We have all experienced fatigue. For the most part it is short lived and can be explained away by our circumstances. It could be work stress, family arguments or illness that is making us feel tired. For a small portion of the population, it’s chronic and debilitating. It can be explained away with a medical diagnosis like anemia or arthritis. These people can be experiencing Chronic Fatigue Syndrome.

Defining Chronic Fatigue Syndrome

There is no single test or universally agreed upon diagnostic criteria for Chronic Fatigue Syndrome. Rather, various health authorities such as National Institute for Health and Clinical Excellence (NICE) in UK and the Centers for Disease Control and Prevention in USA have provided their own criteria.

People with Chronic Fatigue Syndrome often have other medical health conditions such as sleep or mental health conditions. Researchers have also pointed out the overlap between Chronic Fatigue Syndrome and Fibromyalgia. They have gone so far as to say that the two are different aspects of the same disease. 

Health professionals understand that this is confusing for clients. What we have decided to do is breakdown the various components of Chronic Fatigue Syndrome.

Exploring chronic fatigue characteristics

For the diagnosis to be established fatigue has to be new, not lifelong and persistent since onset. The lethargy will impact functioning and activity levels. In adults it is expected the fatigue would have lasted at least 4 to 6 months before looking towards Chronic Fatigue Syndrome as an explanation. 

Specific features of chronic fatigue

There are a number of physical and other associated symptoms of chronic fatigue. For instance, headaches and muscles aches, nausea and lightheadedness, swollen glands and sore throats are all linked to Chronic Fatigue Syndrome. Poor sleep, memory troubles and a worsening following exertion has also been noted. 

These are the symptoms people with Chronic Fatigue Syndrome present with. Unfortunately the symptoms are not specific and could be a marker of a number of illnesses. Also people experiencing chronic fatigue are likely to brush it aside or come up with alternate explanations. 

How prevalent is Chronic Fatigue Syndrome?

As there are differing views on what makes up Chronic Fatigue Syndrome and little understanding of its causes, it isn’t clearly exactly how common the condition is. Most estimates put it around 1 in every 100 of the population, and it being more common among women aged 30 to 40 years. 

Other health conditions that co-present with Chronic Fatigue Syndrome

  • Fibromyalgia
  • Irritable Bowel Syndrome
  • Temporomandibular joint dysfunction
  • Postural orthostatic tachycardia syndrome (POTS)  

Researchers have pointed out that the overlap in symptoms between these conditions might mean that they are in fact differing parts of the one disorder. How symptoms change further supports the view that there is possible a common pathophysiology. 

Causes of Chronic Fatigue Syndrome

The cause of  Chronic Fatigue Syndrome is unknown. It may just be that there are different causes for different people. Scientists have speculated the following causes: 

Neurological Causes

Many of the problems experienced by people with Chronic Fatigue Syndrome are in fact neurological; headaches, memory loss and poor concentration to list some. Brain blood flow scans and neurotransmitter level changes suggest abnormalities. Addressing these, and whether doing so would result in functional improvements is yet unclear in research currently being undertaken. 

Autonomic dysfunction might be another contributor. Take for instance dizziness and feeling nauseated. Researchers wonder if this could be related to poor autonomic nervous system functioning. 

Psychiatric causes 

There is quite some overlap between Chronic Fatigue Syndrome and depression, generalized anxiety disorder and somatization. Of interest the mood and anxiety symptoms usually started before the chronic fatigue symptoms arise. There are a couple of research papers that point to childhood trauma being associated with Chronic Fatigue Syndrome.


Multiple studies point to increases and decreases in certain immune cell gene expression. Thus far the research findings have been inconsistent and non-conclusive. 

Infectious causes

Scientists and doctors have wondered if Chronic Fatigue Syndrome could be the result of infections such as EBV, Hepatitis C or Enterovirus. However the research findings aren’t statistically conclusive. In addition giving people with Chronic Fatigue Syndrome antiviral medication has not been proven helpful. 

Perceptions and understanding

Chronic Fatigue Syndrome is a debilitating illness. Often times people attribute their symptoms to physical causes. They tend to be less mindful of the psychological or personal aspects of the illness. This can be easily understood. The physical symptoms for example lightheadedness and swollen glands are oftentimes what people feel and are reminded of. 

The worse someone feels from their Chronic Fatigue Syndrome the more likely they are to isolate and contribute at home. 

Possibly as a result of their symptoms Chronic Fatigue Syndrome sufferers tend to avoid or escape strategies when faced with challenges. This could be understood from the perspective of being self protective. However it may lead to impairments in functioning plus psychosocial disturbance and ultimately unhappiness. 

Diagnosis Chronic Fatigue Syndrome

There is no single blood test to diagnose the condition. Rather guidelines suggest doing a series of blood tests and other investigations to rule out other medical explanations. For instance it may be helpful to do a coeliac test if there are prominent gastrointestinal symptoms to go along with chronic fatigue and body aches. 

Oftentimes however the laboratory tests are inconclusive. A  through psychological assessment should be done. 

Psychological assessment for Chronic Fatigue Syndrome

Often time depression is the key diagnostic overlap with Chronic Fatigue Syndrome. Whilst diagnosis and treatment of chronic fatigue can be challenge, managing depression is more straightforward. How we respond to chronic fatigue is driven partly by our personality, temperament and psychosocial factors. Assessing and understanding these should form the first step in treating chronic fatigue and other symptoms.


Because of the heterogeneous or variable nature of Chronic Fatigue Syndrome; there are no firm treatment recommendations. Thus far the majority of studies have been inconclusive apart from leaning in favor of physical and behavioral therapies. 

Medication benefits?

Thus far there have been no conclusive evidence supporting the use of medication when treating Chronic Fatigue Syndrome. Researchers have trilled antivirals, immunological agents, hormones, antidepressants and steroids without finding strong supporting evidence.


Two or more studies have shown 1) graduated exercise programs and 2)  psychological therapies to be effective. It is thought that thinking and behavior continue symptoms of chronic fatigue. 

Breaking this pattern with an exercise program that slowly builds physical resilience increases tolerance and self efficacy. A graduated exercise program can lead to a reduction in fatigue, improvement in functional status and overall fitness. Experiencing chronic fatigue can be disempowering. Psychological therapies can make you feel more in control. Research has shown benefits of such program to last for years.

Self Help and Chronic Fatigue

Likely due to a lack of established therapies; self help groups form an important part of learning and support for people experiencing chronic fatigue. Frustration, fear lead to yielding to chronic fatigue which reinforces the cycle of misery and ill health. Here, being part of a self help group or helping oneself can shift the tide with respect to chronic fatigue. 

At Epsychiatry our front desk team at aware of disempowerment of chronic health conditions. The research evidence supports the use of psychological therapies to address Chronic Fatigue Syndrome. Given us a call or send us a web chat to learn more about how our clinicians can help. 


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