Chronic fatigue syndrome (CFS) is a disorder characterized by persistent and unexplained fatigue resulting in severe impairment in daily functioning. Besides intense fatigue, most patients with CFS report concomitant symptoms such as pain, cognitive dysfunction, and unrefreshing sleep. Additional symptoms can include headache, sore throat, tender lymph nodes, muscle aches, joint aches, feverishness, difficulty sleeping, psychiatric problems, allergies, and abdominal cramps. Criteria for the diagnosis of CFS have been developed by the U.S. Centers for Disease Control and Prevention (Table 389-1).
Table 389-1 Diagnostic Criteria for Chronic Fatigue Syndrome |Favorite Table|Download (.pdf)
Table 389-1 Diagnostic Criteria for Chronic Fatigue Syndrome
Characterized by Persistent or Relapsing Unexplained Chronic Fatigue
Fatigue lasts for at least 6 months
Fatigue is of new or definite onset
Fatigue is not the result of an organic disease or of continuing exertion
Fatigue is not alleviated by rest
Fatigue results in a substantial reduction in previous occupational, educational, social, and personal activities
Four or more of the following symptoms, concurrently present for 6 months: impaired memory or concentration, sore throat, tender cervical or axillary lymph nodes, muscle pain, pain in several joints, new headaches, unrefreshing sleep, or malaise after exertion
Medical condition explaining fatigue
Major depressive disorder (psychotic features) or bipolar disorder
Schizophrenia, dementia, or delusional disorder
Anorexia nervosa, bulimia nervosa
Alcohol or substance abuse
Severe obesity (BMI >40)
CFS is seen worldwide, with adult prevalence rates varying between 0.2 and 0.4%. In the United States, the prevalence is higher in women, members of minority groups (African and Native Americans), and individuals with lower levels of education and occupational status. Approximately 75% of all CFS patients are women. The mean age of onset is between 29 and 35 years. It is probable that many patients go undiagnosed and/or do not seek help.
There are numerous hypotheses about the etiology of CFS; there is no definitively indentified cause. Distinguishing between predisposing, precipitating, and perpetuating factors in CFS helps to provide a framework for understanding this complex condition (Table 389-2).
Table 389-2 Predisposing, Precipitating, and Perpetuating Factors in Chronic Fatigue Syndrome |Favorite Table|Download (.pdf)
Table 389-2 Predisposing, Precipitating, and Perpetuating Factors in Chronic Fatigue Syndrome
Childhood trauma (sexual, physical, emotional abuse; emotional and physical neglect)
Physical inactivity during childhood
Premorbid psychiatric illness or psychopathology
Somatic events: infection (mononucleosis, Q fever, Lyme disease), surgery, pregnancy
Psychosocial stress, life events
(Non)acknowledgement by physician
Strong physical attributions
Strong focus on bodily symptoms
Fear of fatigue
(Lack of) social support
Low physical activity pattern
Physical inactivity and trauma in childhood tend to increase the risk of ...