CHRONIC FATIGUE SYNDROME

Abstract

Chronic fatigue syndrome (CFS) in young people may be regarded as a modern disease. The syndrome became an established part of clinical paediatric practice in western countries over the turn of the 20th century. Interest has grown speedily however, and now a number of countries have developed guidelines for assessment and treatment. Chronic fatigue syndrome is a disorder characterised by severe, persistent, impairing fatigue together with a number of other symptoms, all of which are unexplained by a medical or psychiatric disorder. Over the past two decades, a concerted effort was made to rigorously define the basic features of the disorder to aid both clinical work and research. This has resulted in the development of a well-defined chronic fatigue syndrome meeting all diagnostic criteria and a subsyndromal chronic fatigue-like state meeting most but not all diagnostic criteria. In clinical practice, the differentiation between the two is not always clear-cut, and this chapter will consider both chronic CFS and chronic fatigue-like states. The status of chronic fatigue syndrome as a medical disorder has been debated because there is no recognised pathophysiology and there is a strong psychological component. The main symptom is fatigue, which is commonly seen in a variety of medical, surgical and psychological disorders. Fatigue is also a normal everyday experience following physical exercise, psychological stress, mental exertion or a sleepless night, though too much sleep can also lead to fatigue. In chronic fatigue syndrome, the primary patient experience is one of poor physical health and of physical symptoms leading to substantial impairment in everyday life. In spite of the uncertain nature of the syndrome within medicine, patients generally regard it as having a biological cause and to be within the remit of physical rather than psychological medicine (Garralda & Rangel, 2002; Garralda & Chalder, 2005).