BPS understanding of ME's early stages

Hi - for a "capstone" (mini dissertation) I'm writing, does anyone know of any papers where the BPS school lays out its understanding of the earliest stages of ME - the weeks directly following a viral infection? Specifically, how behavioural factors during this phase essentially create and then perpetuate the illness.

 

I have not heard of any suggestion that psychobehavioural factors are involved in the early stages. The idea was that they perpetuate an illness state later I think. BPS people are very keen to point out that their theory is biopsychosocial - that biological, non-psychosocial factors are an integral part of the story, not that it is all psychosocial.

In terms of early psychological risk factors the talk has mostly been in terms of past history of childhood trauma - Crawley has written on that. Another person who likes to weave a complicated story is Hans Knoop who has probably written reviews on this.

 

That's a good example, actually; here's the model:



I haven't paid a lot of attention to modern BPS works but in the early papers a lot of attention is paid to supposed "predisposing", "precipitating" and "perpetuating" factors; you may want to look back at some of them. One that attempted to explore supposed behavioural factors at all the supposed three stages was "Chronic Fatigue Syndrome: A Cognitive Approach" (Surawy et al, Behav Res Ther 33(5):535-544, 1995). Sharpe wrote a chapter of a book ("Science and Practice of Cognitive Behaviour Therapy", ch16) in 1996 in which you'll find an early attempt to draw out all the strands of the cognitive-behavioural model as well as references to a lot of the first papers on the subject. Lots of theories about personality factors, beliefs, illness attributions, coping style, "catastrophising".

Most of the psychobehavioural research seems to have focussed on the supposed predisposing and perpetuating stages rather than the precipitating stage - they don't tend to regard the triggering event as particularly important & often as just a stressor. Searching Scopus for papers mentioning predisposing or precipitating factors in "chronic fatigue", as well as looking through issues of the Journal of Psychosomatic Research & the published works of Sharpe, Chalder, Moss-Morris et al will give you a good idea.

 

Is there much discussion of how the illness could develop in someone who didn't have any of the "predisposing" factors? (Obviously it's moot in BPS practice, because the factors are so broad and common that anybody who ever becomes ill can have at least one assigned to their case history.)

 

I'm not sure if 'type of personality' would fall under this. If it does then there is a lot of info on it under tag 'personality'.
eg
Personality as a risk factor for ME/CFS and similar diseases | Science for ME
Ros Vallings (NZ advocate) unfortunately includes this in many of her talks.

 

Sorry no papers, but that diagram and explanation from Nightsong encompasses the biopsychosocial theory of ME.

I can give you a few ideas from my training.

Behavioural factors that you are looking at, all have predisposing and perpetuating factors - there are many.... so off the top of my head - past history of unusual responses to childhood illness, especially the so-called psychosomatic illnesses, for instance children presenting with stomach ache to get the day off school. History within their family of origin of family members having illnesses and how this might have changed the family dynamic.

There is also the contribution of personality traits and how people cope with the triggering illness and that then informs how they manage their illness, then how they conceptualise a continuation of symptoms past the "normal" expected recovery from an infection.

Of course they believe that people who develop ME also had a stressor at the time of the infection (a psychosocial one - that has many determinants too, which I won't bore you with listing) and that has more impact on their development of ME than the infection itself (swiftly removing the bio and ignoring any research findings) and this psychobehavioural factor moves the thinking into a state of health anxiety, looking up symptoms further reinforcing their beliefs of having a serious potentially chronic illness (hypochondriasis).

So basically it is hard-wired into the person from genetic predisposition to personality traits, factors arising from childhood and family of origin, then there is adverse childhood events - trauma of any kind.

 

Frankly, this seems about as relevant as whether some group believes the universe was generated because a cow licked a salted cup, or whether they believe it was sugary. Or whether it's Satan, or Satan's cousin Karl, who makes gay people succumb to the sin of homosexuality, which has to be converted back into 'normal' thoughts.

There is really no point trying to decipher the stories they tell themselves, or those they say out loud. They're just stories to justify their beliefs, the narratives themselves are entirely irrelevant and they absolutely don't believe that there is any biology involved and it makes zero difference in anything they say, think or do.

I don't get the point of pretending that the big lies of big liars are anything but lies to suit their fancy. All of this is exactly as relevant as it is to peptic ulcers. No one in psychosomatic land bothers with this stuff anymore, it has been overcome by events, and it matters exactly as much as whatever was said about "nervous stomachs" and other junk nonsense they made up back then, which happens to be exactly the same crap that they still parrot mindlessly.

 

Geraghty’s review of the biopsychosocial model for ME/CFS may be useful. However, I have the same impression as @Jonathan Edwards. The model says that patients develop ME/CFS during the recovery phase, after the initial infection. https://pmc.ncbi.nlm.nih.gov/articles/PMC6482658/

 

Not specifically for ME but the CLoCK study in children for Long Covid assessed behavioural and psychological states pre covid to try to do the same thing. There is substantial questionnaire data on this in their papers.