Chronic fatigue syndrome (CFS) is a poorly understood and sometimes controversial illness thought to affect as many as 800,000 Americans. Individuals with CFS often report flulike symptoms with low-grade fever and body aches. CFS is often a diagnosis of exclusion, since other potential medical or psychiatric disorders must be ruled out before a diagnosis of CFS can be made. Currently, scientists use a CFS case definition, which requires a person to experience 6 or more months of chronic fatigue of new or definite onset that is not substantially alleviated by rest, not the result of ongoing exertion, and results in substantial reductions in occupational, social, and personal activities. To be diagnosed with CFS, individuals also need to have the concurrent occurrence of four or more symptoms that did not predate the illness and persisted 6 or more months since onset (i.e., sore throat, lymph node pain, muscle pain, joint pain, postexertional malaise, headaches of a new or different type, memory and concentration difficulties, and unrefreshing sleep). Some research samples have included a high or low percentage of patients with critical CFS symptoms (e.g., postexertional malaise, memory and concentration problems), further complicating identification of comparable samples. A new Canadian case definition does include these critical symptoms (i.e., postexertional malaise, memory and concentration problems), and use of this case definition might aid in the selection of more homogeneous samples.
CFS came to public prominence in the 1980s. At that time, it was believed to be a rare condition affecting primarily upper-class White women, thus the pejorative term “yuppie flu.” More recent epidemiological research indicates that the illness affects individuals from many different classes and ethnic/racial backgrounds and is more common among women.
The cause of CFS is unknown. Often individuals report a viral infection immediately prior to onset. Others may describe trauma, emotional stress, prolonged overexertion, or no particular precipitant before the appearance of symptoms. The lack of a biological marker has caused some within the medical community to theorize that CFS is a psychogenic illness. However, others adopt a more biopsychosocial explanation. Evidence does exist indicating that when the hypothalamic-pituitary-adrenal axis and sympathetic nervous system become upregulated—possibly due to heightened central nervous system sensitivity to stimuli such as cytokines—secretions of glucocorticoids and catecholamines (adrenalin and noradrenalin) are raised. This could result in an immune response shift, which could impair the body’s defense against viral or intracellular bacterial infections. There might be multiple pathways leading to the cause and maintenance of the neurobiological dysregulations and other symptoms experienced by individuals with CFS. Depending on the individual and subtype, these may include unique biological, genetic, neurological, psychological, and socio*environmental contributions. Subgrouping is the key to understanding how CFS begins, how it is maintained, how medical and psychological variables influence its course, and, in the best case, how it can be prevented, treated, and cured.
CFS is a highly stigmatizing illness. Many health care professionals continue to deny its existence. Research has demonstrated that even the name chronic fatigue syndrome leads to minimization of the severity of the illness. Individuals with CFS are often told, directly or indirectly, that their symptoms are purely psychogenic and are caused by depression or some other psychiatric disorder. Because the illness is not widely recognized, sufferers have difficulty being appropriately diagnosed and treated.
No specific treatment currently exists for CFS. Medical management consists of treating specific symptoms, such as medication to aid sleep or relieve pain. Comprehensive rehabilitation programs involving multidisciplinary teams might be helpful, and such programs might include cognitive-behavioral therapy, physical and occupational therapy, and even complementary and alternative therapies such as acupuncture and massage.
- American Association of Chronic Fatigue Syndrome, http://www.aacfs.org/
- Centers for Disease Control, National Center for Infectious Diseases. (n.d.). Chronic fatigue syndrome. Retrieved from http://www.cdc.gov/ncidod/diseases/cfs/
- Chronic Fatigue Syndrome Project, http://condor.depaul.edu/~ljason/cfs/
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