Chronic Fatigue Syndrome

What is Chronic Fatigue Syndrome?

Posted Feb 23, 2010

What is Chronic Fatigue Syndrome?

Chronic fatigue syndrome (CFS) (also referred to as Myalgic Encephalitis [ME], and chronic fatigue immune dysfunction syndrome [CFIDS] is a hotly debated topic, with opinions diverging on its cause or causes. The core symptom of this disorder is severe fatigue, which is worsened by activity (post-exertional fatigue). So, while most people feel better after exercise, people with CFS feel worse, and have difficulty recovering (it usually takes a person with CFS more than 24 hours to recover). Associated with this core symptom are a variety of other symptoms including but not limited to: sore throat, tender lymph nodes, short or long term memory problems, muscle pain, headaches which are new (i.e., didn't pre-exist the onset of the fatigue), joint pains, and unrefreshing sleep. These symptoms must have persisted or recurred during six or more consecutive months of illness, must not have predated the fatigue, and must not be caused by a known medical condition.
You should note, that there is even controversy over the definition above, and there is no laboratory marker that is positive or proves the existence of the syndrome.

The Whole Psychiatry approach to Chronic Fatigue Syndrome

First it is important to understand the meaning of the word ‘syndrome'. A syndrome is a group or set of symptoms that cluster together. A syndrome (e.g., pneumonia) can look the same clinically (with pneumonia, you cough, have a fever, produce sputum, have shortness of breath, fatigue and perhaps chest pain), but have different causes (pneumonia can be caused by tuberculosis, pneumococcal pneumonia, mycoplasma, fungal infections, toxic exposures, etc.) and therefore different treatments, depending on the cause. Additionally there are predisposing antecedents (vulnerability factors) for pneumonia, such as alcoholism, cystic fibrosis, or hypothyroidism. This means that people with these antecedents are at higher risk than the average person. Finally, there are chemical mediators of the pneumonia (the substances or factors that act as the medium of illness) such as white blood cells, hormones (e.g. adrenal steroids), and cytokines (the hormones of the immune system).

When one looks at a syndrome with this ‘Whole' perspective, things are both more complicated, and more understandable and treatable. Thus, with CFS, we assume that there are a variety of antecedents, mediators, and triggers, which in combination can produce a syndrome we call CFS/CFIDS/ME. The attempt to find one cause for all people with CFS is a fruitless exercise, just as the attempt to find one cause of depression, pneumonia, diabetes, or cancer is fruitless. However, it is likely that there may be one or perhaps a few final common pathways (e.g., mitochondrial dysfunction-mitochondria being the energy factories of each cell, reduced capillary blood flow and oxygen delivery), yet to be indentified.

What Chronic Fatigue Syndrome is NOT

The Whole Psychiatry understanding of CFS assumes that while there may be psychological antecedents, triggers, or mediators of CFS, CFS is NOT primarily a psychological condition. While psychological treatments may be helpful (e.g., cognitive behavioral therapy), and medication may be useful in some circumstances, these approaches do not get to the roots of the problem. So, while they are usually a secondary part of the picture and the treatment, the main focus of evaluation and recovery-treatment is geared toward identifying the physiological antecedents, triggers, and mediators, which are modifiable. Using this approach most people with CFS can recover fully or significantly. Yet it is clear that there are unknown factors (antecedents, triggers, and mediators) yet to be discovered or proven (e.g., XMRV, unusual cytokine activation patterns), which, despite treatment, leave some people disabled.

You might wonder, if this is not a psychological or psychiatric problem, why would a psychiatrist treat it? The answer is two-fold. First, I myself have had chronic fatigue syndrome and recovered, and second, it was through the process of treating myself, that Whole Psychiatry was borne. Of course, as a result of my own learning, it became apparent that the body and mind are not separate, and are one entity which must be evaluated and treated simultaneously for the best outcome.

The Evaluation and Treatment of Chronic Fatigue Syndrome

The Whole Psychiatry evaluation of chronic fatigue syndrome will involve a careful history, physical and a wide variety of tests, (determined by the history and physical exam), ranging from genetic tests (to determine for example susceptibility to biotoxins, methylation pathways, detoxification pathways), tests of immune function and infection (e.g., NK cell activity, cytokines, CBC, tick borne diseases, viruses), tests of the environment (e.g., mold, chemical exposure), tests of digestive, liver, nutritional and hormonal status, tests of mitochondrial function, neurological tests (e.g., MRI, SPECT, sleep studies, EEG). Based on these test results a treatment plan is initiated.