Chronic Fatigue Syndrome: Definition, Symptoms, and Treatment

By Cristiano Antonino On Apr 6, 2023

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There are people for whom the tendency to get tired easily becomes the main problem, those who suffer from so-called chronic fatigue

Surely most of us would fit into this group, at least considering certain phases of our lives.

In reality, for people with this disorder, the problem is much more serious.

Symptoms of Chronic Fatigue Syndrome

Symptoms are multiple and heterogeneous:

intense malaise after even minimal physical exercises
flu-like symptoms
unrefreshing sleep
feeling of mental fog
a constellation of unspecified symptoms

The picture would not seem so rare if we consider that in the United States alone the disorder affects about one million people, including adults and children.

It often affects people from racial or ethnic minorities or low socioeconomic status.

Correctly identify the syndrome

Standard laboratory tests almost always do not detect anomalies and this explains why it happens that sometimes people with this picture can be considered pretenders, depressed or “psychosomatic” subjects.

The differential diagnosis with a depressive disorder could be made by asking the subject: “What would you do if you weren’t ill?”.

In depressive disorders usually the person would not know what to answer.

Unlike people with chronic fatigue who instead list multiple activities they find enjoyable and would like to do.

In the scientific community there are scholars who consider the framework specific, autonomous, clear in its manifestations, thus giving it a dignity of existence.

Others, on the other hand, believe that there are not enough elements to speak of a clear and well-defined chronic fatigue syndrome, even denying its existence.

People with these symptoms on average are seen by at least 4 doctors before receiving the specific diagnosis.

The diagnosis can also be formulated after a period of time ranging from 1 to 10 years from the onset.

The history of the diagnosis of chronic fatigue syndrome

The name of chronic fatigue syndrome began to be used in the late 80s of the last century in the USA; in Great Britain, Canada and other countries for the same symptomatic parade the wording “myalgic encephalomyelitis” (ME) was preferred.

Many patients are reluctant to have their disorder referred to as “Chronic Fatigue Syndrome.”

This is because they believe that the expression itself trivializes a picture that can also be very serious and disabling, certainly much more than simple hyper-fatigue.

There has been a compromise in the scientific community in giving this disorder a name, using the term ME/CFS. This would also focus on the biological component and not just on chronic fatigue.

The diagnostic criteria for this disorder will soon be updated and the diagnostic label will most likely also be changed, precisely in light of the new data from biological research.

The causes of chronic fatigue

In fact, it seems that the disorder derives from an abnormal response of the immune system to a large number of environmental or infectious agents.

This would lead to a state of chronic inflammation, a dysregulation of the autonomic nervous system, a dysfunction of the hypothalamic-pituitary-adrenal system with consequent neuroendocrine dysfunction.

A reduced cytotoxic activity of natural killer cells and an increase in the levels of pro-inflammatory cytokines have been observed.

A genetic predisposition would be at the basis of the excessive activation of inflammatory responses to minimal environmental stimuli.

Other intracranial investigations would indicate bilateral white matter atrophy in some brain areas.

Unfortunately, all these data do not allow for the moment to formulate certain diagnoses or to identify the disorder in the early stages so as to be able to implement a prophylaxis.

Therapies available to treat chronic fatigue

Just as at the moment there are no specific therapies: the inflammatory hypothesis has led to the use of anti-inflammatory drugs.

Sometimes antidepressants are used because they would raise the pain threshold.

Improvements were also observed with cognitive-behavioral psychotherapies and with physical exercises to be performed gradually.

Although many times patients refuse this type of approach because they do not believe that the problem can derive from psychological aspects or can improve with psychotherapy.

I believe that this disturbance is paradigmatic of the split, in my opinion incorrect, which still remains between mind and soma; as if the human being can be grasped only in one of the two components.

Clinicians who view the disorder as a problem exclusively on a psychogenic basis think so, as do patients who reject any hypothesis that the psychic state can influence the physical component.

Actually body and brain work as one and influence each other.

It makes no sense to continue with splits resulting from a Cartesian thought that has had its great importance in Western history but which in the light of our present should be revised.

Probably psychoneuroendocrinology, in being able to grasp the “mind-body” union better than other disciplines, will be able to provide us with some further elements for reflection.

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