Fatigue syndrome - causes, symptoms and treatment

Fatigue - causes and therapy

Conditions of exhaustion per se are an extreme burden in everyday life. Even worse, however, is chronic fatigue syndrome (myalgic encephalomyelitis) or CFS, as the syndrome is often called based on its English name "chronic fatigue syndrome". This can result in serious loss of concentration, memory and performance for months. In such a case, patients often mistakenly think that inactivity improves the condition. But that can be a treacherous fallacy.


The chronic fatigue syndrome hides a neurological disease, the mechanism of which has not yet been fully researched. So far, experts are still arguing about the exact forms and differentiation systems for CFS. However, there is agreement on the point in time and under what criteria an exhaustion syndrome actually exists. According to the definition of the Federal Association of Chronic Fatigue Syndrome Fatigatio e.V., this is the case if there is a permanent reduction in performance of at least 60% over a period of at least 6 months.

In addition to fatigue and tiredness, the main characteristic symptoms are sleep and concentration disorders as well as painful symptoms. Affected people are usually no longer able to work properly or concentrate on something. Even everyday routines like doing housework or running errands are a big challenge for people with fatigue syndrome. Around 300,000 people suffer from this syndrome in Germany, with women between the ages of 20 and 50 most commonly affected.

Important: Chronic fatigue syndrome should not be confused with fatigue itself. Although this is also characterized by persistent tiredness, it is usually a side effect of a previous illness and is therefore limited in time, or its causes are easy to determine. In addition, CFS must also be differentiated from the burn-out syndrome.

Immune system dysfunction as the main cause

As described, the exact causes of its origins have so far hardly been clarified. What is certain, however, is that the disease leads to a body-wide dysregulation of the nervous, immune and hormonal systems. This results in chronic fatigue and exhaustion, which affects almost all areas of life. A relatively recent study suggests that CFS may be an autoimmune disease. This would mean that the body's misregistration stems from an impaired immune system.

Various influencing factors are considered for corresponding malfunctions, including viral infections, which are known to have a strong impact on the immune system and can cause numerous disturbances in the immune system. Three diseases that are particularly suspected in this regard to promote fatigue syndrome are:

  • Pneumonia,
  • Rubella,
  • Whistling glandular fever (mononucleosis)

Furthermore, existing allergies cannot be excluded as a possible disruptive factor for the immune system. Since allergy sufferers are naturally sensitive to irritant factors, it is conceivable that the acute irritation caused by allergens exhausts the immune function to such an extent that CFS occurs.

Fatigue syndrome and psychological stress

It's no secret that stress promotes exhaustion in everyday life. Stressful situations can also influence the development of a tangible fatigue syndrome. CFS is not a psychosomatic disease in the strict sense, but everyday stress, mental stress, grief and worry drain the immune system and can also trigger autoimmune reactions.

Dietary habits can play a role

Proper nutrition is essential for trouble-free immune function. For example, the immune system needs a sufficient supply of proteins to produce antibodies. Vitamins and minerals also strengthen the immune system in the event of illness. If malnutrition occurs, immunological disorders cannot be excluded. In addition, a regulated nutrient balance also plays a key role in physical fitness. Decreased performance and fatigue can therefore intensify due to improper nutrition.

Environmental factors

The immune system responds very quickly to an unhealthy living and working environment. A high level of pollution in the air, for example from car or industrial emissions, is always associated with symptoms such as fatigue, fatigue and sleep disorders. The same applies to high noise pollution at the place of residence or work. In addition, toxins in work materials, in the household or in the building fabric of buildings should not be underestimated as triggers of immunological disorders.

Symptoms of chronic fatigue syndrome

The symptoms of a chronic fatigue syndrome are particularly noticeable in the area of ​​the psyche or mental performance. But physical sensitivities are also not uncommon for CFS. Especially when it comes to nerve and heart problems, the disease can be very noticeable. The syndrome also promotes increased sensitivity to irritant factors. Typical are, for example, a special sensitivity to light, noise and temperature, increased sensitivity to joints and lymph nodes with an increased risk of swelling of the armpits and cervical lymph nodes, as well as a special sensitivity to pain, which manifests itself primarily in sore throat, muscle, headache and joint pain. Overall, the following complaints can be recorded for CFS:

  • Psychological complaints such as Irritability, depressive moods or inner unrest
  • Cognitive disorders such as Memory, concentration, reading and perception disorders
  • Sensitivity disorders such as Light, noise, pain and temperature sensitivity, joint and lymph sensitivity
  • Condition and recovery problems such as Disorders of the day-night rhythm, lack of recovery, loss of performance, fatigue
  • Organ disorders such as Difficulty breathing and voiding, gastrointestinal problems, cardiac arrhythmia

Diagnosis and therapy

A detailed patient survey is particularly important at CFS. In order to raise a suspicion, the following questions in particular must be answered here:

  • How long has the patient been suffering from exhaustion?
  • What accompanying symptoms are associated with fatigue?
  • Have the symptoms persisted for more than 6 months?
  • Does the state of exhaustion improve after a good night's sleep or not?
  • Do the symptoms possibly stem from stress or an underlying illness?
    (important for a differential diagnosis with regard to burn out and fatigue)
  • How much does the state of exhaustion have on everyday patient life?

