Diagnosis

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Chronic fatigue syndrome (CFS) is often misdiagnosed because its symptoms are shared by other disorders, including:

• hypothyroidism

• sleep apnea

• narcolepsy

• alcohol or substance abuse

• severe obesity

• lupus

• multiple sclerosis

• cancer

• depression

• anorexia nervosa

• bulimia nervosa

• schizophrenia

• bipolar disorder

• dementia

Thus, the diagnosis of CFS is one of exclusion, i.e., excluding other possible causes of the symptom complex. Some diseases eliminate a diagnosis of CFS, such as multiple sclerosis, lupus or a severe psychiatric disorder such as schizophrenia. It would not provide any benefits in these cases to have a second diagnosis.

The current diagnostic criteria for CFS specifies debilitating fatigue for at least six months that doesn’t improve with rest and gets worse with physical or mental exertion that was previously well tolerated. It also requires the presence of four of the following symptoms:

• unrefreshing sleep

• impairment in short-term memory or concentration

• post-exertional malaise occurring within 12 to 24 hours of exertion and lasting 24 hours or more

• joint pain without joint swelling or redness

• muscle discomfort or pain

• headaches of a new type or severity

• recurrent sore throat

• tender lymph nodes in the neck and underarms

Multiple subjective symptoms are also reported, and although these are not included in the current diagnostic criteria, they are reported with relative frequency. These include:

• Irritable bowel syndrome and other gastrointestinal complaints
• Allergy-like symptoms
• Skin rashes
• Visual disturbances
• Dizziness
• Numbness and tingling in arms and legs
• Sensitivities to various chemicals
• Dry eyes
• Chills
• Night sweats
• Alcohol and medication intolerances

Some CFS patients also report mild to moderate symptoms of anxiety or depression. However, many people with CFS don’t have depression or any other psychiatric illness. Depression may be a secondary effect of CFS, not necessarily a primary condition, as people attempt to cope with the changes in lifestyle that living with a chronic illness dictates.

Whether anxiety or depression occurs before or during the illness is not the significant factor; getting help for these distressing conditions is what is essential.

Some also find allergies are significantly more common in CFS patients than in the general population. Many CFS patients have a history of allergies years before the onset of the syndrome. Sometimes patients report a worsening of allergic symptoms or the onset of new allergies after becoming ill with CFS. Because allergies are so common in people with CFS, it is important to identify symptoms caused by allergies so they can be treated independently.

Your health care professional should take a thorough medical history, and conduct extensive physical and mental status examinations, including laboratory tests.