Issues for a definition of chronic fatigue syndrome

The case definition shown in TabJeJ, has significant limitations.

• It overlaps with other functional medical diagnoses.

• Most patients who meet existing criteria can be given an alternative psychiatric diagnosis.

• The homogeneity of the patient group it identifies is doubtful.

Overlap with other medically unexplained syndromes

Medically unexplained chronic fatigue is common in patients with other 'functional' syndromes. Functional syndromes are medical diagnoses where there is no identifiable pathology such as idiopathic chronic pain, fibromyalgia, and irritable bowel syndrome. Although chronic pain syndromes are principally characterized by pain, fibromyalgia by tender points, and irritable bowel syndrome by symptoms of bowel disturbance, all these syndromes are also associated with chronic fatigue, and patients diagnosed with one of these often meet the diagnostic criteria for CFS.(1.)

Overlap with psychiatric syndromes

Most patients who meet criteria for CFS also fulfil the criteria for a psychiatric diagnosis. Many patients have anxiety and depressive disorders; others merit diagnoses of somatoform disorder or neurasthenia. Therefore from the psychiatrist's perspective it is parsimonious to ask whether a diagnosis of CFS is necessary, if the patient's symptoms can equally well be described by a psychiatric diagnosis.

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