Chronic Fatigue Syndrome

Diagnosing Chronic Fatigue Syndrome

Diagnosis of chronic fatigue syndrome is based on the presence of unexplained exhaustion that is not improved by sleep or rest, persists for three to six months, and causes an all-over weakness and lack of energy so severe that it interferes with normal living. 

The first step in diagnosing chronic fatigue syndrome is to rule out any underlying conditions, including psychological disorders, that may be contributing to the problem. Some of the other illnesses that can cause excessive fatigue are: hypothyroidism, anemia, Lyme disease, and chronic hepatitis. (See the differential diagnosis below.)

1994 Revised Case Definition Of Chronic Fatigue Syndrome (CFS)
The Annals of Internal Medicine 

Major Criteria 

A case of chronic fatigue syndrome must include the presence of the following: 

1. Clinically evaluated, unexplained, persistent, or relapsing chronic fatigue that is of new or definite onset (has not been lifelong); is not the result of ongoing exertion; is not substantially alleviated by rest; and results in substantial reduction in previous levels of occupational, educational, social, or personal activities. 

2. Other clinical conditions that may produce similar symptoms must be excluded by thorough evaluation, based on history, physical examination, and appropriate laboratory findings. These conditions include malignancy, autoimmune disease, localized infection (such as endocarditis, Lyme disease, or tuberculosis), fungal disease (such as histoplasmosis, blastomycosis, or coccidioidomycosis), and parasitic disease (such as toxoplasmosis, amebiasis, giardiasis, or helminthic infestation; disease related to HIV infection; chronic psychiatric disease, either newly diagnosed or by history (such as endogenous depression, hysterical personality disorder, anxiety neurosis, schizophrenia, or chronic use of major tranquilizers, lithium, or antidepressive medications); chronic inflammatory disease (such as sarcoidosis, Wegener's granulomatosis, or chronic hepatitis); neuromuscular disease (such as multiple sclerosis or myasthenia gravis); endocrine disease (such as hypothyroidism, Addison disease, Cushing syndrome, or diabetes mellitus); drug dependency or abuse (such as alcohol, controlled prescription drugs, or illicit drugs); side effects of a chronic medication or other toxic agent (such as a chemical solvent, pesticide, or heavy metal); or other known or defined chronic pulmonary, cardiac, gastrointestinal, hepatic, renal, or hematologic disease. 

Minor Criteria 

Symptom Criteria 

The concurrent occurrence of four or more of the following symptoms, all of which must have persisted or recurred during 6 or more consecutive months of illness and must not have predated the fatigue: 

The method used to establish the presence of these and any other symptoms should be specified. 

Differential Diagnosis

The Differential Diagnosis in Patients Presenting with CFS:

Related Topics: Symptoms of CFS

Next Topic: Causes of CFS

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