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CHAPTER 38: CHRONIC FATIGUE SYNDROME

Gijs Bleijenberg; Jos W. M. van der Meer

DEFINITION

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 38-1).

TABLE 38-1DIAGNOSTIC CRITERIA FOR CHRONIC FATIGUE SYNDROME

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TABLE 38-1 DIAGNOSTIC CRITERIA FOR CHRONIC FATIGUE SYNDROME

Characteristic 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 are 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.

Exclusion Criteria

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 (body mass index >40)

EPIDEMIOLOGY

CFS is seen worldwide, with adult prevalence rates varying between 0.2% and 0.4%. In the United States, the prevalence is higher among women (∼75% of cases), members of minority groups (African and Native Americans), and individuals with lower levels of education and occupational status. The mean age of onset is between 29 and 35 years. Many patients probably go undiagnosed and/or do not seek help.

ETIOLOGY

There are numerous hypotheses about the etiology of CFS; there is no definitively identified cause. Distinguishing between predisposing, precipitating, and perpetuating factors in CFS helps to provide a framework for understanding this complex condition (Table 38-2).

TABLE 38-2PREDISPOSING, PRECIPITATING, AND PERPETUATING FACTORS IN CHRONIC FATIGUE SYNDROME

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TABLE 38-2 PREDISPOSING, PRECIPITATING, AND PERPETUATING FACTORS IN CHRONIC FATIGUE SYNDROME

Predisposing Factors

Childhood trauma (sexual, physical, emotional abuse; emotional and physical neglect)

Physical inactivity during childhood

Premorbid psychiatric illness or psychopathology

Premorbid hyperactivity

↓

Precipitating Factors

Somatic events: infection (e.g., mononucleosis, Q fever, Lyme disease), surgery, pregnancy

Psychosocial stress, life events

↓

Perpetuating Factors

Non-acknowledgment by physician

Negative self-efficacy

Strong physical attributions

Strong focus on bodily symptoms

Fear of fatigue

Lack of social support

Low physical activity pattern

Predisposing factors

Physical inactivity and trauma in childhood tend to increase the risk of CFS in adults. Neuroendocrine dysfunction may be ...

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