Chronic fatigue syndrome: What are its symptoms? Health insurance now recognizes chronic fatigue syndrome as a condition in its own right, ruling out any psychological cause. But what exactly is it, and what symptoms should raise concern?
Health insurance now recognizes chronic fatigue syndrome as a disease in its own right, ruling out any psychological cause. But what exactly is it, and what symptoms should raise concern?
This is a major turning point for patients. On August 6, France’s health insurance system revised the page on chronic fatigue on its Ameli.fr website, as reported by France Inter. The condition is now described as a disease in its own right, and references to a “psychiatric or psychological disorder” have been removed. The syndrome is described as “a disease causing disabling chronic exhaustion and worsening symptoms following minor exertion.”
Chronic fatigue syndrome (CFS), also known as “myalgic encephalomyelitis,” can result in a major loss of independence. Its prevalence is estimated at between 0.2% and 0.4%, or approximately 250,000 to 300,000 patients in France—a figure that has risen following cases of long COVID. The disease primarily affects women (six to seven women for every three to four men) and often develops after a viral infection. The condition is characterized by “persistent fatigue” lasting more than six months and not improved by rest, as well as “prolonged exhaustion even after very light exertion,” according to the French Chronic Fatigue Syndrome Association (ASFC).
“It is disabling chronic fatigue: people can no longer do what they used to do,” Professor Jean-Dominique de Korwin, Professor of Internal Medicine at the University of Lorraine and Nancy University Hospital, explained in a previous article. “This fatigue is accompanied by autonomic and neurocognitive disorders, including orthostatic intolerance—when the person stands up, they feel unwell—and cognitive difficulties (memory and attention problems). Significant sleep disturbances are common, and sometimes pain is also present. Symptoms become more pronounced when people exert themselves. The reactions following physical or mental exertion are disproportionate, resulting in post-exertional exhaustion,” he said. This post-exertional malaise is a key symptom. Other symptoms may also occur, including “sore throats,” “tender cervical or axillary lymph nodes,” “myalgia” (muscle and joint pain), and digestive problems.
Diagnosis is based exclusively on clinical assessment. The general practitioner must first rule out other causes of exhaustion (cancer, sleep apnea, depression) before referring the patient to a specialist (internist or neurologist). Once other possible causes have been ruled out, the combination of the three key features—fatigue, unrefreshing sleep, and post-exertional exhaustion—along with cognitive or orthostatic symptoms can establish the diagnosis. This medical clarification puts an end to the tendency to view the disease primarily through a psychological lens. Before the change in classification, “everything was explained as a psychological problem, and people were told that if they did a little exercise, made more effort, and meditated, they would feel much better,” Pietro Tomé, president of Afemise, recalled on France Inter.
Today, there is no curative treatment. “It is possible to limit worsening of the condition through daily support, treatment of symptoms, and an appropriately adapted level of activity,” France’s health insurance system states on its revised page. Management notably relies on pacing (energy management) to prevent relapses. The ASFC’s practical guides recommend “identifying triggers” and “breaking tasks down” in order to remain below one’s exhaustion threshold. However, this institutional recognition could pave the way for better administrative recognition of disability, adjustments to sick leave arrangements, and easier access to long-term condition status for affected patients.
