Depression, in any case, is very common in the general population. It affects up to one-fifth of all Americans at some point in their lives, and most depressed people feel fatigued.
Stress
There is some evidence that stress may be a trigger for CFS in people genetically at-risk for the disease. A long-term study of twins in Sweden, reported in 2006, found that higher emotional instability and self-reported stress were associated with higher risk of developing a CFS-type illness.
Conditions That Commonly Occur in CFS Patients
A number of conditions overlap or co-exist with chronic fatigue syndrome and have similar symptoms. In fact, in one study of patients with CFS only 38% of patients had a sole diagnosis. The others also had fibromyalgia, multiple chemical sensitivity, or both. It is not clear if these conditions or others are risk factors for CFS, are direct causes, have common causes, or have no relationship at all with CFS.
Fibromyalgia. Fibromyalgia causes prolonged fatigue and widespread muscle aches and is the disease most often confused with CFS. They also commonly appear together. In one study, for example, 37% of patients who met the criteria for CFS also had a co-diagnosis of fibromyalgia. In fact, many experts believe fibromyalgia is simply another variant of chronic fatigue syndrome or different manifestations of the same disease, with CFS patients experiencing severe fatigue while fibromyalgia patients experience more pain. There is a hypothesis that the connection may be found in central sensitization, which is known to cause fibromyalgia and may also cause CFS.
A characteristic feature of fibromyalgia is the existence of at least 11 distinct sites of deep muscle tenderness that hurt when touched firmly. The sites often include the following:
- The side of the neck
- The top of the shoulder blade
- The outside of the upper buttock and hip joint
- The inside of the knee
Some patients with CFS exhibit similar tender pressure points. Recurrent sore throat, headache, low fever, and depression are also common symptoms of fibromyalgia. Like CFS, fibromyalgia is chronic and not curable.
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