A 56-Year-Old Woman With Chronic Fatigue Syndrome

Developing Case Definitions for Symptom-based Conditions: the Problem of Specificity

“…In research studies, there is no assurance that homogeneous populations are being evaluated, either within or between studies, or that the selection of study subjects is unbiased (11,13,16,17). As a result, hypotheses about symptom-based conditions cannot be conclusively refuted (122) and research findings do not lead to generalizations about causes, epidemiology, prognosis, treatment, or prevention (115).…”

“…Using suggested case-definitions, a consistent pattern of organic pathology has not been identified among patients diagnosed with chronic fatigue syndrome (16)(17)(18). Consequently, none of the proposed infectious, toxic, neurologic, endocrine, immunologic, or genetic causes of this postulated disease have been confirmed.…”

“…Consequently, none of the proposed infectious, toxic, neurologic, endocrine, immunologic, or genetic causes of this postulated disease have been confirmed. However, patients frequently describe an acute flu-like illness preceding the development of symptoms (19), and some clinical studies have found indications of diverse types of organic dysfunction among diagnosed patients, including mild hypocortisolism, abnormalities on magnetic resonance imaging and single photon emission computed tomography, hypotension during tilt testing, and changes in CD8+ cytotoxic T cells and natural killer cells (17,18).…”

“…As a result, there is fundamental disagreement over whether chronic fatigue syndrome is a medical or psychiatric disorder, and whether a concurrent psychiatric illness should preclude this diagnosis (9,15,17).…”

A 56-Year-Old Woman With Chronic Fatigue Syndrome, 1 Year Later

“…A 56-Year-Old Woman With Chronic Fatigue Syndrome, 1 Year Later In June 1997, at the Medicine Grand Rounds, Dr Anthony Komaroff discussed Ms H, an educator unable to work because of debilitating symptoms associated with a 2-year history of chronic fatigue. Her ailment, which began shortly after a flu-like illness, was marked primarily by weakness, fatigue, chronic insomnia, and depression that she felt was in response to her symptoms.…”