Although the accounts of fatigue in CFS are very dramatic, fatigue symptoms are not restricted to people diagnosed with CFS. In fact, fatigue is one of the most commonly reported symptoms. Typically, 20 to 40 per cent of participants in general population studies report feeling tired or fatigued all the time (Lewis and Wessely 1992). In primary practice samples, the rates are even higher. A recent study, conducted in 1,000 primary practice patients, found 67 per cent of women and 45 per cent of men reported fatigue in the past month (Kroenke 1998). For 5-10 per cent of patients, fatigue will be the principal reason for the consultation (Cathebras et al. 1992). A large community study found that only a small minority of people reporting excessive fatigue met criteria for CFS (Pawlikowska et al. 1994). However, they did not find a qualitative difference in the fatigue experienced and concluded that CFS exists at the end of a continuum of fatigue severity rather than being a distinct entity.
Other CFS symptoms are also common in the community, with 36 per cent of primary care patients reporting headache, 34 per cent insomnia, and 59 per centjoint or limb pain (Kroenke 1998). General population surveys also show that during any two-week period up to 30 per cent of people complain of muscle aches and pains, 38 per cent of headache, and 16 per cent of sleep disturbance (Dunnell and Cartwright 1972; Hannay 1978). While it may be logical to assume that these symptom reports are a result of biological processes, there is now substantial evidence to show that how individuals interpret bodily sensations and symptoms is strongly affected by psychological processes.
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