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Boudewijn Van Houdenhove
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=== 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 = 396β397|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 = 299β304|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>
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