Elke Van Hoof
Elke L. S. Van Hoof, PhD, is a clinical psychologist and a professor of medicine and health psychology at the Free University, Brussels, Belgium since 2006. Her areas of interests include: stress and burnout, CFS/ME, trauma, adjustment problems, cancer, disability and return to work after prolonged illness. She spent several years in the United States at the Pacific Fatigue Lab now called Workwell Foundation. From 2006 to 2007, she served as Junior Editor of the Journal of Chronic Fatigue Syndrome.
- 2007, Junior Investigator Award to encourage young CFS/FM researchers in recognition of their work awarded by International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis.
- 2006, Pediatric Chronic Fatigue Syndrome by Kenny De Meirleir, Neil McGregor, and Elke L.S. Van Hoof
Pediatric case definition
- 2006, "A Pediatric Case Definition for Myalgic Encephalomyelitis and Chronic Fatigue Syndrome"
"Summary: For a diagnosis of chronic fatigue syndrome (CFS), most researchers use criteria that were developed by Fukuda et al. (1994), with modifications suggested by Reeves et al. (2003). However, this case definition was established for adults rather than children. A Canadian Case Definition (ME/CFS; Myalgic Encephalomyelitis/CFS) has recently been developed, with more specific inclusion criteria (Carruthers et al., 2003). Again, the primary aim of this case definition is to diagnose adult CFS. A significant problem in the literature is the lack of both a pediatric definition of ME/CFS and a reliable instrument to assess it. These deficiencies can lead to criterion variance problems resulting in studies labeling children with a wide variety of symptoms as having ME/CFS. Subsequently, comparisons between articles become more difficult, decreasing the possibility of conducting a meta-analysis. This article presents recommendations developed by the International Association of Chronic Fatigue Syndrome Pediatric Case Definition Working group for a ME/CFS pediatric case definition. It is hoped that this pediatric case definition will lead to more appropriate identification of children and adolescents with ME/CFS."
- 2009, The doctor-patient relationship in chronic fatigue syndrome: survey of patient perspectives
"Abstract: BACKGROUND: When confronted with chronic fatigue syndrome (CFS), general practitioners (GPs) need to deal with diverse complaints. This may introduce a sense of powerlessness and frustration in the GP, which could possibly undermine the doctor-patient relationship. AIM: Our aim was to list the perspectives of patients with CFS regarding the medical encounter. METHOD: This was a questionnaire study of systematically selected patients presenting to a tertiary clinic specialising in CFS. A questionnaire was presented to every third patient attending the clinic. Statistical computations were performed using the SPSS statistical package. RESULTS: One hundred and seventy-seven patients completed the questionnaire. A diagnosis of CFS was made by a GP in 8% of the cases. In 31% of the cases the GP had experience with general CFS complaints, and 35% of the GPs showed experience in CFS. Only 23% reported sufficient knowledge to treat the condition. According to the patients surveyed, 35% felt that their GP had experience in dealing with CFS. CONCLUSIONS: The heterogeneity of CFS and the controversy surrounding this condition seemed to overwhelm GPs and strain the medical encounter. Patients with CFS seemed unsatisfied with the interaction with their doctor. Moreover, the results show that CFS is not addressed well by the medical community, and the failure to diagnose leads to a lack of empathetic care, with consequential loss of the capacity of the doctor to act as a healer."
- 2007, Defining the Occurrence and Influence of Alpha-Delta Sleep in Chronic Fatigue Syndrome
"Abstract: BACKGROUND: Patients with chronic fatigue syndrome (CFS) present a disordered sleep pattern and frequently undergo polysomnography to exclude a primary sleep disorder. Such studies have shown reduced sleep efficiency, a reduction of deep sleep, prolonged sleep initiation, and alpha-wave intrusion during deep sleep. Deregulation of the 2-5A synthetase/RNase L antiviral pathway and a potential acquired channelopathy are also found in a subset of CFS patients and could lead to sleep disturbances. This article compiles a large sleep study database on CFS patients and correlates these data with a limited number of immune parameters as it has been thought that RNase L could be associated with these sleep disturbances. METHODS: Forty-eight patients who fulfilled 1994 Centers for Disease Control and Prevention criteria for CFS underwent extensive medical evaluation, routine laboratory testing, and a structured psychiatric interview. Subjects then completed a complaint checklist and a two-night polysomnographic investigation. RNase L analysis was performed by gel electrophoresis using a radiolabeled 2',5'-oligoadenylate trimer. Basic descriptive statistical parameters were calculated. RESULTS: Patients experienced a prolonged sleep latency, showed a low sleep efficiency index, and had a low percentage of slow wave sleep. The present alpha-delta intrusion correlated with anxiety; no correlations appeared, however, between alpha-delta sleep and immunologic parameters, including RNase L. CONCLUSIONS: The main findings are 1) validation of sleep latency problems and other sleep disturbances as already suggested by several authors; 2) alpha-delta intrusion seems associated with anxiety; and 3) elevated RNase L did not correlate with alpha-delta sleep.
