Feeling tired is a common experience, which we all live in certain periods of life. But what happens when tiredness becomes constant, does not improve even after rest and begins to interfere with daily activities? In these cases we could find ourselves in front of something more complex: a condition known as chronic tiredness syndrome (or chronic fatigue syndrome, cfs).
This represents a complex condition and still the subject of research, but with very specific characteristics: it does not resolve with rest, it has an important impact on the quality of life and mainly involves women between 18 and 50 years 【Carlo-Stella et al., 2004】. The difference with a “normal” condition of tiredness lies in the chronicityin the impossibility of reducing sensations with rest and in the presence of related symptoms.
In this article we will try to clarify: we will see what are the signals not to be underestimated, the possible causes and psychological strategies that can help those who live with this condition. Because recognizing one’s tiredness – and give it a name – can be the first step to return to feel better.
What is chronic fatigue
Let’s try to define the syndrome with the words of Carlo-Stella et al. (2004, p.547):
Currently the pathology is considered a syndrome, consisting of a constellation of at least three symptoms and/or signs that are believed to be connected to each other, but which are not associated with a patognomonic diagnostic data (clinical objectivity, laboratory or instrumental tests). It follows that the diagnosis is essentially clinical, based on the feedback of the symptoms complained by the patient and/or any objective signs that together are considered significant. Diagnosis is a diagnosis of exclusion of other causes of tiredness (for which the differential diagnosis is very extensive)
Symptoms of chronic fatigue: physical, cognitive, emotional
The first attempt to definition dates back to the contribution of Holmes and colleagues (1988). However, the presence of two major criteria and eleven minors was not effective in reducing the great variety of clinical manifestations and allowing diagnosis. Fukuda et al. (1994) thus made changes. The Two major criteria that is to say:
- “New onset of debilitating, persistent or recurring tirednessin negative anamnesis, that does not resolve with bed rest, which reduces daily activities of at least 50% and which has lasted for at least six months“(Carlo-Stella et al., 2004, p.547);
- exclusion of other clinical conditions useful to explain the symptoms (For example, oncological, autoimmune, rheumatological diseases, inflammation, psychiatric diseases, endocrine pathologies, neuromuscular, chronic inflammatory, drug addiction).
THE minor criteria were simplified and identified in the following:
- fever and chills
- sore throat
- MiaStenia (weakness)
- muscle and joint pain
- headaches
- sleep disturbance
- prolonged tiredness after physical exercise that cannot be resolved with rest
- neuropsychological disorders As photophobia (hypersensitivity to light), amnesia, irritability, mental confusion, difficulty in concentration (brain fog or cerebral fog).
I was also redefined i Objective criteria In the following without the actual presence, it is necessary to put the diagnosis:
- fever detected by a doctor
- Faringodenia
- cervical or axillary lymphadenopathy.
The identification of the syndrome would be made complicated by its non -isolated pathology, but associated with psychiatric syndromes (anxiety, depression, somatizations such as irritable colon syndrome) or rheumatological (fibromyalgia) (Carlo-Stella et al., 2004).
To put the diagnosis, i Two major criteria and at least eight than the minor ones. Given the vastness and non -specific symptoms, an accurate anamnesis is fundamental.
Causes and psychological factors
The variety of manifestations and decorations led to hypothesize different etiological hypotheses.
Chronic fatigue causes:
- Infectious factors (infections from epstein-barr virus, mononucleosis, HIV)
- Immunological factors (altered values in the activity of natural killer cells and altered production of cytokines were found in some people to whom the syndrome was diagnosed)
- neurological factors. In this case there could be a involvement of the stress axis (hypothalamic-pituitary-length) (Ursini et al., 2010) with a lower production of cortisol. Another interesting hypothesis is that relating to “SICKNESS Behaviour“. Infections or stress in predisposed subjects would lead to the production of pro-inflammatory cytokines. The production of these substances would determine symptoms similar to those that are found in chronic fatigue syndrome.
A complex syndrome that embraces the still mysterious psyche-soma intertwining. As frequently observed on these occasions, there are also connections with psychological causes (Ercolani & Razzaboni, 2000).
