Anonymous
Not logged in
Talk
Contributions
Create account
Log in
Search
Editing
Boudewijn Van Houdenhove
(section)
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
Namespaces
Page
Discussion
More
More
Page actions
Read
Edit
Edit source
History
Warning:
You are not logged in. Your IP address will be publicly visible if you make any edits. If you
log in
or
create an account
, your edits will be attributed to your username, along with other benefits.
Anti-spam check. Do
not
fill this in!
== Chronic fatigue syndrome == ==="Ill without a disease" === In the 1990s Van Houdenhove expanded his expertise to chronic fatigue syndrome, a disorder in which he saw many similarities with the chronic pain patients he was treating.<ref name=":4" /><ref name=":13" /> In his first book<ref>Van Houdenhove, B. (1998). [https://books.google.be/books?id=Y5V0AAAACAAJ&dq=ziek+zonder+ziekte+van+houdenhove&hl=nl&sa=X Ziek zonder ziekte. Beter begrijpen van psychosomatische klachten]. Tielt: Lannoo.</ref> about the issue, he named CFS "the psychosomatic disease of our time" and claimed CFS patients were "ill without a disease" (in Dutch: "ziek zonder ziekte"). Van Houdenhove also claimed that this was a disease, “ideally suited to rehabilitation."<ref>[http://www.dekamer.be/doc/ccri/pdf/50/ic033.pdf#search=%22vermoeidheidssyndroom%20%2050 Belgische Kamer Van Volksvertegenwoordigers]. Handelingen. Integraal verslag van de openbare vergadering van de commissie voor de Sociale Zaken van 09-11-1999.</ref> As a reporting member for the ‘treatment working group’ of the Superior Health Council in 2001<ref>[http://users.telenet.be/martens-hansen/cfspolitiek/HGR_therapie.html Hoge gezondheidsraad - Syntheseverslag van de werkgroep "therapie"] (12-01-2011).</ref>, he played a vital role in implementing [[cognitive behavioral therapy]] (CBT) and [[graded exercise therapy]] (GET) as the state-sponsored treatments for [[ME/CFS]] in [[Belgium]]. When these therapies failed to show meaningful results<ref>Pardaens K, Haagdorens L, Van Wambeke P, Van den Broeck A, Van Houdenhove B. How relevant are exercise capacity measures for evaluating treatment effects in chronic fatigue syndrome? Results from a prospective, multidisciplinary outcome study. Clin Rehabil. 2006 Jan;20(1):56-66. [[Digital object identifier|doi]]:[http://journals.sagepub.com/doi/10.1191/0269215506cr914oa 10.1191/0269215506cr914oa]. [[PubMed Identifier|PMID]] [[pubmed:16502751|16502751]]</ref>, Van Houdenhove admitted his initial views to be erroneous and too simplistic (translated from Dutch): <blockquote>"When I started to see patients with chronic fatigue symptoms in the early 1990s, I was initially a non-believer. It was hard for me to imagine that the exhaustion of these patients could be so dramatic. Perhaps they - like many [[chronic pain]] patients with whom I had some experience - had become abnormally tired because of the deterioration of their physical condition. I thought practicing a lot would help them to get over it. But in the course of time I went through a metamorphosis. I became a believer. I remember that this change of attitude was encouraged by the contact I had with some patients who had previously been passionate about sports. In their case, there was absolutely no question of severe deconditioning. Nonetheless, they were unable to perform normal efforts and complained of a feeling of sickness, if they tried to force themselves."<ref name=":13">Van Houdenhove, B. (2009) [https://books.google.be/books/about/Herwin_je_veerkracht.html?id=yDauPwAACAAJ&redir_esc=y Herwin je veerkracht. Omgaan met chronische vermoeidheid en pijn]. Tielt: Lannoo.</ref> </blockquote> === The swith hypothesis === Van Houdenhove now believes effort intolerance<ref>{{Cite journal | last = Van Houdenhove | first = Boudewijn | date = 2006 | title = What is the aim of cognitive behaviour therapy in patients with chronic fatigue syndrome? | url = https://www.ncbi.nlm.nih.gov/pubmed/17053343 | journal = Psychotherapy and Psychosomatics | volume = 75 | issue = 6 | pages = 396–397|doi=10.1159/000095448|issn=0033-3190|pmid=17053343}}</ref> to be the main characteristic of ME/CFS.