Chronic Fatigue Syndrome

chronic fatigue syndrome (CFS), collection of persistent, debilitating symptoms, the most notable of which is severe, lasting fatigue. In other countries it is known variously as myalgic encephalomyelitis (ME), chronic fatigue and immune dysfunction syndrome, and postviral fatigue syndrome. It may have been first recognized as a syndrome in the 1860s by George Beard, who used the term neurasthenia to described what he believed to be a neurosis with a fatigue component. Definitions and theories of its cause have changed over the years; many cases have been misdiagnosed as imaginary because doctors could find no cause. In the mid-1980s it came to the public's attention, as affluent women in their thirties began to seek treatment. (For unknown reasons, more women than men seek treatment for the disease.)

Symptoms and Identification

As currently defined, chronic fatigue syndrome is the presence of severe, disabling fatigue lasting for six or more consecutive months. The fatigue is persistent or relapsing, and is new (i.e., not lifelong), not relieved by rest, not the result of ongoing exertion, and interferes with normal work, social, educational, or personal activities. Diagnosis also requires at least four of the following symptoms, each persistent or recurring and not present before the fatigue: impairment of short-term memory or concentration, sore throat, tender lymph nodes in the neck or axillary region, muscle pain, joint pain, headaches peculiar to the syndrome, unrefreshing sleep, and malaise of more than one day's duration following exertion. Chronic fatigue that does not meet all these criteria is termed "idiopathic fatigue."

The course of the disease varies. Many people first experience symptoms after a cold or bout of the flu. Most people reach a plateau early on; the symptoms come and go with varying severity afterward. Some experience complete remission; others have their symptoms indefinitely.

There are no specific diagnostic tests. Diagnosis must first rule out known causes of fatigue such as hypothyroidism, cancer, multiple sclerosis, and major depression with psychotic or melancholic features (e.g., schizophrenia, bipolar disorder). Chronic fatigue syndrome and nonpsychotic, nonmelancholic depression, however, are not mutually exclusive. Substance abuse and side effects of prescribed medications must also be eliminated as possible causes.

Cause and Treatment

There is no known single cause of CFS. Some authorities believe it is a condition shared by many different underlying diseases rather than an entity unto itself; others believe it is caused by a defect of the immune system. Hormonal deficits, low blood pressure, and viral infections have been studied as possible causes or contributors. The postulated causal link with Epstein-Barr virus hypothesized in the mid-1980s has been discounted. In 2009 researchers announced that they had found xenotropic murine-leukemia-virus-related virus (XMRV) in many patients with CFS, but the study did not show that XMRV was linked to CFS. Other studies failed to replicate its findings, and the paper was later retracted.

There is no definitive treatment for CFS, although success has been reported anecdotally with antidepressants, antianxiety medications, antivirals, and immune boosters. Symptomatic treatment for the muscle and joint pains is helpful in some cases, as are psychological and physical therapies. Counseling and peer support groups help some patients cope with the frustrating nature of the disease. A British study released in 2012 found that cognitive behavioral therapy and graded exercise therapy were the most successful and cost-effective treatments.

The Columbia Encyclopedia, 6th ed. Copyright© 2015, The Columbia University Press.

Chronic Fatigue Syndrome: Selected full-text books and articles

Stress and Disease Processes By Neil Schneiderman; Philip McCabe; Andrew Baum Lawrence Erlbaum Associates, 1992
Librarian’s tip: Chap. 7 "Chronic Fatigue Syndrome and Psychoneuroimmunology"
Contemporary Rorschach Interpretation By J. Reid Meloy; Marvin W. Acklin; Carl B. Gacono; James F. Murray; Charles A. Peterson Lawrence Erlbaum Associates, 1997
Librarian’s tip: Chap. 21 "Personality Factors in Chronic Fatigue Syndrome: Psychological Assessment"
Theater of Disorder: Patients, Doctors, and the Construction of Illness By Brant Wenegrat Oxford University Press, 2001
Librarian’s tip: "Chronic Fatigue Syndrome and Some Related Disorders" begins on p. 21
Chronic Fatigue Syndrome By Swenson, Tracy S The Journal of Rehabilitation, Vol. 66, No. 1, January-March 2000
PEER-REVIEWED PERIODICAL
Peer-reviewed publications on Questia are publications containing articles which were subject to evaluation for accuracy and substance by professional peers of the article's author(s).
Recognizing and Understanding Chronic Fatigue Syndrome: Implications for Rehabilitation Counselors By Harley, Debra A The Journal of Rehabilitation, Vol. 67, No. 2, April-June 2001
PEER-REVIEWED PERIODICAL
Peer-reviewed publications on Questia are publications containing articles which were subject to evaluation for accuracy and substance by professional peers of the article's author(s).
Monitoring Energy Levels in Chronic Fatigue Syndrome By Jason, Leonard A.; Holden, John; Taylor, Stephanie; Melrose, Harriet J The Psychological Record, Vol. 45, No. 4, Fall 1995
PEER-REVIEWED PERIODICAL
Peer-reviewed publications on Questia are publications containing articles which were subject to evaluation for accuracy and substance by professional peers of the article's author(s).
Talking about the ME Generation By Wessely, Simon New Statesman (1996), Vol. 127, No. 4370, January 30, 1998
Fatigue and Impairment in Man By S. Howard Bartley; Eloise Chute McGraw-Hill, 1947
Librarian’s tip: Chap. XIX "Chronic Fatigue and Related Syndromes"
Psychosocial Treatment for Medical Conditions: Principles and Techniques By Leon A. Schein; Harold S. Bernard; Henry I. Spitz; Philip R. Muskin Brunner-Routledge, 2003
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