| Onset | | | | university and was unable to work. He has |
| Some cases of CFS start gradually, but the | | | | commented that the degree of isolation he |
| majority start suddenly, often triggered by a | | | | suffered directly contributed to his strong |
| 'flu-like viral or similar illness. People with CFS may | | | | Christian faith and his choice to become a |
| improve or recover after several months, or | | | | song-writer and singer. |
| many years, or not at all. It is not known whether | | | | Post-exertion symptom exacerbation |
| any CFS sufferer has truly recovered to | | | | One of the most common and recognizable |
| pre-illness levels, or whether their symptoms have | | | | aspects of CFS is what is called "post-exertional |
| merely subsided enough for them to live a more | | | | malaise". When people with CFS exert themselves |
| normal life. Some sufferers have a remission for | | | | beyond their limits (and their limits may change |
| months or years only to later relapse, often more | | | | daily), their symptoms worsen. Exertion includes |
| severely. | | | | cognitive effort. The harder the exertion and the |
| Sudden onset cases | | | | longer it lasts, the worse the symptoms will be |
| Many people with CFS report a sudden, drastic | | | | afterward, and with greater recovery time. |
| start to their illness. Some people can remember | | | | Although symptoms may increase immediately |
| a specific day or even hour when they first | | | | and proportionally, usually their full extent is |
| became ill. | | | | delayed by 24 or more hours, which can make |
| Often CFS starts with, or is triggered by, another | | | | judging appropriate activity difficult. |
| illness. Many people report getting a case of the | | | | A cyclical pattern can occur when patients work |
| 'flu', exposure to an allergen (a cough or sniffle | | | | harder because they "feel better" or are having a |
| caused by paint, a new pet, or construction dust), | | | | "good day", leading them to think they can exert |
| or a severe infection such as bronchitis, from | | | | themselves more than usual. However, the |
| which they seem never to fully recover and | | | | excess exertion leads to worse symptoms on |
| which slowly evolves into CFS. Some patients | | | | the following day. Thus it is difficult for patients to |
| claim that vaccination, especially with recombinant | | | | maintain an even level of activity, or to tell if they |
| vaccine against hepatitis B, is another cause of | | | | are improving. In sufferers without a diagnosis of |
| acute onset CFS. Other patients begin with Lyme | | | | CFS, or a proper understanding of how CFS |
| disease, which despite a standard course of | | | | affects exertion, this can lead to a "downward |
| treatment, may 'evolve' clinically from the | | | | spiral", where a sufferer will try to work harder to |
| symptoms of acute Lyme to those of CFS. | | | | make up for the previous day's lack instead of |
| Because CFS symptoms bear a striking similarity | | | | resting. This exhausts them further, and often |
| to those of late-stage Lyme disease,[9] this has | | | | can trigger a relapse or worsening of their |
| become an area of great controversy. Some | | | | condition. If the original exertion, which can be |
| clinicians assume the Lyme infection has been | | | | physical or mental in nature, was particularly |
| eradicated after a course of treatment and | | | | severe, the sufferer may deteriorate to a point |
| diagnose CFS by the Fukuda definition, while | | | | where they are unable to care for themselves. |
| others treat such cases as seronegative, chronic | | | | Many cases then result in hospitalisation because |
| Lyme infection (see The Lyme controversy). | | | | the condition has deteriorated a great deal. |
| Other, noninfectious triggers may include car | | | | However, it must be noted that patients may |
| accidents, moving house, and stressful life | | | | deteriorate due to external stressors, |
| situations. Some patients say they felt unusual or | | | | complications, co-morbid illness, or for unknown |
| uneasy for a short period (days or weeks) | | | | reasons, and in those cases, patient exertion |
| before the onset. | | | | cannot be blamed for a patient's deterioration. |
| Gradual onset | | | | Also, some patients have a progressive course |
| Other cases have a very slow, gradual onset, | | | | which cannot be explained through activity levels. |
| sometimes spread over years. People with gradual | | | | When the illness is coupled with unaccommodating |
| onsets may not realize there is anything wrong | | | | family, friends, colleagues, often due to stigma, |
