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Chronic Fatigue Syndrome

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Amber had swollen glands and frequent headaches, and felt surprisingly weak. She was so tired that she had trouble concentrating at school and her grades began to drop. Some days, she found it hard to get out of bed.

Amber had been feeling like this since August — and it was now March. Her parents thought she might have mono, so they took her to the doctor. But after a physical exam and several blood tests, Amber's doctor said she had chronic fatigue syndrome.

What Is Chronic Fatigue Syndrome?

Chronic fatigue syndrome (CFS) is a complicated disease for doctors to diagnose — and even fully understand. Although it is a physical condition, CFS also has psychological components. This means that someone with CFS may feel physical symptoms, such as headaches or joint pain. But the person may also notice emotional components to the illness, such as a loss of interest in favorite activities.

To make it even more complicated, different people with CFS can have different symptoms. And the symptoms of CFS often mimic those of other health conditions, like mono, Lyme disease, or depression. As if that's not hard enough, symptoms of CFS can vary over time, even in the same individual.

All of this makes treating the illness a little more complicated because no single medication or treatment can address all the possible symptoms.

What Causes It?

Scientists have researched CFS for more than 20 years, but they still don't know for sure what causes it.

Many doctors now believe that the way certain conditions interact within the body and mind might leave some people at risk of developing the condition. For example, if someone has a virus and is under a lot of stress, the combination of these two things might make the person more likely to develop CFS.

Doctors currently believe that the following things might interact with each other in this way, putting certain people at risk for CFS:

Researchers also have discovered that some people with CFS have a type of low blood pressure and are looking into whether there's a connection between this and CFS.

Who Gets CFS?

Chronic fatigue syndrome can affect people of all ages and ethnicities, although more girls than guys get CFS. CFS is very rare in kids. A few teens do get CFS, but it's more likely to happen to people in their forties or fifties. Teens with CFS seem to improve over time much more frequently than do older patients.

Sometimes different people in the same family get CFS. This may be because the tendency to develop CFS is genetic. Doctors are also pretty sure the disease is not contagious.

How Do People Know they Have CFS?

Right now, there's no test to tell if someone has CFS. Because the illness can be hard to diagnose, the Centers for Disease Control and Prevention (CDC) established two criteria to guide doctors in knowing when a patient might have chronic fatigue syndrome:

  1. Unexplained fatigue that lasts for 6 months or longer. Someone with CFS feels overwhelming tiredness and lack of energy that can go on for months with no obvious cause. This kind of fatigue makes it really difficult to get out of bed, get dressed, and eat. It impacts school, work, and anything a person does for pleasure — even just going to the movies or playing an instrument. CFS fatigue does not get better with rest or sleep.
  2. Four or more of the following symptoms:

To be diagnosed with CFS, a person must have both the long-lasting fatigue and four or more symptoms from the list above.

Diagnosis by Exclusion

What Do Doctors Do?

A doctor will take a detailed medical history and perform a thorough physical exam, usually along with a number of lab tests, in order to rule out the following:

After ruling out these conditions, doctors will often suggest that a patient meet with a therapist before diagnosing CFS. Why? Because it's important to have as much information as possible about how the symptoms affect a person's overall mental health, including memory, personality, ability to concentrate, and overall outlook on life.

How Is CFS Treated?

There's no known cure for CFS. Although there is no hard and fast treatment, experts say that these lifestyle changes can help:

Work It Out

Counseling and Medications

In addition to lifestyle changes, meeting regularly with a licensed therapist or counselor can help in CFS treatment. (So can getting involved in a support group for people with CFS.) The main goals of therapy are to help people cope with the illness and to change negative or unrealistic thoughts or feelings into positive, realistic ones. Having a positive feeling that you can get better is very helpful to CFS patients.

Some people find that antidepressant medications, taken under a doctor's supervision, can help ease the symptoms of CFS. And prescription or over-the-counter pain medications and anti-inflammatory drugs (such as ibuprofen) may also help some people.

Because scientists have not found any link between viruses or other types of infections and CFS, doctors don't treat the illness with antibiotics or antiviral medications. (Doctors have tried using these medications with CFS patients in the past, but they have not helped.)

Coping With CFS

Therapy and support groups can help teens with CFS and their parents deal with the academic or social challenges brought on by the illness, such as missed school, falling grades, or withdrawal from friends and social situations.

Here are some other ways to cope:

Getting Well

For most people, the symptoms of CFS are most severe in the beginning, and afterward they may come and go. According to the CDC, almost half of all CFS patients experience partial or full recovery within 5 years after the CFS symptoms began — once again, the outlook is better for teens than for adults.

Most important, don't give up. There's no doubt that CFS can be hard, and it's easy to become demoralized. But teens with CFS generally get better faster and recover from CFS more completely than adults do.

Many experts stress that it's more important for people with CFS to keep a positive approach to getting well instead of looking for the reason why they developed CFS. Unfortunately, many people spend too much time looking for a single cause and not beginning therapy — and therapies like the stress-management techniques and graded exercise previously mentioned have been shown to be effective in many cases. In other words, even without knowing the exact cause of CFS, people who take action and approach the condition with a positive outlook can have a good outcome.

CFS might be one of today's most misunderstood illnesses, but awareness is growing and scientists are working to find out more about it every day.

Reviewed by: J. Carlton Gartner Jr., MD
Date reviewed: May 2013

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Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
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