- 2006, Guidelines for the Diagnosis of Pediatric Chronic Fatigue Syndrome: Things Parents Need to Know
"Abstract - In this volume, chronic fatigue syndrome (CFS) in children and adolescents is specifically addressed. It is a topic long overdue. It is my sincere hope that the criteria presented here will begin a process of rigorous clinical testing and refinement so that pediatricians and other medical providers will come to have a reliable and accepted way of making the diagnosis of ME/CFS in a person under 18 years of age. This short review is meant for parents and other caregivers as a brief summary of the guidelines that may be of value. The primary role of these guidelines is to present a strict and rigorous definition that can be tried and tested. This summary is to make the process of diagnosis somewhat easier for parents and caregivers alike until the testing process is completed. Therefore, for more detailed symptom description and exclusionary illness description, I would refer the reader to the primary article. Professional caregivers and clinicians may make this article available to inform parents with a child/adolescent suffering from CFS."
- 2006, Pediatric Chronic Fatigue Syndrome and Munchausen-By-Proxy: A Case Study
"Abstract - Pediatric chronic fatigue syndrome (CFS) posits even more challenges for professional caregivers in comparison with adult CFS samples. Most children with CFS display a decrease in school attendance and a decrease in social activities. As several conditions such as school phobia, primary psychiatric disorders or family disturbance present the same characteristics, the diagnostic process appears more complex. Family disturbance, moreover, is often specified as child abuse, neglect or even Munchausen-by-proxy. As skepticism is frequently associated with a diagnosis of CFS, patients and parents must fend for themselves, fighting allegations of child abuse and neglect. This case study illustrates what happens when such allegations are put forward."
- 2004, The Influence of Chronic Fatigue Syndrome on the Personality Profile: A Case Report
"Abstract - Objective: Chronic fatigue syndrome (CFS) functionally impairs many patients. Despite numerous studies and reviews in CFS, little is known about the behavioral consequences. Several researchers have already suggested the influential role of personality as a possible predisposing or perpetuating factor. Method: A case study is presented of a 34-year-old man with a history of CFS. Psychological profiling using the MMPI-2 was performed during the course of his condition. Results: His passive-aggressive manner during the medical encounter was underscored by his personality profile (code type 3-2). After his recovery, however, a spike 3 profile emerged indicating a fulfilled individual. Somatic items included in the inventory, created a secondary increase of the clinical scales. Physical complaints diminished as his condition improved and subsequently, decreased the clinical scales. Conclusion: The relevance of classifying personality characteristics in CFS patients as traits could not be supported by this case report."
- 2004, Association Between Fennell Phase Inventory Scores and Immune and RNase-L Parameters in Chronic Fatigue Syndrome
"Abstract - All patients suffering from a chronic condition, are challenged to manage the reality of their disease, the accompanying anxiety, the problems of daily living, and the effect on relationships. Therefore, when confronted with debilitating complaints, patients suffering from chronic fatigue syndrome (CFS) need to adapt to a new way of living during the course of their illness. Fennell developed an integrated model to manage CFS. This article is a follow-up of a study by Jason et al. (2000) to verify the existence of the different phases. Although not all differences are statistically significant, a clear distinction is made according to the conclusions drawn by Jason et al. (2000). Relationships between these distinctions and measures of symptoms, disability, psychological distress, coping, and immune parameters were revealed using non-parametric statistical tests."
- 2004, The Fennell Phase Inventory in a Belgian Sample
"Abstract: The present study is a follow-up of the research conducted by Jason, Fennell et al. (1995, 1999, 2000) on a multistage theory for chronic fatigue syndrome (CFS). This multistage model is a very promising method for the evaluation of patients suffering from CFS and could facilitate the appropriate selection of various psychosocial therapies that improve the patient’s ability to cope with their illness. Four predictive factors emerged with moderate to excellent reliability. A Spearman’s rank correlation revealed positive correlations between our four-factor model and the three-factor model identified by Jason et al.(1999). A correlation matrix between the dimensional psychological investigation and the Fennell Phases revealed characteristics as suggested by previous research. Biological parameters varied over the different phases suggesting an important interaction between body and psyche."
