whereas precipitating events such as environmental exposures could mark the development of specific syndromes or their sub-phenotypes.<ref name=":17" /> White has also emphasized the role of interoception<ref>{{Cite journal | last = Smith | first = Wayne R | last2 = White | first2 = Peter D | last3 = Buchwald | first3 = Dedra | date = 2006-11-13| title = A case control study of premorbid and currently reported physical activity levels in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1647270/|journal=BMC Psychiatry|volume=6 | pages = 53|doi=10.1186/1471-244X-6-53|issn=1471-244X|pmc=1647270|pmid=17101056}}</ref> and abnormal perception of effort in CFS.<ref name=":5" /> His research however indicated that CFS patients do no have an exercise phobia.<ref name=":11" />
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