Chronic Fatigue

We all experience fatigue. It can be work stress, family arguments or illness that is making us feel tired. For a small portion of the population, it’s chronic and wearing. 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 criteria for its Syndrome. Rather, various health authorities such as National Institute for Health and Clinical Excellence (NICE) in the UK and the Centers for Disease Control and Prevention in the USA have provided their own criteria. People with CFS often have other medical health conditions such as sleep or mental health conditions. Researchers pointed out the gap between CFS and Fibromyalgia. They have gone so far as to say that the two are different sides of the same disease. Health professionals understand that this is confusing for clients. What we have decided to do is break down the various components of CFS.

Exploring chronic fatigue characteristics

For someone to have this, the fatigue has to be new, not lifelong and lasting since onset. The slowness will impact activity levels. In adults, the fatigue last at least 4 to 6 months before looking towards CFS 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 all connect to its Syndrome. Poor sleep, memory troubles and a worsening following exertion have 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 clear 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 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 its 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 its 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 this Syndrome antiviral medication has not been proven helpful.

Perceptions and understanding

Chronic Fatigue Syndrome is a debilitating illness. Oftentimes 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 Syndrome the more likely they are to isolate and contribute at home. Possibly as a result of their symptoms and 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 thorough psychological assessment should be done.

Psychological assessment for Chronic Fatigue Syndrome

Often time depression is the key diagnostic overlap with this Syndrome. Whilst diagnosis and treatment of chronic fatigue can be challenging, 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 this Syndrome; there are no firm treatment recommendations. Thus far the majority of studies have been inconclusive apart from leaning in favour of physical and behavioural therapies.

Medication benefits?

Thus far there has been no conclusive evidence supporting the use of medication when treating its 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 behaviour 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 the benefits of such a 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 to 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.

Get Help Today

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