Classification Principles provided by the World Health Organisation re. ME/CFS

On 28th June 2001 Andre L'Hours, the Technical Officer at the
WHO headquarters in Geneva who is responsible for the ICD,
confirmed that it was "unacceptable" if the same disorder had
been included in two places in the ICD-10 and that the same
disorder could not be differently categorised under the one WHO
banner.  When he was informed of what was happening in the
UK, he promised to look into the matter.

Andre L'Hours confirmed that the ICD classifications are
approved by the World Health Assembly and therefore take legal
precedence over unapproved modifications made by a WHO
Collaborating Centre.

On 16th October 2001, Dr B Saraceno from the WHO provided
the following clarification in writing:

"I wish to clarify the situation regarding the classification of
neurasthenia, fatigue syndrome, post-viral fatigue syndrome and
benign myalgic encephalomyelitis.  Let me state clearly that the
World Health Organisation (WHO) has not changed its position
on these disorders since the publication of the International
Classification of Diseases, 10th Edition in 1992 and versions of
it during later years.

"Post-viral fatigue syndrome remains under the diseases of
nervous system as G93.3.  Benign myalgic encephalomyelitis is
included within this category.

"Neurasthenia remains under mental and behavioural disorders
as F48.0 and fatigue syndrome  (note: not THE CHRONIC
FATIGUE SYNDROME) is included within this category.
However, post-viral fatigue syndrome is explicitly excluded from

"The WHO ICD-10 Diagnostic and Management Guidelines for
Mental Disorders in Primary Care, 1996, includes fatigue
syndrome under neurasthenia (F48.0) but does not state or
imply that conditions belonging to G93.3 should be included

"I would also like to state that the WHO's position concerning this
is reflected in its publications and electronic material, including

"It is possible that one of the several WHO Collaborating
Centres in the United Kingdom presented a view that is at
variance with WHO's position.

"Collaborating Centres are not obliged to seek approval from
WHO for the material they publish.  I understand that the
Collaborating Centre concerned has now made changes to the
information on their website after speaking with WHO".

In the debate on ME/CFS in the House of Lords on 22nd
January 2004, the Health Minister (Lord Warner) stated:

"The current version, ICD-10, classifies CFS in two places: as
neurasthenia in the mental health chapter, F48.0; and also as
myalgic encephalomyelitis in the neurology chapter, G93.3.  The
diagnostic criteria used in the ICD shows that the WHO has
essentially put the same condition in both places.  That is the
WHO's formal position".

Following his speech (recorded in Hansard at column 1195), a
copy of this letter was  given to the Health Minister by the
Countess of Mar; Lord Warner said that he would take it to the
Chief Medical Officer to be discussed.

On 23rd January 2004, Andre l'Hours from the WHO
headquarters provided the following clarification  (in writing):

"This is to confirm that according to the taxonomic principles
governing the Tenth Revision of the World Health Organization's
International Statistical Classification of Diseases and Related
Health Problems (ICD-10), it is not permitted for the same
condition to be classified to more than one rubric as this would
mean that the individual categories and subcategories were no
longer mutually exclusive".

Andre l'Hours also stated that if a country accepts the WHO
Regulations concerning nomenclature (which the UK does), then
that country is obliged to accept the ICD classification.  For the
avoidance of doubt, the UK has registered no reservations
about the ICD-10 and therefore formally accepts it.

Margaret Williams