What Causes Chronic Fatigue Syndrome?

Researchers Find That Possible Sources Span Mind and Body

Medically Reviewed by Ann Edmundson, MD, PhD on January 26, 2006

Jan. 26, 2006 -- A mix of physical and psychological factors may affect chronic fatigue syndrome, according to a new review published in The Lancet.

The report sums up medical research on chronic fatigue syndrome, which is severe fatigue affecting daily functioning that lasts at least six months despite rest and isn't due to other health problems.

The researchers -- based at Radboud University Nijmegen Medical Centre in the Netherlands -- list physical and psychological symptoms that may make some people more vulnerable to chronic fatigue syndrome.

Mind and body both seem involved, write Judith Prins, PhD, and colleagues. Glitches in the central nervous system's mix of molecules may be the key, they note.

Possible Influences

Prins' team reviewed previous scientific research on chronic fatigue syndrome.

They identified the following factors that have been reported to raise the odds of developing chronic fatigue syndrome:

  • Neuroticism
  • Introversion
  • Genetics
  • Inactivity in childhood
  • Inactivity after mononucleosis

However, they don't place the blame exclusively on those factors. The exact cause of chronic fatigue syndrome isn't known.

Sudden, severe psychological stress may trigger the syndrome's onset, the researchers note. "Serious life events, such as the loss of a loved one or a job, and other stressful situations have been found to precipitate the disorder," they write.

Physical stress -- such as serious injury, surgery, pregnancy, or labor -- has been reported by patients to precipitate the onset of chronic fatigue. But the researchers note that these factors have not been studied systematically.

Counseling Approaches

The report also covers research on two types of therapy for chronic fatigue syndrome: cognitive behavior therapy and graded exercise therapy.

Cognitive behavior therapy emphasizes managing symptoms and challenging patients' beliefs about their condition. Graded exercise therapy encourages patients to gradually become more physically active.

More research supports cognitive behavior therapy than graded exercise therapy for chronic fatigue syndrome, but neither approach seems to work for everyone, the researchers note.

They stress that their interest in psychological approaches to chronic fatigue syndrome doesn't dismiss the condition's physical side.

"The use of a psychobiological [chronic fatigue syndrome] model does not preclude neurobiological components," they write. "The challenge is to find out what is wrong in the molecular interplay at the level of the central nervous system."

Researchers' Therapy Advice

Much remains to be understood about chronic fatigue syndrome, write Prins and colleagues.

Meanwhile, they write that cognitive behavior therapy should be tailored to chronic fatigue syndrome, not depression, and that "therapists should broaden the patient's vision to a future life as a healthy person," the researchers write.

"A personal goal can never be achieved if it is not aimed for," they continue. "By striving for rehabilitation only, therapists might deprive patients with CFS of a potential cure."

The researchers cite a recent study that found that success with graded exercise therapy was related more to a decrease in a patient's focus on symptoms than to an increase in exercise fitness.

It may be that focusing on what you can do -- instead of what you can't do -- is the common theme for successful therapy for chronic fatigue syndrome.

Show Sources

SOURCES: Prins, J. The Lancet, Jan. 28, 2006; vol 367: pp 346-355. News release, The Lancet.
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