Chronic Fatigue Syndrome Criteria: A Critique of the Requirement for Multiple Physical Complaints

doi:10.1001/archinte.1992.00400200042008

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Vol. 152 No. 8, AUGUST 1992

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Chronic Fatigue Syndrome Criteria

A Critique of the Requirement for Multiple Physical Complaints

Wayne Katon, MD; Joan Russo, PhD

Arch Intern Med. 1992;152(8):1604-1609.

Abstract

Objective.—
The purpose of this study was to test the hypothesis that thepatients with chronic fatigue who have the highest number ofmedically unexplained physical symptoms over their lifetimewould also have the highest prevalence of current and lifetimeaffective and anxiety disorders, lifetime affective symptoms,and the most functional disability. A further goal was to usethis information to modify the current case definition to betteridentify a subgroup of patients with chronic fatigue syndromewho are less likely to have psychiatric illness.

Design.—
Two hundred eighty-five consecutive patients with chronic fatiguewere interviewed with the National Institute of Mental HealthDiagnostic Interview Schedule and completed four self-ratingquestionnaires measuring psychologic distress, functional disability,and the tendency to amplify symptoms. Based on previously publisheddata, patients were divided into four groups with a progressivelyhigher number of lifetime medically unexplained physical symptoms.The prevalence of current and lifetime psychiatric disorders,lifetime psychologic symptoms, and extent of functional impairmentwas then compared in these four groups of patients.

Main Results.—
The prevalence of current and lifetime psychiatric diagnosisand lifetime depressive symptoms increased linearly with thenumber of lifetime physical symptoms that the patient experienced.The extent of impairment in activities of daily living and thetendency to amplify symptoms also increased linearly with thenumber of medically unexplained physical symptoms.

Conclusion.—
The patients with the highest numbers of medically unexplainedphysical symptoms had extraordinarily high rates of currentand lifetime psychiatric disorders. These data suggest thatthe current case definition for chronic fatigue syndrome inadvertentlyselects for patients with the highest prevalence of lifetimepsychiatric diagnoses. A recommendation based on these resultsis to modify the case criteria for chronic fatigue syndrometo include patients with fatigue and few physical symptoms andto identify and consider excluding patients with high numbersof physical complaints.

(Arch Intern Med. 1992;152:1604-1609)

Author Affiliations

From the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle.

Footnotes

Accepted for publication January 16, 1992.

Reprint requests to Department of Psychiatry, RP-10, Universityof Washington, Seattle, WA 98195 (Dr Katon).

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