Chronic fatigue syndrome - Diagnosis 

Diagnosing chronic fatigue syndrome 

There is no test for chronic fatigue syndrome (CFS), but there are clear guidelines to help doctors diagnose it.

Many people consult their GP because they think they have CFS, but only a small minority go on to be diagnosed with it.

CFS is not diagnosed in people who simply feel tired all the time. There are other symptoms that help to confirm the diagnosis (see symptoms of CFS for more information).

Your GP will ask you about your medical history and carry out a physical examination. You may have blood tests and scans to rule out other conditions, such as anaemia (not enough red blood cells), an underactive thyroid gland or liver and kidney problems.

NICE guidelines for diagnosing CFS

Guidelines released in 2007 from the National Institute for Health and Clinical Excellence (NICE) state that doctors should consider diagnosing CFS if a person has fatigue and all of the following apply:

  • There was a clear starting point.
  • It is persistent and/or recurrent.
  • It is unexplained by other conditions.
  • It substantially reduces the amount of activity you can do.
  • It feels worse after physical activity.

The person should also have one or more of these symptoms:

  • difficulty sleeping, or insomnia
  • muscle or joint pain without inflammation (swelling) 
  • headaches 
  • painful lymph nodes that are not enlarged
  • sore throat 
  • poor mental function, such as difficulty thinking
  • symptoms getting worse after physical or mental exertion
  • feeling unwell or having flu-like symptoms
  • dizziness or nausea
  • heart palpitations, without heart disease

This diagnosis should be confirmed by a clinician after other conditions have been ruled out and the above symptoms have persisted for four months in an adult and three months in a child or young person.

For more information, read the NICE guidelines on CFS.

  • show glossary terms
Fatigue
Fatigue is extreme tiredness and lack of energy.

Last reviewed: 13/07/2011

Next review due: 13/07/2013

Comments

6 Comments

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Comments are personal views. Any information they give has not been checked and may not be accurate.

jane clout said on 12 September 2011

This diagnostic criteria is too broad to be of use. Recently, an international team of doctors and scientists with 400 years of experience of ME have published a new, more accurate version known as Myalgic Encephalomyelitis - International Consensus Criteria. You can find the full version, open access here - www.meassociation.org.uk/?p=7173 and the abstract from the J. Int. Med. (the rest behind a paywall) here - onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02428.x/abstract

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nobodysfool said on 21 July 2011

The diagnostic criteria are unclear and misleading . They and contribute to great prejudice and hardship amongst sufferers of ME/CFS.

NICE criteria states that the symptoms must have existed for a minimum of 4 months. The problem is that 4 months is an inadequate period in which to differentiate between cases of prolonged Post Viral Fatigue that are not chronic and ME/CFS which includes a chronic form of Post Viral Fatigue. It can require up to 2 years to establish that there is a chronic syndrome, and even longer if the patient has been neglected.

This failure to differiantiate between Post Viral Fatigue and ME/CFs allows the dangerous bogus notion to persist, that ME/CFS is not caused by neurological damage and immune system abnormality. It allows naive, bigotted and malicious people the opportunity to neglect, discrimminate against, and abuse seriously ill patients.

There is overwhelming evidence that ME/CFS is a persistant neuroligical disorder. It is entirely consistant with an abnormailty of the immune system. Brain scans show considerable abnormalites in brain function which is not consistant with a psychological disorder.

NICE guidlines also include bogus claims based on dishonest reseach co-ordinated by a non-independent reasearcher.

NICE have given undue weight to the unsubstatiated evidence presented by an employee of the Insurance industry.

The guidlines claim that Graded Exercise Therapy can be curative, whereas all patient surveys and respected independent reseachers have reported it as being harmful. There is no scientific rationale as to how GET could possibly work. It is dangerous nonsense.

The claim that CBT can also be curative is also made, in spite of overwhelming evidence to the contrary.

NICE disregards the important benefits of pacing, because it is not curative. This is equivalent of saying it isn't important for a diabetic to maintain an appropriate diet, because it will not cure their condition.

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Janan said on 28 May 2011

The NICE guidelines for diagnosing CFS/ME are outdated and misleading. Applying the above criteria, a person suffering from depression for example, and perhaps experiencing tiredness and headaches could be given a diagnosis of CFS/ME. The Canadian definition, which requires that neurological symptoms must be evident, is much more accurate.
At present, a large number of patients in the UK are mis-diagnosed. Many people suffering from depressive illness are labelled as having CFS/ME. At the same time, many people much more severely affected are diagnosed as having an unknown neurological illness, when they actually have CFS/ME.

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rockinhippy said on 16 June 2010

I am pleased to see that this has been updated & is vastly better than last time I looked....., but having just read the Symptoms list & diagnosis criteria on here, I have to agree with the above poster......I followed their advice & also looked at the Canadian definition ...see here...hope its a link, if not cut & paste

<<http://www.cfids-cab.org/MESA/ccpc.html>>


from my own experience of this illness, & symptoms confirmed as CFS (oh I hate that term as its such a massive understatement) the Canadian definition is MUCH more accurate, I suffer with lot of nerve pain , ANS type symptoms, none of that mentioned here, but seemed well known to your CFS specialist whom I was lucky enough to see............its much less frightening to have these symptoms accepted & listed here, rather than ignored & leave us to wonder what else, or what is really wrong with us....please update

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walkingdead said on 04 June 2010

THANK YOU....

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JustinReilly said on 29 December 2009

I have M.E. and am from the US. The NHS' adoption of the above, extremely inaccurate, 'Oxford' definition of ME/CFIDS, greatly muddies and hampers the science and understanding of the science. This is because the Oxford definition purports to describe 'CFS'; but instead describes Idiopathic Chronic Fatigue i.e. a wastebasket of unexplained states of chronic fatigue. Please change your official definition to the Canadian ME/CFS definition, which is the most accurate definition by far. If the Canadian definition is adopted, useful information will be generated by studies and the patient community will be very thankful and much less combative. Thank you.

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