As soon as the most important questions within a medical history have been clarified, various laboratory tests are available depending on the suspicion regarding possible causes. These can include allergy, blood and urine tests, for example, which can be used to collect information on existing immune sensitivities, nutrient supply and signs of illness. Imaging methods such as ultrasound or CT are used as required.

Treatment for CFS

Appropriate therapeutic measures for chronic fatigue syndrome include less drug-related than behavior-oriented steps and measures for recovery. However, the latter does not mean to assume alleged passivity, because targeted employment measures are extremely important to alleviate fatigue. However, these should also bring a certain routine back into the patient's everyday life.

Behavioral therapy

In the course of behavioral training, the main thing with CFS is to restore cognitive performance. Since depression and the feeling of being exhausted in the everyday demands play an important role in the illness-related symptoms, above all measures for mental and mental stress management have to be carried out. Relaxation measures such as yoga, meditation or private relaxation rituals (e.g. through music or aromatherapy) are very suitable for this.

It is imperative to refrain from clinging to stressful everyday patterns at CFS. This may also mean withdrawing from work, even if society or the boss would expect otherwise. Excessive external pressure usually only worsens the disease. Instead, an attempt should be made to find a daily rhythm that is beneficial for the exhausted body. In an emergency, this must also be discussed with employers, families and friends so that a solution for constructive time planning can be found together. Nonetheless, patients should value routine sleep hygiene. Regulated bed times, ideally accompanied by a soothing evening ritual, contribute a lot to regeneration.

Tip: A cup of calming tea with relaxing herbs such as lavender, St. John's wort or valerian is highly recommended before going to bed.

Harmful environmental influences should also be avoided with regard to one's own behavior. This means not only noise and stressful social contacts, but also pollutant effects such as exhaust gases, allergens and other disease-causing factors (e.g. infectious agents). Furthermore, a healthy diet is essential to strengthen the weakened immune system again. In this regard, minerals such as iron, iodine, selenium and zinc as well as vitamins A, C and E are a must for a strong immune system.

Exercise and occupational therapy

In addition to relaxation, relaxing activities should not be missing when it comes to facing a state of exhaustion. Physiotherapy can be just as effective here as a regular walk or moderate exercise, such as swimming or cycling. Leisure activities such as gardening, interior design, reading, cooking rituals or cozy evenings with friends help the body to regain its balance.

It should be mentioned that the respective activities should be tested individually by each patient. Not everyone responds to the same measures, which is why people should discover for themselves what helps them to overcome their exhaustion. However, it is generally not advisable to use exhausting extreme sports and hectic activities in everyday life.

Talk therapy

Emotional stress, trauma and emotional exceptional states are best discussed in CFS as part of a psychotherapeutic interview. Addressing or processing them yourself is not always successful, especially not when it is a very serious issue. As a result, we recommend that you seek professional help in this area. (Ma)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Miriam Adam, Barbara Schindewolf-Lensch


  • Professional associations and specialist societies for psychiatry, child and adolescent psychiatry, psychotherapy, psychosomatics, neurology and neurology from Germany and Switzerland, fatigue as a permanent condition - the chronic fatigue syndrome (accessed: July 16, 2019), neurologen-und-psychiater-im-netz.org
  • Merck & Co., Inc .: Chronic Fatigue Syndrome (Systemic Stress Intolerance Disease; SEID) (accessed: July 16, 2019), msdmanuals.com
  • German Society for General Medicine and Family Medicine: S3 guideline fatigue, as of December 2017, degam.de
  • Centers for Disease and Prevention (CDC): Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (accessed: July 16, 2019), cdc.gov
  • Fatigatio e.V .: Federal Association of Chronic Fatigue Syndrome (accessed: July 16, 2019), fatigatio.de
  • German Society for ME / CFS e.V .: What is ME / CFS? (Accessed: 16.07.2019), mecfs.de
  • Robert Koch Institute: RKI report on chronic fatigue syndrome, January 2015, rki.de
  • Mayo Clinic: Chronic fatigue syndrome (accessed: July 16, 2019), mayoclinic.org

ICD codes for this disease: F48, G93ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.

Video: Chronic Fatigue Syndrome at UCLH (January 2022).