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

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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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