<ref name=":13" /> He suspects that this is caused by a dysregulation of the stress system. Van Houdenhove has argued that when a normal person experiences acute stress, the [[Hypothalamic-pituitary-adrenal axis|HPA axis]] gets activated and the body produces of [[hormone]]s like [[cortisol]], which instigates a state of arousal.<ref name=":7" /> When this state persists for too long and stress becomes chronic, Van Houdenhove speculates this to result in a [[crash]]<ref name=":14" /> after which the body is no longer able to produce enough [[cortisol]], as is often seen in ME/CFS patients.<ref>{{Cite journal | last = Jerjes | first = W.K. | last2 = Cleare | first2 = A.J. | last3 = Wessely | first3 = S. | last4 = Wood | first4 = P.J. | last5 = Taylor | first5 = N.F. | date = 2005-08-01 | title = Diurnal patterns of salivary cortisol and cortisone output in chronic fatigue syndrome | url =http://www.sciencedirect.com/science/article/pii/S0165032705000881 | journal = Journal of Affective Disorders | volume = 87 | issue = 2 | pages = 299–304|doi=10.1016/j.jad.2005.03.013|issn=0165-0327}}</ref> Because cortisol has immunosuppressive properties, this switch from HPA axis hyper- to hypofunction is thought to be accompanied by an overactivation of the [[immune system]] and excessive production of [[cytokine]]s.<ref name=":14" /> According to Van Houdenhove, this induces sickness behavior that could account for the fatigue experienced by ME/CFS patients. The final result is a lack of resilience, which he sees as the main characteristic of ME/CFS.<ref name=":14">Van Houdenhove B, Van Den Eede F, Luyten P. Does hypothalamic-pituitary-adrenal axis hypofunction in chronic fatigue syndrome reflect a 'crash' in the stress system? Med Hypotheses. 2009 Jun;72(6):701-5. [[Doi:|doi]]:[https://doi.org/10.1016/j.mehy.2008.11.044 10.1016/j.mehy.2008.11.044]. [[PubMed Identifier|PMID]] [[pubmed:19237251|19237251]]</ref> === Perfectionism and overactivity === According to Van Houdenhove ME/CFS patients partly create their own stress, for example by being too [[personality traits and patient attitudes in ME/CFS|perfectionistic]].<ref>{{Cite journal | last = Luyten | first = Patrick | last2 = Van Houdenhove | first2 = Boudewijn | last3 = Cosyns | first3 = Nele | last4 = Van den Broeck | first4 = Anne-Lies | date = 2006-05-01 | title = Are patients with chronic fatigue syndrome perfectionistic—or were they? A case-control study | url = http://www.sciencedirect.com/science/article/pii/S0191886906000043 | journal = Personality and Individual Differences | volume = 40 | issue = 7 | pages = 1473–1483|doi=10.1016/j.paid.2005.10.023|issn=0191-8869}}</ref><ref name=":15">Van Houdenove B, Neerinckx E. (1998). [http://www.tijdschriftvoorpsychiatrie.nl/assets/articles/articles_510pdf.pdf Overzichtsartikel De ziel uit het lijf... Verhoogt een overactieve levensstijl de vatbaarheid voor het chronische-vermoeidheidssyndroom?] Tijdschrift voor Psychiatrie 40 (4).</ref> In one of his first major studies into the disease, he showed that ME/CFS patients were more "action-prone", meaning naturally more active, than healthy controls or people with anxiety disorders, and at a similar level to people with chronic musculoskeletal pain.<ref name=":6">{{Cite journal | last = Van Houdenhove | first = B. | author-link = Boudewijn Van Houdenhove | last2 = Onghena | first2 = P. | author-link2 = Patrick Onghena | last3 = Neerinckx | first3 = E. | author-link3 = Eddy Neerinckx | last4 = Hellin | first4 = J. | author-link4 = J Hellin | author-link5 = | date = Jul 1995 | title = Does high 'action-proneness' make people more vulnerable to chronic fatigue syndrome? A controlled psychometric study | url = https://www.ncbi.nlm.nih.gov/pubmed/7490698 | journal = Journal of Psychosomatic Research | volume = 39 | issue = 5 | pages = 633–640|issn=0022-3999|pmid=7490698|quote=|via=}}</ref> Van Houdenhoe argued that these patients weren't [[Stigma and discrimination|lazy]] or too sedentary as is sometimes claimed by proponents of the [[deconditioning]] hypothesis, instead they were overactive.