Chronic Fatigue Syndrome: More Than Just Feeling Tired

Medically reviewed by April Justice, LICSW
Updated June 12, 2024by BetterHelp Editorial Team

Everyone may feel tired and experience fatigue occasionally, such as after a few nights of poor sleep, strenuous exercise, or a particularly challenging bout of jet lag. However, these forms of fatigue tend to be much different than what people experience when they have chronic fatigue syndrome (CFS). Also known as myalgic encephalomyelitis, chronic fatigue syndrome can be defined as a condition that causes long-term, severe fatigue, as well as other symptoms, like brain fog, joint pain, and more. In addition to physical symptoms, CFS can also be emotionally and mentally debilitating. However, both cognitive behavioral therapy and graded exercise therapy have shown potential as effective treatment methods for CFS. Those living with this condition may prefer to complete treatment through an online therapy platform, as this generally requires less energy expenditure than visiting a therapist’s office in person.

Chronic fatigue syndrome can make life more challenging

Symptoms of chronic fatigue syndrome

Chronic fatigue syndrome usually has a variety of symptoms, but there are generally three core symptoms that can be important to note. These include:

  1. A significantly lowered ability to do things that were common before the illness: For a diagnosis of CFS, this lowered ability to tolerate activity must typically occur along with fatigue and last for at least six months. The fatigue accompanying this core symptom can be severe, tends to be unrelated to unusually difficult or strenuous activity, and does not generally go away with rest or sleep.
  2. Symptoms worsen after physical or mental exercise that would not have been an issue before the illness: This aspect of the condition is often known as post-exertional malaise (PEM). People with CFS may explain it as a collapse or crash. After physical or mental activity, people with CFS might experience increased symptoms, or new symptoms may appear, including a sore throat, unrefreshing sleep, dizziness, headaches, or exhaustion. Recovering from PEM can take days or even weeks, leaving some people homebound or unable to get out of bed. 
  3. Sleep problems: People with CFS may have problems falling or staying asleep and may not feel rested, even after a full night of sleep.

In addition to these three core symptoms, people must generally experience at least one of the following:

  • Thinking and memory problems: People with CFS may struggle with memory, attention to detail, or quick thinking. Some individuals with the condition describe it as having brain fog. 
  • Having worsening symptoms when sitting or standing upright (orthostatic intolerance): While standing or sitting, people with CFS may feel weak, lightheaded, or dizzy, and they may faint or experience vision changes, like seeing spots or blurring.

Physical symptoms

Some people with CFS have physical symptoms as well. Pain can be common, but it can vary significantly, potentially involving joint pain, swelling and redness, muscle aches and pains, or headaches. 

Other physical symptoms may include the following: 

  • Tender lymph nodes in the armpits or neck
  • Recurring sore throat
  • Irritable bowel syndrome
  • Night sweats and chills
  • Allergies or sensitivities to chemicals, light, odors, food, or noises
  • Shortness of breath
  • Muscle weakness
  • Irregular heartbeat

According to the CDC, people with CFS may have experiences that differ from those without the condition. These may include:

  • Going to a school event may leave someone with CFS housebound for days and unable to do necessary tasks. 
  • Grocery shopping might cause an individual with CFS to need a nap in the car before they can drive home.
  • Showering may leave someone with CFS unable to do anything for days. 

Causes and risk factors

Researchers do not currently know the exact cause of CFS, but they are studying possible causes, including changes in the immune system, infections, genetics, changes in energy production, and stress.

Risk factors of CFS include the following:

  • Age – CFS most commonly occurs in adults between 40 and 60 years of age.
  • Gender – Women seem more likely to develop CFS, but this may be because they are more likely to report their symptoms than men. 
  • Other medical issues – People with a history of complex conditions, like postural orthostatic tachycardia syndrome or fibromyalgia, may be more likely to develop CFS, and they can share similar symptoms, potentially making it difficult for healthcare providers to diagnose the correct condition.


There is substantial evidence that two treatments for CFS can be effective: cognitive behavioral therapy (CBT) and graded exercise therapy.

CBT generally focuses on how people think, feel, and act. It can help people with CFS understand how their fears of activity may cause more stress and fatigue and teach them how to change their thoughts surrounding different activities. 

Although updated research may be needed, one study involving adults with CFS found that CBT usually had positive effects on fatigue levels, anxiety, depression, and PEM. Participants in the study typically rated their health levels more positively after completing therapy. 

Graded exercise therapy frequently involves a gradual increase in physical activity with the goal of enhancing an individual’s ability to function. The study discussed above found that this form of therapy was normally just as effective as CBT for extreme fatigue and other aspects of CFS, excluding depression. 

In this trial, participants were asked to gradually increase their physical activity over the course of a year, with the final goal being 30 minutes of light exercise five days a week while watching their heart rate to avoid overexertion. 

Despite the success of these treatments, the effects are usually only moderate and do not necessarily cure CFS. However, everyone’s experience tends to be different. 

CFS and mental health

Chronic fatigue syndrome can affect mental health in many ways, particularly because of how isolating the condition can be. 

Depression and anxiety commonly appear alongside CFS. People with CFS can also be prone to catastrophizing or assuming the worst-case scenario. Meanwhile, because many of them fear movement, believing it’ll worsen their symptoms, they’re usually more likely to withdraw and experience social isolation.

Adults with CFS may face additional pressure due to economic setbacks. Many people with this condition are unable to work a full-time job and may take on easier jobs with less pay as a result. Medical bills may also be significant.

Chronic fatigue syndrome can make life more challenging

Benefits of online therapy

For people with chronic fatigue syndrome, the thought of driving to a therapist’s office and meeting with someone face-to-face may seem overwhelming. Online therapy may be a more accessible option for those with CFS because it can give them access to the kind of support they deserve from the comfort of their own homes. Platforms like BetterHelp can usually match users with a qualified mental health professional within 48 hours of signing up online. Instead of worrying about long drives to an office, individuals with CFS can connect with a therapist through video chats, phone calls, or in-app messaging. This can help them preserve their energy while receiving care.

Effectiveness of online therapy

One of the most effective treatments for chronic fatigue syndrome may be cognitive behavioral therapy (CBT). Research has shown that online CBT can provide an effective method of treating individuals living with CFS. In one study, individuals with CFS participated in an online intervention aimed at reducing fatigue and disability. The outcomes of the study generally showed significant improvements in fatigue severity and physical functioning.


Chronic fatigue syndrome can be defined as a condition that causes long-term, debilitating fatigue, as well as several other physical symptoms that can take a significant toll on a person’s mental health. Research shows that cognitive behavioral therapy can be an effective treatment for CFS, and it may also help with some of the mental health effects of this condition. Online therapy may be a more viable option for people with CFS, as it can empower them to get the help they deserve without expending the energy necessary to leave their homes.
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