The Mysteries of Chronic Fatigue Syndrome
Nov. 9, 1999 (Atlanta) -- Chronic fatigue syndrome -- a debilitating illness that over the last decade has been called Epstein-Barr virus, chronic mononucleosis, and yuppie flu -- may be an illness caused by one or more infections, according to a paper appearing in the current issue of Annals of Behavioral Medicine.
Stress and depression may act to perpetuate the condition by disrupting immune, neurological, and hormone functions necessary to fight the infection, Susan K. Johnson, PhD, a psychologist with the University of North Carolina at Charlotte, tells WebMD. "There very much is a mind-body connection," she says.
Studies conducted at a Chronic Fatigue Research Center at the New Jersey Medical School have looked at the role psychiatric disease plays in CFS. They have identified two types of CFS patients. One group had a gradual onset of physical symptoms, accompanied by psychiatric problems, such as depression and anxiety. The other group had a sudden onset of physical symptoms with no psychiatric problems. Studies have shown that when CFS is accompanied with depression or anxiety, the chance for cure is dramatically reduced, Johnson says.
Several additional studies have shown CFS patients have a tendency to minimize the psychological implications of their illness. Other studies show many people with CFS tend to regard the disease as the sole problem in their lives, and believe that it has a biological origin. They are resistant to implications that the disease has a psychological rather than biological basis, says Johnson.
Chronic fatigue is an illness that impairs daily function and involves numerous arthritis-related, infectious, neurological, and psychiatric symptoms. Criteria for diagnosis once focused on infectious symptoms, but in 1992 it was modified to include depression and anxiety. Symptoms may include mild fever, muscle weakness, sore throat, severe fatigue after mild exercise, headaches, body aches, sleep problems, depression, and anxiety.
Fewer doctors today consider chronic fatigue to be a trivial complaint. "It's taken much more seriously than it once was," Johnson tells WebMD.
The illness is difficult to diagnose, in part because fatigue is a very common, subjective symptom found in many illnesses. "Fatigue can denote problems with muscle weakness, exhaustion ... mental tiredness ... or lack of motivation," says Johnson. Most doctors today establish a diagnosis by ruling out all the other diseases, she adds.
While chronic fatigue primarily affects middle-aged women, it seems to be most prevalent among black and Native American women with incomes under $40,000. "The image of chronic fatigue syndrome as an illness of the white professional class is inaccurate," says Johnson.
Because researchers have been unable to pinpoint any physical cause, a true explanation of the illness' cause has eluded researchers. There is an unresolved debate whether chronic fatigue is an emotional disorder or an organic disease, says Johnson. Also, the type of depression found in chronic fatigue patients can be quite different from classical depression, with significantly lower evidence of sadness in CFS patients.