The principalThe psychological factors At the base of the syndrome they can be:
- the stress: in all its different forms and events, for example in correlation to work or in burnout syndrome;
- mental and emotional overload: the difficulty in recognizing, elaborating and transforming emotions connected to particular moments of life (relationships, particular evolutionary tasks, important changes) can determine an increased emotional weight and the feeling of being dominated;
- trauma or mourning difficult to process: traumatic or mournful events can become complicated and block the person in the evolutionary trajectory of their life cycle generating stagnation, a sense of inadequacy or mood disorders;
- depression And anxiety: the presence of anxious disorders and mood disorders can be associated with chronic tired syndrome;
- lifestyles that are difficult to support: tendency to control, hyperactivity, poor rest, excessive rigidity in the cognitive and emotional style with which we look out at the different situations, can favor the onset of symptoms.
When to worry and to whom to contact
The psychoinmunoneuroendocrinología is helping to reveal the complexity of the relationship between mind and body in the manifestation of numerous pathologies which, apparently, do not only find their cause and explanation only in the soma.
Numerous syndromes find greater possibility of explanation in a model that describes the intertwining and mutual influence of the physicist and the psychic. In numerous syndromes, the body takes charge of giving plastic representation and embodied to what the mind struggles to process and express consciously. Somatization processes are increasingly studied and recognized in numerous areas of medicine.
The complexity of a syndrome such as chronic fatigue requires to deepen symptoms and signals that are placed on the border between mental and body. Specifically, it may be useful to pay attention to the following signs:
- presence of tiredness and weakness that do not resolve with recovery and rest
- persist over time of symptoms and feeling of weakness and tiredness
- impact on the daily activities of tiredness (reduction of the ability to work, study or face free time)
- Impact on mood and presence of anxiety: depression and chronic fatigue.
In these cases it may be useful to contact a doctor first. As the Higher Institute of Health in the Pages of the Index dedicated to chronic effort syndrome highlights, however, the importance of emotional support in the therapy of people who find the symptomatological framework is not to be underestimated.
Alongside the body, it is important to take care of the mental aspect therefore. Contacting a professional psychologist or psychotherapist can ultimately be useful above all to deal with any aspects connected to anxiety and depression, in managing the impact of syndrome on everyday life, in facing an adequate psychoeducation about symptoms and strategies to deal with them.
When the syndromes are placed on the border between mind and body, adequate coordination of the therapeutic action in concert between general practitioner, psychologist or psychotherapist and possibly of the specialist also becomes essential. This model is strongly supported by the approach of primary care.
How to fight chronic fatigue: psychological strategies and healthy habits
Any pharmacological interventions (prescription of antidepressants, antiretroviral, anxiolytic drugs) must be evaluated and decided by a doctor. However, a psychological path can be useful in suggesting the remedies for chronic fatigue:
- Stress and thoughts management: Psychotherapy can help manage the stress linked to work and relationships, to refigate dysfunctional thoughts and schemes that can produce expenditure of energy with ruminations or a sense of inadequacy, uselessness, impotence and ineffectiveness;
- Psychoeducation about hygiene of sleep and rest: a psychological journey can help reflect on the need to take rest spaces and the care of good practices and routines that favor asleep and sleep
- Mindfulness and relaxation techniques: psychological paths based on technical specifications can favor the ability to create spaces for reflection, dialogue with their own interiority, listening to one’s emotions, identification of dysfunctional cognitive patterns
- listening, self -care and body: The space of psychotherapy can become an invitation to slow down, stop, listen to your needs, desires, emotions and sensations.
To conclude: listen to your yawn!
Weakness, tiredness, physical symptoms (headache, sore throat, fever, sleep disorders), cognitive (difficulty in concentrating, brain fog), emotional (anxiety and mood disorders), make chronic fatigue syndrome a clinical manifestation that can be placed in the border area between the body and the mind.
In the event that the persomatología perdui over time and does not resolve with rest, it is useful not to underestimate it. Contacting a doctor in the first instance and subsequently to a psychologist or a psychotherapist are fundamental passages to take care of their physical and psychological well -being. In short, we listen to our yawns!