<ref name=":15" /> According to Van Houdenhove, they showed the same 'ergomania' he had previously seen in his unexplained [[chronic pain]] patients.<ref name=":16" /> === Victimization === Van Houdenhove wondered why ME/CFS patients were in a continuous state of overdrive before falling ill, as his research indicated. He argued that this behavior acted as a "stabilizing factor in the psychic economy". He wrote: <blockquote>"In our clinical practice, we often hear from CFS/FM patients that—before they got ill—they never could sit still, they were always busy to avoid becoming nervous, or they needed physical workout to chase away negative thoughts or feelings."<ref name=":1">Van Houdenhove B. [http://www.uppitysciencechick.com/van_houdenhove_pain-fatigue-overactivity.pdf Letter to the Editor. Premorbid "overactive" lifestyle and stress-related pain/fatigue syndromes.] Journal of Psychosomatic Research 2005;58:389-390.</ref> </blockquote> In another study by Van Houdenhove and colleagues, ME/CFS patients reported more emotional and physical [[trauma#abuse|abuse]] than controls with [[multiple sclerosis]] (MS) or [[rheumatoid arthritis]] (RA).<ref name=":17" /> A considerable subgroup experienced lifelong victimization.<ref name=":17">Van Houdenhove B, Neerinckx E, Lysens R, Vertommen H, Van Houdenhove L, Onghena P, Westhovens R, D'Hooghe MB. Victimization in chronic fatigue syndrome and fibromyalgia in tertiary care: a controlled study on prevalence and characteristics. Psychosomatics. 2001 Jan-Feb;42(1):21-8. [[doi:]][https://doi.org/10.1176/appi.psy.42.1.21 10.1176/appi.psy.42.1.21] [[PubMed Identifier|PMID]] [[pubmed:11161117|11161117]]</ref> Van Houdenhove uses this to support his claim that ME/CFS patients are often perfectionistic and in need of external validation. <blockquote>"This case report illustrates the multifactorial etiology of CFS. Mr. A’s severe abuse history and his premorbid overactive lifestyle may be considered important vulnerability factors. Based on a deep-rooted lack of self-esteem, this man was driven to work hard and take part in sports to a fanatic degree (bodybuilding and karate) as a means of compensation for feelings of emptiness, worthlessness, and insufficiency."<ref>Cuykx V, Van Houdenhove B, Neerinckx E. [[pubmed:9854653|Childhood abuse, personality disorder and chronic fatigue syndrome.]] Gen Hosp Psychiatry. 1998 Nov;20(6):382-4.</ref></blockquote> When their outlet of overactivity becomes hampered, persons like Mr. A are susceptible to developing ME/CFS: <blockquote>"What happens, then, when a protracted illness or physical injury makes further (over)activity impossible? Such events may seriously threaten the patient’s psychobiological equilibrium and precipitate a dysregulation of the stress system."<ref name=":1" /> </blockquote> === A lumper standpoint === According to Houdenhove the mechanism described above is not unique to ME/CFS. He argues that low cortisol levels for example have also been reported in other stress-related disorders like atypical depression, fibromyalgia, [[post-traumatic stress disorder]] (PTSD) and [[burnout]].<ref name=":18" /> Van Houdenhove sees a lot of similarity between these conditions, stating for example: <blockquote> "Could it be that the over-ambitious athlete complains about 'overtraining', the over-committed social worker about 'burnout', and the over-burdened modern woman who feels obliged to combine three 'fulltime' jobs (household, professional career and educator of children).., about ME?"<ref name=":18">Van Houdenhove B, Onghena P, Neerinckx E, Hellin J. [[pubmed:7490698|Does high 'action-proneness' make people more vulnerable to chronic fatigue syndrome?]] A controlled psychometric study. J Psychosom Res. 1995 Jul;39(5):633-40.</ref> </blockquote> Van Houdenhove confesses that he is a lumper, not a splitter i.e. he thinks fibromyalgia (FM) and ME/CFS should be regarded and treated as one disease.<ref name=":7" /> In line with Simon Wessely he thinks the splitting of many so called functional somatic syndromes represents an artifact of specialized modern medicine.<ref name=":7" /> In 2007 he proposed to rename FM and ME/CFS into "stress intolerance and pain hypersensitivity (SIPH) syndromes".