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Chronic Fatigue Syndrome
Epidemiology and
Treatment Considerations
Renee R. Taylor, Ph.D.
University of Illinois at Chicago
Chronic Fatigue
Syndrome
Current US Case Criteria
(Fukuda et al., 1994)
Development sponsored by the
Centers for Disease Control
CFS Criteria
Persistent or relapsing fatigue
of 6 months or longer duration
with other known medical and
primary psychiatric conditions
excluded by clinical diagnosis
CFS Criteria
(Continued)
• clinically evaluated, unexplained,
persistent or relapsing chronic
fatigue that is of new or definite
onset (i.e., not life-long)
• fatigue is not the result of ongoing
exertion
CFS Criteria
(Continued)
Concurrent occurrence of four
or more of the following:
1. Short term memory/concentration
Persistent or recurring impairment in
short term memory or concentration
severe enough to cause substantial
reductions in previous levels of
occupational , educational, social,
or personal activities
CFS Criteria
(Continued)
2. sore throat
3. tender cervical or axillary lymph
nodes
4. muscle pain
5. joint pain in multiple joints without
joint swelling or redness
CFS Criteria
(Continued)
6. headaches of a new type, pattern
or severity
7. unrefreshing sleep
8. post exertional malaise lasting
more than 24 hrs
History of CFS
• Neurasthenia coined in 1869 by George
Beard.
• One of the most prevalent diagnoses in
the late 1800’s.
• Herbert James Hall (a physician and
one of the founders of occupational
therapy) treated patients with
neurasthenia.
• By the early 1900’s the diagnosis was
used less frequently and it is possible
that those with severe fatigue were
considered to have depression or
another psychiatric condition.
History of CFS
• Cluster outbreaks of unexplained
fatiguing illnesses have been
documented throughout the world
for the past 45 years (e.g., icelandic
disease, epidemic neuromyalsthenia,
chronic encephalomyelitis).
• Patterns of associated symptoms
have differed and differed from
modern case criteria.
• Further controlled investigations of
so-called cluster outbreaks were not
confirmed (Fukuda et al., 1997).
Conditions That Can
Explain Chronic Fatigue
•
•
•
•
•
•
•
Cancer
Narcolepsy
Sleep apnea
Severe obesity
Hypothyroidism
Alcohol or substance abuse
Unresolved hepatitis B or C
Conditions That Can
Explain Chronic Fatigue
(Continued)
•
•
•
•
•
Lupus
• Iatrogenic,
Tuberculosis
e.g.,
Lyme disease
medication
side effects
Multiple sclerosis
• HIV/AIDS
Rheumatoid
arthritis
Conditions That Can
Explain Chronic Fatigue
(Continued)
•
•
•
•
•
•
Dementia
Schizophrenia
Bipolar disorder
Bulimia nervosa
Anorexia nervosa
Major Depression with Melancholia
Possible Causes of CFS
• Infectious agents
• Immunological defects
• Hypothalamic-pituitary-adrenal axis
dysfunction (cortisol dysregulation,
hypocortisolism, dysfunction in
neuroendocrine-immune
communication).
• Orthostatic intolerance/Neurally
Mediated Hypotension
• Biopsychosical
Epidemiology
Findings from the Jason et al. (1999)
Chicago Prevalence study
Jason, L.A., Richman, J.A.,
Rademaker, A.W., Jordan, K.M.,
Plioplys, A.V., Taylor, R.R., McCreedy, W.,
Huang, C., & Plioplys, S. (1999).
A community-based study of chronic
fatigue syndrome.
Archives of Internal Medicine, 159,
2129-2137.
Myths about CFS
Late 1980s and early 1990s
• Patients were thought to have
“Yuppie Flu”
–Few minority group members
–Mostly women
–Well educated
Myths vs. Facts
Myth: CFS is a relatively rare
disorder
Fact: CFS affects over 800,000
adults and adolescents in the
United States
(Jason et al., 1999)
Myths vs. Facts
Myth: The highest prevalence of
CFS is among young, affluent,
white professionals
Fact: Latinos have the highest
prevalence; African Americans have
the second highest
Race
• Latinos: 726 per 100,000
(twice that of Whites/non-Latino
EuroAmericans)
• Whites: 318 per 100,000
• African Americans: 337 per 100,000
Gender
• Women have a much higher
rate of CFS than men
• 522 women per 100,000
compared to
291 men per 100,000
Social Loss
100% report
disruption in
relationships
CFS in Context
CFS
Health Care
Stigma
77% report
negative
interactions with
health care
providers
Immunological
Neurological
Gastrointestinal
Musculoskeletal
Endocrinological
Psychiatric
Job/Income
Loss
76%
Unemployment
Median
Income Loss:
$13,000
Sociopolitical
Stigma
Mass Media
CDC
Misappropriating
Research Funds
Four Models of Chronic
Fatigue Syndrome Etiology
PSYCHIATRIC
CFS is a
form of
somatic
depression
or hypo
chondriasis
Chronic
Fatigue
Syndrome
BIOLOGIC
The validity
of CFS is
supported
by Patho
physiology
SOCIAL -
BIO-
ENVIRONMENT PSYCHOSOCIAL
Negative
contacts,
multiple
roles
Relational
synergy
between all
factors
Is CFS a Distinct Entity?
Findings from the Taylor et al.
(2001) study
Taylor, R.R., Jason, L.A., &
Schoeny, M. (2001). Latent
variable models of functional
somatic distress in a
community-based sample.
Journal of Mental Health, 10,
335-349.
CFS: A Distinct Diagnostic Entity?
QUESTION:
• Debate regarding whether CFS differs from
somatic depression, somatic anxiety,
fibromyalgia, and irritable bowel syndrome.
• Are these disorders better explained as a
single unitary construct of functional
somatic distress (somatoform disorders)?
METHOD:
• Tested one-, two- and five-factor solutions
using confirmatory factor analysis
• Used factor scores to predict actual
diagnostic outcomes in logistic regression
CFS and Child Abuse?
The Current Status of
Trauma Research
• While many have speculated that
histories of childhood sexual,
physical, or emotional abuse may
play a role in the etiology or course
of CFS, few rigorous empirical
studies have been conducted.
Prior Studies
• Rosenthal (1996). 27 physician-diagnosed
participants with CFS responded to a
survey query in The CFIDS Chronicle.
• 100% reported a history of severe or
prolonged stress or repeated traumatic
events.
• 67% reported comorbid diagnosis of PTSD
• 74% felt that stress or trauma contributed
to the development of CFS
Prior Studies
• Tiersky et al. (1998) compared the
occurrence of childhood trauma in
individuals with CFS and healthy
controls.
• Individuals with CFS demonstrated a
higher incidence of extreme illness or
injury prior to age 17.
• No other significant group differences
related to abuse history were found.
Prior Studies
• Doyle et al. (1999) conducted a largescale study of domestic violence and
sexual abuse history among women
physicians.
• There was a significantly higher rate
of CFS among physicians reporting a
history of domestic violence (16.1%)
as compared with physicians not
reporting such history (3.5%).
Prior Studies
• Doyle et al. (1999) did not
detect significant differences
in rates of CFS among
physicians reporting a lifetime
history of sexual abuse.