Handbook of Psychology

CHAPTER 16

Chronic Fatigue Syndrome

LEONARD A. JASON AND RENEE R. TAYLOR

365

CASE DEFINITION 365
SOCIODEMOGRAPHICS 369
EPIDEMIOLOGY 369
ETIOLOGY 371
SUBTYPES 374
PROGNOSIS 377
TREATMENT 378
Pharmacological and Alternative Treatments 378
Nonpharmacological Interventions 379

Medical Utilization 380

Treatment Attributions 381

STIGMA 381

FUTURE DIRECTIONS 383

REFERENCES 384

This chapter explores chronic fatigue syndrome (CFS), an
illness that is not easily explained, and the societal re-
sponse to it. In addition, it offers research strategies to
address stigmatization caused by biases and unexamined
assumptions. In the area of CFS, key decisions regarding
the name, case definition, epidemiology, and treatment
were made many years ago within a sociopolitical context
in which CFS was assumed to be a psychologically based
problem (Friedberg & Jason, 1998). In part, some of the
decisions may have been due to the predominance of fe-
male patients with this illness, whose medical complaints
have historically been discredited by the predominantly
male establishment (Richman & Jason, 2001; Richman,
Jason, Taylor, & Jahn, 2000). Many physicians and
other professionals have continued to believe that most in-
dividuals with this syndrome have a psychiatric illness.
Many CFS activists have argued that the current diagnostic
label contributes to the invalidation and stigmatization
process. Due to the controversy surrounding the diagnos-
tic label, etiology, and diagnostic criteria of CFS, people
with the illness frequently face disbelieving attitudes from
their doctors, family, and/or friends; and many experience
profound losses in their support systems (Jason et al.,
1997).

CASE DEFINITION

The original case de“nition of CFS (Holmes et al., 1988)

de“ned CFS as a new onset of persistent or relapsing, debili-

tating fatigue •severe enough to reduce or impair average

daily activity below 50% of the patient•s premorbid activity

level for a period of at least six months.ŽIn addition, a patient

must meet one of the following minor criteria requirements:

(a) 8 or more of 11 minor symptoms (e.g., sore throat, painful

lymph nodes, unexplained generalized muscle weakness)

must be reported; or (b) at least 6 of the 11 minor symptom

criteria must be reported and at least 2 of 3 physical signs

must be documented by a physician on two occasions. How-

ever, the requirement for a high number of nonspeci“c symp-

toms in the original case de“nition of CFS, in conjunction

with misuse and biased scoring of certain types of psychiatric

measures, has been associated with erroneous estimates of the

extent of comorbidity between CFS and psychiatric disorders.

The syndrome called CFS did not emerge spontaneously

in the mid-1980s. Chronic fatigue has been described clini-

cally for more than 150 years, and the term neurasthenia

(fatigue as an illness in the absence of disease), which was

coined in 1869 by George Beard, was one of the most preva-

lent diagnoses in the late 1800s (Wessely, Hotopf, & Sharpe,

1998). However, by the early part of the twentieth century,

the diagnosis neurastheniawas used infrequently, and those

with a diagnosis of severe fatigue were often considered by

medical personnel to have either a depressive illness or

another psychiatric condition.

Financial support for this study was provided by NIAID grant

number AI36295.