Chronic Fatigue Syndrome: Symptoms, Diagnosis, Causes, Treatment

  • Chronic Fatigue Syndrome (CFS) is not well understood and therefore difficult to diagnose.
  • About a quarter of people with CFS cannot leave their homes due to severe pain and fatigue.
  • The cause of CFS is unclear and there is no cure, but lifestyle changes can help manage symptoms.

Chronic fatigue syndrome (CFS) is a serious condition characterized by severe exhaustion that does not improve with rest or sleep.

The disease, also known as myalgic encephalomyelitis (ME), is not well understood, but doctors believe that it involves both the neurological and immune systems, and that it is often triggered by a seemingly unrelated bacterial or viral infection, which makes it difficult to diagnose.

There are currently no FDA-approved treatments for CFS, but certain protocols may improve quality of life, says Emily Taylorvice president of advocacy and engagement at Solve ME/CFS.

Keep reading to learn more about CFS and how to tell if you might have the condition.


Many people with CFS are not able to carry out daily activities such as working or cooking due to their intense fatigue and 25% are confined to the house. This is explained by low quality of life.

What’s more, people with CFS experience symptoms beyond just fatigue, says Medhat MikhaelMD, Pain Management Specialist and Medical Director of the Nonoperative Program at Spine Health Center in MemorialCare Orange Coast Medical Center.

The following symptoms may come and go, or get worse over time:


Research suggests that up to 2.5 million Americans may have CFS, but that less than 10% people with CFS have been diagnosed.

This is at least partly because there are no test for SFCand these symptoms can be confused with other autoimmune and nervous system conditions, or mental illness, including:

  • Fibromyalgia
  • Dysautonomia
  • Endometriosis
  • Arthritis
  • Depression
  • Anxiety

Additionally, doctors are often unfamiliar with CFS, making it difficult for patients to get a diagnosis, says Jacob TeitelbaumMD, internist with Vitality101.

“CFS is no more a mental illness than cancer,” he says. “Unfortunately, over the last century, some doctors have had a habit of suggesting to people that ‘I don’t know what’s wrong with you, so you are crazy.'”

Teitelbaum adds that it can “delay treatment and cause deep anguish.”


Because CFS is underdiagnosed, it’s hard to know who is most affected. Some research indicates that the condition is more common in 40-60 years oldwhile other research shows that it is more common in 20-40 years old.

CFS is diagnosed most in white individuals and four times more often in women than in men. Many people diagnosed with CFS have had a recent infection, and infections are explored as a possible cause. Another risk factor is childhood trauma.

Although no definitive cause or mechanism of CFS is understood, Teitelbaum says that to research indicates that people with the condition may have “tripped a circuit breaker” – so to speak – in the hypothalamus. This area of ​​the brain that produces hormones that control vital body functions ranging from heart rate and hunger to libido and sleep.

Symptom management

There is no cure for CFS, but some people manage their symptoms through lifestyle changes, medications, and research-backed protocols.

Be prepared: CFS treatment often involves trial and error. Doctors usually treat symptoms causing the greatest disruption in a person’s life, including:

Post-exercise discomfort

Post-exercise sickness (PEM) occurs when symptoms worsen even with minor physical or mental exertion.

To combat PEM, doctors recommend perambulatean approach where a person carefully paces their efforts throughout the day in order to control symptoms.

You can do this with the help of your doctor who can help you track patterns between certain strains and symptoms. While the day-to-day approach is flawed, it helps many people in the long run, Taylor says.

Sleep problems

Sleep disturbances are common with CFS. The first step in dealing with difficulty falling or staying asleep is establishing good sleep hygiene, with practices like going to bed at the same time every day and avoiding screens before and during bed.

Treatments for insomnia, including cognitive behavioral therapy, short-term sleeping pills, and


can also help. Addressing other symptoms, such as pain, can to help people fall asleep and stay asleep.


People with CFS often experience widespread, widespread pain throughout their body, especially in their joints.

Doctors work with people with CFS to manage aches and pain with light exercise like yoga or stretching and complementary medicine like acupuncture or massage. Over-the-counter pain relievers, such as aspirin or ibuprofen, can also help.

If the pain persists, your doctor may recommend working with a pain management specialistwho can help develop a pain management plan using lifestyle changes, behavioral therapy, and possible prescriptions.

Stress, anxiety and mental health

People with CFS are more likely than the general population to have mood disorders, including anxiety and



Researchers are still investigating whether there is a biological mechanism at play, or whether the daily challenges of living with CFS and being unable to do normal activities lead to an increased risk of depression.

Treatment for CFS-related mental health disorders includes mindfulness and relaxation therapies, as well as medication to treat depression or anxiety.

General well-being

People with CFS particularly benefit from a healthy lifestyle, including a balanced diet and mental health care.

Teitelbaum recommends the SHINE Protocol, which he developed to treat people with CFS and fibromyalgia. It is a comprehensive set of lifestyle adjustments and medical interventions that addresses:

  • Sleep: The protocol recommends getting 8-9 hours of sleep and using insomnia treatments, if necessary, to achieve this.
  • Hormones: The protocol aims to stabilize hormone levels through drugs that target the thyroid and adrenal glands.
  • infections: The protocol identifies, treats and prevents infections, ranging from yeast infections to viral illnesses.
  • Nutrition: The protocol recommends a well-balanced diet to remedy any nutritional deficiency.
  • Exercise: After 10 weeks of the program, patients are asked to increase their exercise slowly and under the supervision of a doctor.

Insider’s Takeaways

Chronic fatigue syndrome is a condition that causes extreme exhaustion, mental fog, as well as generalized pain throughout the body.

Up to 90% of cases go undiagnosed and researchers are working to better understand the disease.

If you think you have CFS or have recently been diagnosed, finding a doctor who knows about CFS can improve your outcomes, Teitelbaum says.

“It’s a complex disease that requires a doctor who knows the disease well,” he says.