The epidemiology of CFS is a frequent source of confusion. Many of the current estimates of prevalence are flawed because of inadequate methodology. Several factors may influence the estimate and associations found.

• Some studies have failed to differentiate CFS as defined by patients or their doctors, who believe that CFS (or sometimes myalgic encephalomyelitis) is the appropriate diagnosis, from CFS as defined by meeting the symptom criteria.(9) We suspect the latter outnumbers the former by perhaps ten to one. For example, only 12 per cent of primary care patients who fulfilled the complete CFS criteria used an equivalent term to refer to their illness. (19

• As described above it can be very difficult to differentiate CFS from depressive and anxiety disorders. Estimates that do not exclude these diagnoses are much higher than those that do.(1>

• Recent studies demonstrate that previous reports suggesting that teachers or health-care professionals are susceptible to CFS may be influenced by selection bias and treatment-seeking behaviour, and hence are not true risk factors. A similar argument applies for social class—the apparent excess of higher socio-economic classes visible in all specialist clinics is probably due to selection, referral, and attributional biases. (1.1)

New epidemiological studies of improved methodological rigour have begun to emerge. It is too early to give an exact picture, but it is clear that somewhere between 0.3 and 1 per cent of the general population fulfil the current criteria (3) for CFS, the figures for primary care being slightly higher.(1) CFS is thus both common and, because it is by definition associated with functional impairment, is also a public health problem worthy of note.

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