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=== Subgrouping: to both 'lump' and 'split' === White has argued that CFS is a heterogeneous label representing more than one separate condition and that this might explain the lack of replication in the field. “If CFS is found to be more than one separate condition", he wrote, “this could explain why no replicated causes have been found associated with the illness, since an association found only in one subgroup would be diluted, and risk being found non‐significant, by mixing the subgroup with others.”<ref name=":12">{{Cite journal | last = White | first = Peter Denton | date = 2019-08-01| title = A perspective on causation of the chronic fatigue syndrome by considering its nosology|url=https://www.ncbi.nlm.nih.gov/pubmed/31373106|journal=Journal of Evaluation in Clinical Practice|doi=10.1111/jep.13240|issn=1365-2753|pmid=31373106}}</ref> White was able to perform subgroup analysis on the data collected during two large epidemiological studies by the Centers for Disease Control and Prevention in the United States. Principal components analysis was conducted on selected CFS patients, patients with idiopathic chronic fatigue and healthy controls from the Wichita, Kansas study.<ref name=":13">{{Cite journal | last = Vollmer-Conna | first = Uté | last2 = Aslakson | first2 = Eric | last3 = White | first3 = Peter D. | date = Apr 2006| title = An empirical delineation of the heterogeneity of chronic unexplained fatigue in women|url=https://www.ncbi.nlm.nih.gov/pubmed/16610946|journal=Pharmacogenomics|volume=7|issue=3|pages=355–364|doi=10.2217/14622416.7.3.355|issn=1462-2416|pmid=16610946}}</ref> The analysis indicated 6 different classes which were mostly based on factors such as obesity, depression, and apnea.<ref name=":13" /><ref>{{Cite journal | last = Aslakson | first = Eric | last2 = Vollmer-Conna | first2 = Uté | last3 = White | first3 = Peter D | date = 2006-04-01| title = The validity of an empirical delineation of heterogeneity in chronic unexplained fatigue|url=https://www.futuremedicine.com/doi/abs/10.2217/14622416.7.3.365|journal=Pharmacogenomics|volume=7|issue=3|pages=365–373|doi=10.2217/14622416.7.3.365|issn=1462-2416}}</ref> Similar groups were found in the analysis of data from the CDC’s prevalence study in Georgia.<ref name=":14">{{Cite journal | last = Aslakson | first = Eric | last2 = Vollmer-Conna | first2 = Uté | last3 = Reeves | first3 = William C. | last4 = White | first4 = Peter D. | date = 2009-10-05| title = Replication of an empirical approach to delineate the heterogeneity of chronic unexplained fatigue|url=https://www.ncbi.nlm.nih.gov/pubmed/19804639|journal=Population Health Metrics|volume=7|pages=17|doi=10.1186/1478-7954-7-17|issn=1478-7954|pmc=2761845|pmid=19804639}}</ref> According to the authors, this replication supported “the broadening of the concept of CFS to include patients with fewer symptoms but similar disability.”<ref name=":14" /> White has recommended that NICE guidelines for the diagnosis of CFS as the most useful as it requires only one additional symptom beyond post‐exertional fatigue.<ref name=":12" /><ref name=":26">[https://www.youtube.com/watch?v=doY1WK1plOQ Psychiatrist Peter White at the Royal Society of Medicine 2008 - Defining CFS/ME.]</ref> White has however been critical of proposals to lump several functional somatic syndromes (FSS) - which in his view includes ME/CFS - into one diagnostic entity.<ref name=":15">{{Cite journal | last = Wessely | first = Simon | last2 = White | first2 = Peter D. | date = Aug 2004| title = There is only one functional somatic syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/15286058|journal=The British Journal of Psychiatry: The Journal of Mental Science|volume=185 | pages = 95–96|doi=10.1192/bjp.185.2.95|issn=0007-1250|pmid=15286058}}</ref><ref name=":16">{{Cite journal | last = White | first = Peter D. | date = May 2010| title = Chronic fatigue syndrome: Is it one discrete syndrome or many? Implications for the "one vs. many" functional somatic syndromes debate|url=https://www.ncbi.nlm.nih.gov/pubmed/20403504|journal=Journal of Psychosomatic Research|volume=68|issue=5 | pages = 455–459|doi=10.1016/j.jpsychores.2010.01.008|issn=1879-1360|pmid=20403504}}</ref><ref>{{Cite journal | last = White | first = Peter D. | date = Jan 2013| title = Functional somatic syndromes may be either "polysyndromic" or "monosyndromic"|url=https://www.ncbi.nlm.nih.gov/pubmed/23272980|journal=Journal of Psychosomatic Research|volume=74|issue=1|pages=2–3|doi=10.1016/j.jpsychores.2012.10.005|issn=1879-1360|pmid=23272980}}</ref> He has argued that there is little overlap between conditions such as fibromyalgia and irritable bowel syndrome, that treatments and risk factors between FSS may differ and that “historically, more progress has been made through splitting illnesses rather than lumping them together.”<ref name=":15" /> According to White “A general functional somatic syndrome can be consistent only with psychogenesis, since it is difficult to conceive of a pathophysiological mechanism that would be common to all functional somatic syndromes.”<ref name=":15" /> As an alternative White proposes to be “over‐inclusive regarding the diagnosis as a first step, while subdividing the condition into likely subgroups as a means of finding valid and reliable associations with potential causes”<ref name=":12" /> He has argued that "the solution to the debate is that we need to both 'lump' and 'split.' We need to study both the similarities between syndromes and their dissimilarities to better understand what we currently call the FSSs."<ref name=":16" />
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