Wed, 22 Aug 2001 

WHO ICD-10 clarification

dear all

It appears to me on the classification of CFS and ME in the WHO ICD-10,
that few have actually read the published ICD-10 - this includes
The Institute of Psychiatry at Kings College, London who
are responsible for publishing the incorrect page in their WHO Guide to Mental Health
in Primary Care (UK):

http://cebmh.warne.ox.ac.uk/cebmh/whoguidemhpcuk/disorders/f48-0.html

Firstly, the published ICD-10 consists of three volumes -

Volume 1 is the actual classification (published in 1992)

Volume 2 is the Instruction Manual to the Classification (1993)

Volume 3 is the Alphabetical Index to the Classification (1994)

The publication dates of each volume are significant.

There is no mention whatsoever of CFS in the actual classification (volume 1, 1992) -
the term CFS appeared too late for the publication schedule. (I will return to this
point below).

ME and PVFS appear as equivalent terms under G93.3 (diseases of the nervous system)
in volume 1.

Chronic fatigue is not classified as a disease - it is classified as a symptom (of
disease) under R53 (Malaise and Fatigue) - so it has no legitimacy as a diagnosis.
Importantly, G93.3 (ME/PVFS) is excluded from the R53 classification.

Neurasthenia and Fatigue Syndrome appear as equivalent terms under F48.0. Again,
importantly, G93.3 is excluded from this classifcation.

The term CFS does appear in the ICD-10 - but only in the later volume 3 (1994) -in
the alphabetical index. It is found under S (syndrome), as fatigue, chronic. Most
importantly, it is classified under G93.3 as an equivalent term to ME and PVFS. Here
is the entry:

Syndrome
- fatigue (F48.0)
- - chronic (G93.3)
- - postviral (G93.3)

So, we can now see how the Institute of Psychiatry has taken a "pick and mix"
approach to its F48.0 classification entry. "Chronic Fatigue" is a symptom under R53
- and so incorrect. CFS is G93.3 - and so incorrect. Neurasthenia is F48.0 - which is
correct. ME is G93.3 - and so incorrect.

In reality, the ICD-10 F48.0 classifies Neurasthenia (aka Fatigue Syndrome) but it
specifically excludes ME, CFS and PVFS.


Jed Gallagher
Founder, CFSsocNIMr
http://www.square-sun.co.uk/cfs-nim/index.htm