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Comment by nicoburns | Hacker News Reader

Is there any evidence that it is psychosomatic? My understanding is that CFS (and long covid which indeed appears to be similar) affects a wide range of people, most often after some kind of viral infection that is very much physical in nature. And furthermore that the most successful treatment programs tend to focus on careful regulating exercise and diet which again seems to be largely physical.

Just because the underlying biological mechanism isn't understood doesn't mean that there isn't one. To me CFS seems like a case of a disease neglected by medical science because it's dismissed as being psychosomatic.

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A study of ~25,000 persons found stronger statistical correlations between the belief in having been infected and long COVID symptoms, than between serology tests of prior infections and long COVID symptoms. Except for the persistent loss-of-taste symptom, which does not correlate with belief in prior infection and only correlates with serology test results. https://pubmed.ncbi.nlm.nih.gov/34747982/

The layman interpretation of this is that long COVID is possibly a mental health issue associated with the belief in having had a prior infection, except for the loss-of-taste symptom which is very specific to COVID (vs, say, persistent fatigue). Not to say "it's not real", but maybe "it's not always viral in origin".

Yep. This would line up exactly with what I've said: a post-viral sequelae (with unique post-viral effects for covid) superimposed on a CFS-like disease population that is more driven by psychological factors, both being referred to by the label "long covid."

It’s really easy to discard that study. Someone who thinks they had COVID-19 and didn’t even bother getting tested is likely to have had a more severe case. Maybe it wasn’t even a case of COVID-19 but a severe viral infection nonetheless. Meanwhile serology positives would show up even after mild infection.

It's really easy to discard if you don't know what a serology test is, that's for sure.

A serology test is just proof of prior infection. It says nothing about the severity and would even count asymptomatic cases. So the study is comparing apples and oranges.

1. Antibody positives are more likely the more severe the case of covid

2. Your point was that people with more severe covid would

> thinks they had COVID-19 and didn’t even bother getting tested

The problem with that theory is that the serology testing in this study was conducted on everybody so whether or not people chose to get tested when they had covid was irrelevant. The fact that perceived infection correlates higher with these symptoms means that these symptoms are more related to someone's self perception of infection than any physical change.

CFS is far from neglected and there have been a number of studies attempting to show a physical cause. We've had a number of false positives that have later been debunked.

> the most successful treatment programs tend to focus on careful regulating exercise and diet which again seems to be largely physical.

This is coming from the PACE study, I'm assuming. PACE is largely viewed as suggesting that CFS has a substantial psychological component. There is a bunch of other literature on this as well.

Exercise and diet changes are usually successful treatments for psychosomatic-like illnesses, so I disagree that this treatment means that it is a physical disease.

Many of the original researchers who provided evidence that the disease is non-physical in nature have since left the field after extensive death threats and harassment. [0]

> Reuters contacted a dozen professors, doctors and researchers with experience of analysing or testing potential treatments for chronic fatigue syndrome. All said they had been the target of online harassment because activists objected to their findings. Only two had definite plans to continue researching treatments.

[0]: https://www.reuters.com/investigates/special-report/science-...

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