Wed, 22 Aug 2001 

Neurasthenia, CFS and ICD-10

dear all

In the 19th century, ME/PVFS/CFS was known as neurasthenia - it was a originally a
legitimate "physical" diagnosis. It was later "hi-jacked" by the newly emerging
psychiatric profession as an example of psychiatric theory proved correct.

Neurasthenia made its way into the ICD-10 and remains classified as F48.0 in the
Mental and Behavioural Disorders (F) classification. Here is the full-text from
ICD-10:

===================================================================
Neurasthenia

Considerable cultural variations occur in the presentation of this disorder, and two
main types occur, with substantial overlap.

In one type, the main feature is a complaint of increased fatigue after mental
effort, often associated with some decrease in occupational performance or coping
efficiency in daily tasks. The mental fatiguability is typically described as an
unpleasant intrusion of distracting associations or recollections, difficulty in
concentrating, and generally inefficient thinking.

In the other type, the emphasis is on feelings of bodily or physical weakness and
exhaustion after only minimal effort, accompanied by a feeling of muscular aches and
pains and inability to relax.

In both types a variety of other unpleasant physical feelings is common, such as
dizziness, tension headaches, and feelings of general instability. Worry about
decreasing mental and bodily well-being, irritability, anhedonia, and varying minor
degrees of both depression and anxiety are all common. Sleep is often disturbed in
its initial and middle phases but hypersomnia may also be prominent.

Fatigue Syndrome

Use additional code, if desired, to identify previous physical illness.

Excludes: asthenia NOS (R53)
          burn-out (Z73.0)
          malaise and fatigue (R53)
          postviral fatigue syndrome (G93.3)
          psychasthenia (F48.8)
===================================================================

Personally, this description of neurasthenia is one of the most concise definitions
of ME/PVFS/CFS that I have read - not suprising as historically it was ME/CFS/CFS.

Yet, in direct contradiction, neurasthenia now excludes ME/PVFS/CFS (G93.3).
Neurasthenias meaning has now been transfered back to a physical disorder.
Neurasthenia (Fatigue Syndrome) is therefore an historically redundant term- and
should be removed from the ICD.

We can see, however, how the introduction of the term CFS has added confusion and
impetus to the existing psychiatric term, Fatigue Syndrome (Neurasthenia). Not
suprising, then, that psychiatry continues to run with this ball. It is yet another
example of the USA-conceived global patient disaster of creating the term CFS.

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