Joan realized that something was wrong. She had swollen glands, trouble thinking clearly, and dragged through her day. She seemed to be more sensitive to everything in her environment. After a careful examination by the doctor and multiple blood tests, she was told she was HIV+.

Ellen had a bout with the flu and never seemed to recover. She had swollen glands, trouble thinking clearly, and dragged through her day. She seemed to be more sensitive to everything in her environment. After going to several different doctors and having multiple blood tests, she was told she had Chronic Fatigue Syndrome.

Is this an illness or is it an acceptable label for hypochondriacs? Chronic Fatigue Syndrome is a controversial illness. There are some in the medical community who believe strongly that this illness exists and there are many who think Chronic Fatigue Syndrome is a "catch all" for sloppy diagnosticians. The public is split in a similar fashion to the medical community. Some believe it is truly a debilitating illness, with people being sick for months and usually years, sometimes never recovering. Others believe that it is a convenient diagnosis for those who are "burned out," depressed, or chronically symptomatic.

A growing number of medical professionals blame the controversy on troublesome diagnostic criteria put out by the Center for Disease Control in 1988. There were several problems with that criteria:

1. A person would have to be severely fatigued for 6 months before a diagnosis could be given.
2. The average daily activity level had to drop below 50%, a requirement difficult to verify.
3. It was a diagnosis of exclusion. If the person didn't test positive to other illnesses, then the symptom picture was labelled Chronic Fatigue Syndrome.
4. The symptom list was general, so that many illnesses could look like Chronic Fatigue Syndrome.
5. Physical signs were required, something difficult to establish when symptoms change considerably throughout the course of the illness.

The Center for Disease Control has revised the case definition and this was published in December of 1994. Some problems were addressed, but not all:

1. There is a requirement of persistent, chronic fatigue with a definite onset that is not the result of ongoing exertion. All symptoms, however, must be present for 6 months.
2. There is no specific average daily activity level requirement.
3. Unfortunately, other illnesses have to be ruled out first before a diagnosis of Chronic Fatigue Syndrome can be given. This is because a clear diagnostic tool, such as a blood test, has not yet been developed.
4. The symptom list has been reduced and is still general. The symptoms must include at least four (4) of the following in addition to fatigue:
   • Short-term memory or concentration problems
   • Sore throat
   • Tender lymph nodes
   • Muscle pain
   • Joint pain without swelling
   • Headaches
   • Unrefreshing sleep
   • Debility after exercise lasting more than 24 hours
   
   
5. An examination does not have to reveal physical signs; a complete symptom picture is sufficient.

All admit the working case definition is not perfect and will continue to be refined as more is discovered about this illness. Some wonder how an illness recognized by the Center for Disease Control and Social Security can still be disbelieved.

There are those who wonder what the difference is between Chronic Fatigue Syndrome and depression. Pain, weakness, fatigue, confusion, troubles concentrating, memory disturbance, and sleep disorders all can be symptoms of depression. They are different in the following ways:

• Sore throat and swollen lymph nodes are not symptoms of depression.
• Depressed patients usually feel better after exercise, Chronic Fatigue Syndrome patients feel worse and this lasts more than 24 hours.
• Most people, whether healthy or depressed, can improve their performance on a memorization test by using reminders. Reminders are largely worthless to Chronic Fatigue Syndrome patients because of a problem forming new memories.
• A depressed person can handle a brief interruption when memorizing something. Chronic Fatigue Syndrome patients' performance suffers six times as much from the interruption.
• When asked to predict how they will do on a thinking test, depressed people tend to underestimate their abilities, while Chronic Fatigue Syndrome patients tend to overestimate theirs.

So what is the answer? More research. If you do believe you have Chronic Fatigue Syndrome (CFS) and need a diagnosis, find a physician who is familiar with CFS. Most CFS associations and support groups have lists of doctors who are knowledgeable and supportive. For more information, contact

• The Life Strategy Center at (619) 295-9313
  
• The CFIDS Association of America, Inc. at (800) 442-3437.

5/30/98

Barbara Pino, MA, MFCC, is a psychotherapist in private practice in San Diego, California. Having recovered from Chronic Fatigue Syndrome after four years of disability, she specializes in working with immune system issues. Ms. Pino is a CFS resource contact person in San Diego and regularly writes and lectures to promote education in the area of immune system problems. For more information on CFS, please call her at: The Life Strategy Center (619) 295-9313 or contact The CFIDS Association of America, Inc. (800) 442-3437.