Chronic Fatigue Syndrome Diagnostic Criteria
The criterion for diagnosing chronic fatigue immunodysfunction syndrome was set by the Center for Disease Control (CDC).
The diagnosis is made based on a thorough exam and an in-depth medical history evaluation. The assessment should include a complete physical exam; a thorough investigation of environmental, viral, and chemical exposure issues; a mental status exam; lab tests; and other diagnostic exams to rule out any underlying or contributing condition that may mimic chronic fatigue immunodysfunction. Chronic fatigue immunodysfunction is a diagnosis of exclusion. This means the diagnosis is made when all other possible conditions have been ruled out.
According to the 1994 criteria, a revision of the 1988 CDC diagnostic criteria, there must be unexplained persistent or recurring chronic fatigue of new onset and the symptoms must have persisted for at least six or more months and must not have predated the fatigue. The fatigue associated with chronic fatigue immunodysfunction is not alleviated by rest, most patients have post-exertional exhaustion and these effects have a significant impact on the patient’s activities of daily living. Activities affected include occupational, educational, social, and personal activities.
Four or more of the following symptoms must be present in order to meet the criteria.
- Cognitive impairment, substantial - reduced short-term memory or loss of concentration. BRAIN FOG - difficulty processing information or finding words
- Throat soreness - nonexudative pharyngitis (unexplained inflammation without secretions)
- Lymph node tenderness
- Muscle pain (myalgia) - persistent and reproducible on repeated examination
- Joint pain(arthralgias), multiple, without swelling or redness
- Headaches of a new type, pattern or severity
- Non-restorative sleep
- Post-exertional malaise (ill feeling) lasting more than 24 hours
The CDC, says the following are commonly observed symptoms in addition to the eight primary defining symptoms of chronic fatigue immunodysfunction.
- allergies or sensitivities to foods, alcohol, odors, chemicals, medications or noise
- brain fog (poor concentration, comprehension, word finding, reasoning and memory)
- chills and night sweats
- chest pain
- chronic cough
- irritable bowel, abdominal pain, nausea, diarrhea or bloating
- irregular heartbeat
- jaw pain
- difficulty maintaining upright position (orthostatic instability, irregular heartbeat, dizziness, balance problems or fainting)
- psychological problems, depression, irritability, mood swings, anxiety, panic attacks
- shortness of breath
- visual blurring, eye pain or dry eyes
- weight loss or gain
Other symptoms that may accompany chronic fatigue immunodysfunction but are not included as part of the diagnostic criteria.
- alcohol intolerance
- gynecological problems including PMS and endometriosis
- low grade fever or low body temperature
- muscle twitches
- paresthesias - abnormal sensations, i.e. burning, numbness, tingling
- ringing in the ears (tinnitus)
- seizures
- sensitivity to heat and/or cold
- SICCA syndrome (mucosal dryness, such as dry mouth and eyes)
Note: Chest pain, bowel dysfunction, irregular heart beat, jaw pain, balance problems, headaches, muscle pain, paresthesias, tinnitus, shortness of breath, SICCA symptoms, sore throat, and visual disturbances can also be caused from untreated trigger points found in chronic myofascial pain. Chronic myofascial pain should be excluded before a diagnosis of chronic fatigue immunodysfunction is made if those are the only contributing symptoms.