CFS (Chronic Fatigue Syndrome)

What Is Chronic Fatigue Syndrome?

Chronic fatigue syndrome (CFS) is a debilitating disorder characterized by extreme fatigue or tiredness that doesn’t go away with rest, and can’t be explained by an underlying medical condition. CFS can also be referred to as myalgic encephalomyelitis (ME) or systemic exertion intolerance disease (SEID).

The causes of CFS aren’t well-understood. Some theories include viral infection, psychological stress, or a combination of factors. Because no single cause has been identified, and because many other illnesses produce similar symptoms, CFS can be difficult to diagnose. There are no tests for CFS, so your doctor will have to rule out other causes for your fatigue.

While CFS has in the past been a controversial diagnosis, it’s now widely accepted as a real medical condition. CFS can affect anyone, though it’s most common among women in their 40s and 50s. There is no current cure, so treatment for CFS focuses on relieving your symptoms.

What Causes CFS?

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The cause of CFS is unknown. Researchers speculate that viruses, hypotension (unusually low blood pressure), a weakened immune system, and hormonal imbalances could all be contributing factors. It’s also possible that some people are genetically predisposed to develop CFS.

Though CFS can sometimes develop after a viral infection, no single type of infection has been found to cause CFS. Some viruses that have been studied in relation to CFS include Epstein-Barr virus (EBV), human herpes virus 6, Ross River virus (RRV), rubella, Coxiella burnetti, and mycoplasma. Researchers have found that a person who has been infected with at least three of the implicated pathogens has a greater chance of developing CFS.

The U.S. Centers for Disease Control and Prevention (CDC) have suggested that CFS may be the end stage of multiple different conditions, rather than one unique condition. In fact, 10 to 12 percent of people with Epstein-Barr virus, Ross River virus, and Coxiella burnetti develop a condition that meets the criteria for a CFS diagnosis.

People with CFS sometimes have weakened immune systems, but doctors don’t know whether this is enough to cause the disease. Additionally, people with CFS sometimes have abnormal hormone levels, but doctors haven’t yet concluded whether this is significant.

Risk Factors for CFS

Risk Factors

CFS is most common among people in their 40s and 50s. Gender also plays an important role in CFS, as women patients outnumber men by a nearly 2 to 1 ratio. Genetic predisposition, allergies, stress, and environmental factors may also increase your risk.

What Are the Symptoms of CFS?

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The symptoms of CFS vary from person to person and based on the severity of the condition. The most common symptom is fatigue that is severe enough to interfere with your daily activities. For CFS to be diagnosed, fatigue must last for at least six months and must not be curable with bed rest, and you must have at least four other symptoms as well.

Other symptoms of CFS may include:

  • loss of memory or concentration
  • feeling unrefreshed after a night’s sleep
  • chronic insomnia (and other sleep disorders)
  • muscle pain
  • frequent headaches
  • multijoint pain without redness or swelling
  • frequent sore throat
  • tender lymph nodes in your neck and armpits

You may also experience illness or extreme fatigue after physical or mental activities. This can last for more than 24 hours after the activity.

People are sometimes affected by CFS in cycles, with periods of feeling worse and then better again. Symptoms may sometimes even disappear completely (remission). However, it’s still possible for them to come back again later (relapse). The cycle of remission and relapse can make it difficult to manage your symptoms.

How Is CFS Diagnosed?

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CFS is a very challenging condition to diagnose. According to the CDC, only 20 percent of the estimated 1 to 3 million Americans with CFS have been diagnosed. There are no lab tests to screen for CFS and its symptoms are common to many illnesses. Many people with CFS don’t look obviously sick, so doctors may not recognize that they are ill.

In order to be diagnosed with CFS, you must have at least four of the above symptoms listed. You also must have severe, unexplained fatigue that cannot be cured with bed rest. The fatigue and other symptoms must last for six months or longer.

Ruling out other potential causes of your fatigue is a key part of the diagnosis process. Some conditions whose symptoms resemble those of CFS include:

  • mononucleosis
  • Lyme disease
  • multiple sclerosis
  • lupus (SLE)
  • hypothyroidism
  • fibromyalgia
  • major depressive disorder

You may also experience symptoms of CFS if you are severely obese or have depressive disorders or sleep disorders. The side effects of certain drugs, such as antihistamines and alcohol, can mimic CFS as well.

Because the symptoms of CFS resemble those of other conditions, it’s important not to self-diagnose and to talk to your doctor.

How Is CFS Treated?

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There is currently no specific cure for CFS. Each afflicted person has different symptoms and may therefore benefit from different types of treatment aimed at managing the disease and relieving their symptoms.

Home Remedies and Lifestyle Changes

Making some changes to your lifestyle can help reduce your symptoms. Limiting or eliminating your caffeine intake will help you sleep better and ease your insomnia. You should limit your nicotine and alcohol intake, too. Try to avoid napping during the day. Create a sleep routine: You should go to bed at the same time every night and aim to wake up around the same time every morning.

It’s also important to pace yourself during activities. Overexertion can make your symptoms worse and bring on an episode of fatigue. Avoid emotional and physical stress. Take time each day to relax or participate in activities you enjoy.

Two types of therapy appear to benefit people with CFS. One is psychological counseling to help you cope with CFS and improve your mindset. The other is physical therapy. A physical therapist can evaluate you and create an exercise routine for you that gradually increases in intensity. This is known as graded exercise therapy, or GET.


No one medication can treat all of your symptoms. Also, your symptoms may change over time. In many cases, CFS can trigger depression, and you may need an antidepressant to combat it. If lifestyle changes don’t give you a restful night’s sleep, your doctor may suggest a sleep aid. Pain medication can also help you cope with aches and joint pain caused by your CFS.

Alternative Medicine

Acupuncture, tai chi, yoga, and massage may help relieve the pain associated with CFS. Always talk to your doctor before beginning any alternative or complementary treatments.

What Can Be Expected in the Long Term?

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Despite increased research efforts, CFS remains a poorly understood condition with no cure. Managing CFS can therefore be challenging. You will likely need to make major lifestyle changes in order to adapt to your chronic fatigue. As a result, you may experience depression, anxiety, or social isolation, so some people find that joining a support group can be helpful.

CFS progresses differently in different people, so it’s important to work with your doctor to come up with a treatment plan that works for you. Many people benefit from working with a team of healthcare providers, including doctors, therapists, and rehabilitation specialists. It’s not known how many people recover from CFS.

The Solve ME/CFS Initiative has resources that you may find helpful, and the CDC also offers recommendations for managing and living with CFS.

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