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The most widely used case definition of chronic fatigue syndrome, published in 1994, consists entirely of symptoms.1 Because anyone can say they have symptoms, clinicians have asked whether objective evidence of underlying biological abnormalities exists.
The Institute of Medicine (IOM) and the National Institutes of Health (NIH) recently concluded that CFS has a biological basis.2,3 Based on a survey of >9000 research articles, the IOM states that CFS “is a serious, chronic, complex systemic disease that often can profoundly affect the lives of patients.”2 Moreover, CFS “is not, as many clinicians believe, a psychological problem,”4 although some patients certainly have psychiatric comorbidities re…