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SUMMARY Patients (n = 47) presenting to a neurological centre with unexplained chronic "postviral" fatigue (CFS) were studied prospectively. Controls were patients with peripheral fatiguing neuromuscular diseases and inpatients with major depression in a psychiatric hospital. Seventy-two percent of the CFS patients were cases of psychiatric disorder, using criteria that excluded fatigue as a symptom, compared with 36% of the neuromuscular group. There was no difference in subjective complaints of physical fatigue between all groups. Mental fatigue and fatigability was equally common in CFS and affective patients, but only occurred in those neuromuscular patients who were also cases of psychiatric disorder. Overall, the CFS patients more closely resembled the affective than the neuromuscular patients. Attribution of symptoms to physical rather than psychological causes was the principal difference between matched CFS and psychiatric controls. The symptoms of "postviral" fatigue had little ability to discriminate between CFS and affective disorder. The fatigue in CFS appeared central in origin, suggesting it is not primarily a neuromuscular illness. The implications for research and treatment of chronic fatigue are discussed.The clinical problem of patients with severe fatigue without obvious cause has received renewed attention in the professional literature, accompanied by intense media interest. Many of these patients are being diagnosed as "postviral" fatigue (or "chronic mononucleosis" in the USA'), whilst a patients' organisation, the Myalgic Encephalomyelitis ("ME") Association, has become Britain's fastest growing charity.Nevertheless, there remains a lack of data on aetiology, nosology, characteristics, prognosis and treatment.2 There is also no consensus about nomenclature. The term "chronic fatigue syndrome" (CFS)34 has been proposed, as it is an accurate clinical description but has no aetiological implications. It will be used in this paper.Most of the information on the aetiology of chronic fatigue states derives from case-control studies. Evidence of an increased rate of exposure to viral agents in cases, but not controls, has been found in some,56 but not all, studies.7 However, in these papers

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