Redefining the Chronic Fatigue Syndrome

The chronic fatigue syndrome, a disease that devas-tates patients ' lives and affects between 836 000 and 2.5 million Americans (1), is often ignored or mis-managed by clinicians. The disease affects both chil-dren and adults and both males and females. Affected individuals present with persistent, intense exhaustion that worsens after physical, cognitive, or emotional ef-fort. Even basic household chores can be exhausting, and such tasks as grocery shopping may only be pos-sible on a “good day. ” People with the condition may also have trouble with cognition, finding simple ques-tions hard to answer and describing themselves as hav-ing “brain fog ” and having trouble “finding the right words. ” Despite the intense exhaustion, they find sleep unrefreshing. Persons with the disease experience frustrating ef-fects on their daily functioning and desperately want their old lives back. Although these patients have se-vere disability, many clinicians misdiagnose—and, un-fortunately, sometimes dismiss—the condition as a psychological problem. This may be because many cli-nicians believe there is no objective evidence of pathol-ogy. Adding to the confusion, since Holmes and col-leagues proposed the name and case definition for “chronic fatigue syndrome ” in 1988 (2), several differ-ent diagnostic strategies for the disease have been de-veloped (3, 4), and various names, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), have been used. With this background, the U.S. De-