Physical, Behavioral, and Psychological Risk Factors for Chronic Fatigue Syndrome:A Central Role for Stress?

In spite of the distinct epidemiologic features of chronic fatigue syndrome, its cause remains unknown and no risk factors for the illness have been identified. In order to better characterize CFS, we conducted a case-control study of well-defined CFS cases to identify physical, behavioral, and psychological factors related to the occurrence of CFS. The study, conducted in the metropolitan area surrounding Newark, New Jersey, USA, included 20 patients who fulfilled the CFS case definition and 20 matched controls. All subjects completed a self-administered questionnaire. The greatest difference between cases and controls was the reported level of stress from any of five sources in the 5 years prior to onset of illness (95% vs. 55%; P = 0.01 1). In addition, the risk of CFS was significantly related to the number of sources of stress, especially three or more. Other significant risk factors included a hislory of premenstrual syndrome, a history of eczema, loss of interest in daily activities, and panic altacks. Our results suggest lhat stress may be one of lhe factors related to lhe development of CFS. However, the possibility remains that the observed relationship resulted from a biased recollection of events preceding lhe illness. It is also possible that lhe perception of stress is correlated wilh sorne olher variable related to the pathogenesis of CFS.