- 2003, Article: Cognitive Behavioural Therapy as Cure-All for CFS - Critical Reviews and Comments on Current Research by Elke Van Hoof
- 2003, Hyperbaric Therapy in Chronic Fatigue Syndrome
"Abstract - The aim of this study was to determine if hyperbaric oxygen treatment (HBOT) could be used as adjunctive therapy and if HBOT could increase the quality of life in such a way that the functional status would improve in patients with an infection. A randomized, controlled trial was conducted on 15 Mycoplasma sp. infected CFS (CDC 1994) patients and 14 CFS (CDC 1994) patients with no evidence of a Mycoplasma infection were enrolled in a convenience randomization sample from our referral clinic. No statistical differences were found by use of univariate repeated measures although Bodily Pain as measured by the SF-36 seems to decrease after hyperbaric therapy (Greenhouse-Geisser: p = .010). Trends were found using paired t-testing for Mycoplasma infected CFS patients. The general perceived fatigue seemed to decrease after hyperbaric therapy (General Fatigue: p = .06). Directly after one week of hyperbaric therapy general fatigue improved (p = .03) but there was a reduction of activity (reduced activity: p = .05) and general perceived health (general health: p = .04). One month later the physical role increased (Role-Physical: p = .07). Although more data is required to make firm conclusions, trends were found. Reduced fatigue, increased levels of activity and an improved reaction time improved significantly their quality of life and therefore, enhanced also their functional status and thus could be used as an adjunctive therapy."
- 2003, Comparison of Activity Limitations/Participation Restrictions Among Fibromyalgia and Chronic Fatigue Syndrome Patients
"Abstract - Fibromyalgia (FM) and Chronic Fatigue Syndrome (CFS) are related yet overlapping disorders; the current case definitions prohibit a clear-cut differential diagnosis. These diagnostic criteria mainly address the impairment level of the World Health Organization's International Classification of Functioning, Disability and Health. This study aimed at comparing activity limitations and participation restrictions in patients with FM (n = 90) and CFS (n = 47). The Chronic Fatigue Syndrome Activities and Participation Questionnaire (CFS-APQ) was used for assessing functionality in both groups. The convergent validity of the scores obtained with the questionnaire with visual analogue scales for pain, fatigue and concentration was investigated in FM patients, as well as the content validity. No differences in total scores and 25 out of 26 individual items on the CFS-APQ were observed between the 2 groups (independent samples Mann-Whitney U test). This sample of FM patients reported to be more disabled in ‘sitting for two hours’ as compared to the CFS group (mean scores 3.0 ± 1.0 and 2.3 ± 1.0; P = .004). Four hundred and thirty-seven of the 497 (87.9%) responses to the request to list difficult activities matched the content of the CFS-APQ. The overall scores of the CFS-APQ correlated statistically significant in respect to visual analogue scales for pain and concentration (Spearman rho for the total scores ranged between .44 and .49). These data question the disease specificity of the CFS-APQ for CFS, but suggests its applicability in ‘the Chronic Pain-Fatigue Syndromes.’ The present report provides evidence for both the content and convergent validity of the CFS-APQ in FM patients.
- 2002, Activity Limitations and Participation Restrictions in Patients with Chronic Fatigue Syndrome—Construction of a Disease Specific Questionnaire
"Abstract - Review of the literature indicated the lack of disease specific measures for assessing activity limitations and participation restriction in patients with Chronic Fatigue Syndrome. Retrospective analysis of Karnofsky Performance Status questionnaires and Activities of Daily Living questionnaires (a Dutch version of the Barthel index, modified for CFS) of 141 subjects was performed to create a new questionnaire. Data analysis resulted in the following item selection, based on most frequently reported activity limitations and participation restriction; cleaning, washing dishes and returning them to cupboard, iron, do the wash, gardening, replace light bulb, walking, climb one flight of stairs, stand one hour, sit two hours, doing groceries, thirty minutes of computer work, carrying heavy objects, write a full page letter, use a screwdriver, hammer a nail, make one bed, reading, social activities, doing sports, studying, driving a car, going to school/working, preparing meals and caring for a child. These data were used to create the CFS-Activities and Participation Questionnaire (CFS-APQ). The reliability and different aspects of validity of this new measure still need to be established."