<ref>Van Houdenhove B, Luyten P. [https://www.ingentaconnect.com/contentone/ben/crr/2007/00000003/00000004/art00009?crawler=true Fibromyalgia and Related Syndromes Characterised by Stress Intolerance and Pain Hypersensitivity: Do We Need a New Nosology?] Current Rheumatology Reviews. 2007Nov; 3(4): 304-308. </ref> === ME/CFS; a symptom of a sick society? === Inspired by historian [[Edward Shorter]], Van Houdenhove emphasizes how culture shapes the way we define illnesses.<ref name=":2" /> For example, in a letter to The Lancet, he explained the curious situation in his home country, Belgium: <blockquote>"French-speaking Belgian colleagues have repeatedly confirmed that the chronic fatigue syndrome (CFS) has not yet become a hyped illness, as it is in Flanders (as well as in the Netherlands and the UK). In Flanders, for example, there are currently four CFS/ME self-help groups, whereas none exists in Wallonia. The Flemish press, has regularly reported the disorder for 10 years (eg, describing patients’ experiences about disbelief and incomprehension, or about so-called research breakthroughs), but the Walloon press has shown interest only in the past few years. Walloons are more oriented— culturally as well as scientifically—to France, whereas Flemish people are on the same wavelength as countries with Anglo-Saxon culture and science. Consequently, Walloon and Flemish patients and doctors use different labels to communicate about distress and ill health."<ref name=":2">Van Houdenhove B. [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)05002-9/fulltext Does myalgic encephalomyelitis exist?] Lancet. 2001 Jun 9; 357 (9271): 1889.</ref> </blockquote> Van Houdenhove speculates the prevalence of ME/CFS to be on the rise because of consumerism and the high social demands modern society places on the individual. In this respect he ponders if ME/CFS should be regarded as a "symptom of a sick society".<ref name=":3">Van Houdenhove B, Vanthuyne S, Neerinckx E, Vanden Wyngaert M. [https://www.tvg.be/article/moet-het-chronische-vermoeidheidsyndroom-erkend-worden Moet het chronische-vermoeidheidssyndroom erkend worden?] Tijdschrift voor Geneeskunde. 1999; 55: 1732. </ref> === Listening to the patient === According to Van Houdenhove the whole controversy around ME/CFS can be explained by doctors and researchers not listening to the story of the patient.<ref name=":20" /> If they did, they would know that this isn’t merely a matter of [[deconditioning]] and [[illness beliefs |unhelpful cognitions]]. Only if one listens closely to the life history of patients, is it possible to grasp the many complex dimensions this illness has. Psychologists who rely solely on questionnaires will often miss the underlying factors (childhood abuse, maladaptive perfectionism, overactivity etc.) that help explain why a person got ill. According to Van Houdenhove this is the main reason why the effectiveness of CBT in ME/CFS has been so disappointing.<ref name=":20" /> He has argued that herapists should expand their scope: <blockquote> "[…] when the patient’s story is left out of the therapeutic project, the risk of nonresponse or relapse might be substantial as soon as he or she is confronted with unresolved intrapsychic conflicts or ongoing psychosocial (e.g. interpersonal) problems. This surely does not imply that all CFS patients should engage in formal psychodynamic or interpersonal therapy. It does, however, suggest that [[Cognitive behavioral therapy |cognitive – behavioural]] therapists should— besides their traditional focus on illness maintaining and reinforcing factors— broaden their scope to include predisposing and initiating psychosocial factors as well."<ref name=":20">Van Houdenhove B. [https://www.jpsychores.com/article/S0022-3999(01)00297-5/pdf Listening to CFS: why we should pay more attention to the story of the patient]. J Psychosom Res. 2002 Jun;52(6):495-9. [[PubMed Identifier|PMID]] [[pubmed:12069874|12069874]]</ref> </blockquote> === Adaptation instead of recovery === When analyzing the results of the multidisciplinary center for CFS at the University of Leuven, Van Houdenhove and colleagues found that among all factors of the cognitive-behavioral model, only severity of [[depression]] before treatment was significantly associated with post-treatment fatigue.