| for quite some time. Patients may believe they | | | | and social repercussions such as financial needs, |
| have a minor illness, or ascribe their weakened | | | | housing problems, the struggle to obtain disability |
| condition to stress, and assume they will improve | | | | benefits or insurance, discrimination and |
| with time. It is only when the patient realized that | | | | misconception within the care sector, it can put |
| their condition is truly debilitating, or the stress is | | | | demands on the sufferer exceeding their safe |
| removed and the symptoms remain, that the | | | | capabilities. Many sufferers describe needing to do |
| patient will begin to seek treatment. | | | | things for themselves in the times they feel |
| There is no standard course for CFS. For a | | | | better simply because there is no-one to delegate |
| patient to be officially diagnosed with chronic | | | | to. |
| fatigue syndrome, the symptoms must have | | | | Duration |
| persisted for at least six months. However, the | | | | People with CFS may improve after a few |
| Fukuda paper also contains a definition of "chronic | | | | months, or after many years, or never at all. |
| fatigue" which is reserved for those who do not | | | | They may reach a plateau at some constant level |
| meet the full criteria for CFS. Since the 50% rule | | | | of health, or may progressively decline. Often, the |
| of Holmes et al was dropped, it is possible that | | | | symptoms change over time, or cycle irregularly. |
| there are people with CFS whose level of disability | | | | Relapses are common, especially after stressful |
| is so low that they never seek treatment, or | | | | life events or additional illness. Exertion can cause |
| receive an accurate diagnosis, though this is not | | | | not merely a relapse, but a worsening of overall |
| permitted by the Canadian definition. | | | | health. Undiagnosed cases of CFS often worsen |
| Activity levels | | | | as the sufferer attempts to return to a 'normal' |
| Activity levels vary widely among CFS patients. | | | | level of activity, only to make their condition |
| While some are able to lead a relatively normal | | | | worse through exertion. |
| life, others are totally bed-bound and unable to | | | | Of those CFS patients moderately to severely |
| care for themselves. Almost all patients find they | | | | affected, many may expect to remain so for an |
| must drastically reduce their activity from | | | | indeterminate period, even for the duration of |
| pre-illness levels, regardless of their previous level | | | | their life. It is not known whether any patients |
| of athleticism, and must severely modify or give | | | | truly 'recover' entirely from the illness, or merely |
| up physical hobbies and exercise. Many patients | | | | recuperate enough to regain previous levels of |
| find themselves unable to work full-time, or at all. | | | | activity. Few patients report a total 'cure'. CFS can |
| A considerable number of CFS cases in many | | | | prove to be fatal, as in the case in the UK of |
| countries are on disability benefits or private | | | | Sophia Mirza, where the coroner recorded a |
| insurance, or have made claims and been denied. | | | | verdict of "Acute anuric renal failure due to |
| One notable CFS sufferer is soccer legend Michelle | | | | dehydration arising as a result of CFS". The |
| Akers, who reported struggling with the illness for | | | | pathologist said, "ME describes inflammation of the |
| many of the later years of her career. However, | | | | spinal cord and muscles. My work supports the |
| more severe sufferers felt that an active | | | | inflammation theory. There was inflammation in |
| professional athlete "poster child" like Akers helped | | | | the basal root ganglia." (It should be noted that |
| to trivialize the syndrome in the eyes of the | | | | inflammation of the 'muscles' is erroneous, as |
| public, and made it much more difficult for highly | | | | opposed to the CNS inflammation, as this has |
| incapacitated patients to be taken seriously. It is | | | | never been a criteria for a ME diagnosis). CFS has |
| worth noting that the condition can strike persons | | | | been linked[1] to heart damage and cardiac arrest |
| of all activity levels, and that patients may have | | | | among other causes of death; research has not |
| had high levels of physical health and activity | | | | yet progressed to determine whether this is in |
| before onset. | | | | fact the case, and some patients die from |
| Another sufferer was Stuart Murdoch of the | | | | co-morbid diseases. To date there is one study |
| Scottish indie-rock band, Belle & Sebastian. | | | | on CFS life expectancy |
| Murdoch was afflicted before graduating from | | | | |