Understanding Chronic Fatigue Syndrome

In this abridged excerpt from Overcoming Chronic Fatigue, authors Mary Burgess and Trudie Chalder give some background information about chronic fatigue syndrome and discuss factors that may contribute to its onset.

What is fatigue?

Fatigue is a difficult concept as it means different things to different people. People will often describe their fatigue using words such as weakness, listlessness, profound tiredness or sleepiness, a complete lack of energy or feeling totally drained. Fatigue feels very different from the normal sort of tiredness experienced by a healthy person.

Fatigue is a very common problem. It is a symptom that can be associated with many illnesses, including chronic pain, thyroid problems, anaemia and cancer. A single explanation for fatigue is rarely found but sometimes develops following a viral infection such as glandular fever and sometimes occurs when life is very busy and stressful. Whatever the cause of fatigue, it is a real and debilitating problem.

What is chronic fatigue syndrome?

Chronic fatigue syndrome (CFS), also known as post-viral fatigue syndrome (PVFS) or myalgic encephalomyelitis (ME), is an illness that has attracted much attention over recent years. Agreeing a name for the illness has been problematic as there has been much debate about the relative contributions of ‘physiological’ and ‘psychological’ factors in its development. This outmoded, dualistic view of illness assumes that the body and mind work separately and is unhelpful in understanding any condition.

Chronic fatigue syndrome is a relatively new label, although the illness itself was clearly described more than a hundred years ago; at that time, it was called neurasthenia. The main symptom experienced by people with CFS is persistent mental and physical fatigue that feels overwhelming and unlike normal tiredness. Other symptoms may include painful muscles and/or joints, sore throat, headaches, pins and needles, dizziness and sensitivity to light and noise. CFS has some marked similarities to fibromyalgia, a disorder involving widespread musculoskeletal pain and fatigue; however, the component of muscle pain in fibromyalgia is generally higher.

People with CFS often report impairments of their thinking, such as poor concentration, difficulty in finding words and impaired short-term memory. People will sometimes describe feeling ‘woolly-headed’. Problems with sleep are also common: for example, difficulty getting to sleep, sleeping for very long periods, restless sleep with frequent dreams, waking frequently and waking feeling unrefreshed. Many people with CFS also report digestive disturbances such as bloating, nausea or loss of appetite. Food intolerances and increased sensitivity to some foods, alcohol and substances containing caffeine, such as tea and coffee, are often reported.

Symptoms vary among individuals and affect their lives in different ways. For some people this may mean giving up work or studying; alternatively, or in addition, it may mean reducing or restricting social and/or leisure activities. Life at home can change: for example, you may be able to do less chores or cooking or be less able to help care for children. Personal relationships may change, with less inclination or energy for intimacy. The severity of symptoms may lead a small percentage of people with CFS to be housebound for much of the time. Symptoms are often made worse by physical and mental exertion and sometimes by stress. The impact of symptoms may for some people lead them to feel anxious and/or low in mood.

What causes chronic fatigue syndrome?

There is no single cause of CFS. People report a variety of different things that happened at the beginning of their illness. Some people can pinpoint the exact date that their CFS started; for others, the onset is more gradual. In light of this wide range of experience, it is unlikely that a single cause for CFS will ever be identified. However, there is a growing body of evidence suggesting that a number of factors may be involved in triggering the illness.

If you have chronic fatigue syndrome, it is likely that you will be able to identify some, though probably not all, of the triggers listed below:

• Infection
• Busy/inactive lifestyle
• Stressful life events
• Personality type

What keeps the chronic fatigue problem going?

Just as there are a number of factors involved in triggering CFS, there are also likely to be many factors involved in keeping it going. Your own story is unique, but you may feel that some of the following factors may apply to your situation:

• Resuming normal activities too soon after an initial infection
• Resting too much
• Receiving confusing messages about the illness itself and how to deal with it
• Over-vigorous activity alternating with resting for long periods
• Disturbed sleep pattern
• Focusing on symptoms
• Worries about activity making your symptoms worse
• Life stress and low mood