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A psychodynamic view of the Chronic Fatigue Syndrome (CFS). The role of object relations in etiology & treatment

  [ 43 votes ]   [ Discuss This Article ] • September 3, 1994

The chronic fatigue syndrome (CFS) is a constellation of physical
and psychological symptoms including incapacitating fatigue
associated with a marked reduction in activity. Although the
etiology of CFS is unclear, reports in the literature suggest
the presence of both physical and psychological dysfunction in
this patient population. These findings have led to a debate
between those who consider CFS to be primarily organic in
origin and those who view CFS as a primary psychiatric
disorder characterized by somatic preoccupations. This debate
led the authors to develop a working model for CFS designed to
integrate the psychological and physiological findings, based
on the hypothesis that early object relations have an
etiologic relationship to CFS. This hypothesis then formed the
rationale for a psychoanalytic treatment approach which will
be described. There are no published case reports describing
psychoanalytic psychotherapy as a primary treatment modality
for this patient population. The current paper attempts to
fill a void. Two case reports of long-term (> 18 months),
intensive (2-3 times per week) psychoanalytic psychotherapy
with CFS patients referred by infectious disease specialists
at a university teaching hospital will be presented. The
following aspects of the treatment will be highlighted: 1) the
unique opportunity afforded by this treatment to view the
nature of CFS, namely, the intimate relationship over time of
fatigue symptoms to disturbances in object relationships,
particularly within the transference; (2) the improvement in
symptoms when this relationship is seen and understood by the
patient; (3) the importance of the patient-therapist bond as a
facilitating medium for clinical improvement; (4) the
challenges involved in treating CFS patients with

Taerk G, Gnam W

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