[jessriedel]

> the consensus is that this is a physiological disease with an unknown mechanism

Can you point me towards a statement of that consensus?

> I don't know where you get the idea that the null hypothesis for the cause of any set of symptoms not explained by known biomarkers needs to be "psychosomatic disorder".

I didn't say that, and in particular never used the words you put in quotes and attributed to me. However, I'm pretty comfortable with what I did say: absent evidence to the contrary, a collection of self-reported subjective symptoms with no apparent physiological counterparts is significantly more likely to have a psychological origin. Can you say more about why it doesn't make sense to you? Or point me towards the evidence specific to CFS/ME that makes you think it doesn't fit that description?

[mindgonehaywire]

Myalgic Encephalomyelitis is not a collection of self-reported subjective symptoms. It never was. Currently the CDC has adopted criteria for which post-exertional malaise is a required symptom. This is measured by 2-day CPET as mentioned elsewhere. I realize that a lot of people don't keep up on this stuff as much as those affected by this illness, but I have to say that it gets a bit tedious having to correct these commonly held, incorrect perceptions about what this illness is. Chronic Fatigue Syndrome is 'tired all the time,' 'fatigue,' sore throats, headaches, muscle & joint pain. Ramsay ME is closer to 'deathlike paralysis.' There's a reason why it was once described as 'atypical polio.' And as has been pointed out elsewhere, while a person suffering from depression is likely to respond positively to exercise, an ME patient responds so negatively that it is to be considered contraindicated, in the strongest possible terms. That's why the Institute of Medicine recommended renaming it to describe exactly what exertion does.

[thatthatis]

There are even objective tests for pain based on heart rate response to exertion