Talks & interviews
- Jason, Leonard A; Jordan, Karen; Miike, Teruhisa; Bell, David S; Lapp, Charles; Torres-Harding, Susan; Rowe, Kathy; Gurwitt, Alan; De Meirleir, Kenny; Van Hoof, Elke LS (2006), "A Pediatric Case Definition for Myalgic Encephalomyelitis and Chronic Fatigue Syndrome", Journal of Chronic Fatigue Syndrome, 13 (2-3): 1-44, doi:10.1300/J092v13n02_01
- Elke Van Hoof. (2009). The doctor-patient relationship in chronic fatigue syndrome: survey of patient perspectives. Quality in Primary Care. Vol 17, Iss 4, pp. 263-70. PMID: 19807959.
- Van Hoof E1, De Becker P, Lapp C, Cluydts R, De Meirleir K.. (2009). Defining the Occurrence and Influence of Alpha-Delta Sleep in Chronic Fatigue Syndrome. The American Journal of the Medical Sciences. Vol 333, Iss 2, pp. 78-84. PMID: 17301585.
- David S. Bell & E. Van Hoof. (2006). Guidelines for the Diagnosis of Pediatric Chronic Fatigue Syndrome: Things Parents Need to Know. Journal of Chronic Fatigue Syndrome, Vol. 13, Iss. 2-3, pp. 79-88. http://dx.doi.org/10.1300/J092v13n02_05
- E. Van Hoof, P. De Becker & K. De Meirleir. (2006). Pediatric Chronic Fatigue Syndrome and Munchausen-By-Proxy: A Case Study. Journal of Chronic Fatigue Syndrome, Vol. 13, Iss. 2-3, pp. 45-53. http://dx.doi.org/10.1300/J092v13n02_02
- Elke Van Hoof & Kenny De Meirleir. (2004). The Influence of Chronic Fatigue Syndrome on the Personality Profile: A Case Report. Journal of Chronic Fatigue Syndrome, Vol. 12, Iss. 3, pp. 63-71. http://dx.doi.org/10.1300/J092v12n03_05
- Elke Van Hoof, Danny Coomans, Raymond Cluydts & Kenny De Meirleir. Association Between Fennell Phase Inventory Scores and Immune and RNase-L Parameters in Chronic Fatigue Syndrome. Journal of Chronic Fatigue Syndrome, Vol. 12, Iss. 2, pp. 19-34. http://dx.doi.org/10.1300/J092v12n02_03
- Van Hoof, Elke; Coomans, Danny; Cluydts, Raymond; De Meirleir, Kenny (2004), "The Fennell Phase Inventory in a Belgian Sample", Journal of Chronic Fatigue Syndrome, 12 (1): 53-69, doi:10.1300/J092v12n01_04
- Elke Van Hoof. (2003). Cognitive Behavioural Therapy as Cure-All for CFS. Journal of Chronic Fatigue Syndrome, Vol. 11, Iss. 4, pp. 43-47. http://dx.doi.org/10.1300/J092v11n04_05
- Elke Van Hoof, Danny Coomans, Pascale De Becker, Romain Meeusen, Raymond Cluydts & Kenny De Meirleir (2003). Hyperbaric Therapy in Chronic Fatigue Syndrome. Journal of Chronic Fatigue Syndrome, Vol. 11, Iss. 3, pp. 37-49. http://dx.doi.org/10.1300/J092v11n03_04
- Jo Nijs, Peter Vaes, Neil McGregor, Luc Lambrecht, Elke Van Hoof & Kenny De Meirleir. (2003). Comparison of Activity Limitations/Participation Restrictions Among Fibromyalgia and Chronic Fatigue Syndrome Patients. Journal of Chronic Fatigue Syndrome, Vol. 11, Iss. 4, pp. 3-18. http://dx.doi.org/10.1300/J092v11n04_02
- Jo Nijs, Peter Vaes, Elke Van Hoof, Pascale De Becker, Neil McGregor & Kenny De Meirleir. (2002). Activity Limitations and Participation Restrictions in Patients with Chronic Fatigue Syndrome—Construction of a Disease Specific Questionnaire. Journal of Chronic Fatigue Syndrome, Vol. 10, Iss. 2, pp. 3-23. http://dx.doi.org/10.1300/J092v10n03_02