<ref>Kempke S, Goossens L, Luyten P, Bekaert P, Van Houdenhove B, Van Wambeke P. Predictors of outcome in a multi-component treatment program for chronic fatigue syndrome. J Affect Disord. 2010 Oct;126(1-2):174-9. [[doi:]][https://www.jad-journal.com/article/S0165-0327(10)00099-6/fulltext 10.1016/j.jad.2010.01.073] [[PubMed Identifier|PMID]] [[pubmed:20167377|20167377]]</ref> As Van Houdenhove noticed, this wasn’t the only time findings contradicted the [[cognitive behavioral therapy]] (CBT) paradigm: <blockquote> "[…] in [[Cognitive behavioral therapy|CBT]]-oriented literature concerned with CFS, different treatment goals can be discerned. Some authors suggest that the therapist should mainly incite patients to diminish their somatic focus and correct inappropriate physical attributions. However, the usefulness of this goal is doubtful since the majority of patients with CFS and the largely overlapping fibromyalgia syndrome (FM) seems to accept a combined psychological/somatic causation of their illness. According to other authors, the therapist should in the first place tackle the patients’ activity avoidance or irregular activity patterns (outburst of activity followed by prolonged periods of rest), and stimulate them to engage in a graded exercise program in order to fight physical deconditioning. However, most CFS patients do not show kinesiophobia and loss of exercise capacity does not seem to play a major role in the pathophysiology of CFS."<ref name=":21">Van Houdenhove B. What is the aim of cognitive behaviour therapy in patients with chronic fatigue syndrome? Psychother Psychosom. 2006;75(6):396-7. [[doi:]][https://doi.org/10.1159/000095448 10.1159/000095448] [[PubMed Identifier|PMID]] [[pubmed:17053343|17053343]] </ref> </blockquote> Van Houdenhove criticizes his Dutch colleague [[Gijs Bleijenberg]] for arguing that full recovery should be the main goal of CBT. Based on years of experience working in ME/CFS clinic, Van Houdenhove does not see this as a realistic objective.<ref name=":21" /> Instead he suggests clinicians should recognize the lasting vulnerability of ME/CFS patients. He advises ME/CFS patients that: <blockquote>"…they should accept their ailment and functional limitations and work through the painful grieving process resulting from the fact that CFS means giving up many important things in life. Second, they should realistically adapt to their effort intolerance by learning to carefully pace activities in order to avoid post-exertional malaise reflecting abnormal immune activation. In many patients, this implies abandoning their previous ‘overactive’ lifestyles, which may be rooted in [[personality traits and patient attitudes in ME/CFS|narcissistic, perfectionistic or counter-dependent tendencies]]."<ref name=":21" /> </blockquote> Despite these criticisms, Van Houdenhove continues to promote [[graded exercise therapy]] (GET) and CBT as an essential part of the treatment of ME/CFS patients.<ref>Finoulst M, Vankrunkelsven P, Van Houdenhove B. [https://www.tvg.be/article/cvs-me-en-fibromyalgie-waar-staan-we CVS, ME en fibromyalgie: waar staan we?] Tijdschrift voor Geneeskunde. 2018; 74: 666.</ref>
Summary:
Please make sure your edits are consistent with
MEpedia's guidelines
.
By saving changes, you agree to the
Terms of use
, and you irrevocably agree to release your contribution under the
CC BY-SA 3.0 License
and the
GFDL
. You agree that a hyperlink or URL is sufficient attribution under the Creative Commons license.
Cancel
Editing help
(opens in new window)
This page is a member of a hidden category:
Category:CS1 Nederlands-language sources (nl)
Navigation
Navigation
Skip to content
Main page
Browse
Become an editor
Random page
Popular pages
Abbreviations
Glossary
About MEpedia
Links for editors
Contents
Guidelines
Recent changes
Pages in need
Search
Help
Wiki tools
Wiki tools
Special pages
Page tools
Page tools
User page tools
More
What links here
Related changes
Page information
Page logs