Different modes of fatigue onset in male Gulf War veterans versus male civilians raise the possibility that chronic fatigue syndrome (CFS) may not be a single disease entity. We addressed this issue by comparing 45 male veterans with CFS to 84 male civilians who satisfied identical case criteria. All were evaluated for fibromyalgia (FM), multiple chemical sensitivity and psychiatric comorbidity. CFS was more likely to present in a sudden flu-like manner in civilians than veterans (p < .01) and comorbid FM was more prevalent in civilians (p < .01). These findings question the assumption that all patients with CFS suffer from the same underlying disorder.
Black, D.W., Doebbeling, B.N., Voelker, M.D., Clarke, W.R., Woolson, R.F., Barrett, D.H. et al. (2000). Multiple chemical sensitivity syndrome: Symptom prevalence and risk factors in a military population. Archives of Internal Medicine, 160, 1169-1176.
4.
Bourdette, D.N., McCauley, L.A., Barkhuizen, A., Johnston, A., Wynn, M., Joos, S.K. et al. (2001). Symptom factor analysis, clinical findings, and functional status in a population-based case control study of Gulf War unexplained illness. Journal of Occupational and Environmental Medicine, 43, 1026-1040.
5.
Buchwald, D., Umali, P., Umali, J., Kith, P., Pearlman, T., & Komaroff, A.L. (1995). Chronic fatigue and the chronic fatigue syndrome: Prevalence in a Pacific Northwest health care system . Annals of Internal Medicine, 123, 81-88.
6.
Card, J.J. (1987). Epidemiology of PTSD in a national cohort of Vietnam veterans. Journal of Clinical Psychology, 43, 6-17.
7.
Ciccone, D.S., & Natelson, B.H. (2003). Comorbid illness in the chronic fatigue syndrome: A test of the single syndrome hypothesis. Psychosomatic Medicine, 62, 268-275.
8.
Fukuda, K., Nisenbaum, R., Stewart, G., Thompson, W.W., Robin, L., Washko, R.M. et al. (1998). Chronic multisymptom illness affecting Air Force veterans of the Gulf War. Journal of the American Medical Association, 280, 981-988.
9.
Fukuda, K., Straus, S.E., Hickie, I., Sharpe, M.C., Komaroff, A., Schluederberg, A. et al. (1994). The chronic fatigue syndrome: A comprehensive approach to its definition and study. Annals of Internal Medicine , 121, 953-959.
10.
Gray, G.C., Hawksworth, A.W., Smith, T.C., Kang, H.K., Knoke, J.D., & Gackstetter, G.D. (1998). Gulf War veterans' health registries. Who is most likely to seek evaluation? American Journal of Epidemiology, 148, 343-349.
11.
Helzer, J.E., & Robins, L.N. (1988). The Diagnostic Interview Schedule: Its development evolution, and use. Social Psychiatry and Psychiatric Epidemiology , 23, 6-16.
12.
Helzer, J.E., Spitznagel, E.D., & McEvoy, L. (1987). The predictive validity of lay Diagnostic Interview Schedule diagnoses in the general population. Archives of General Psychiatry, 44, 1069-1077.
13.
Holmes, G.P., Kaplan, J.E., Schonberger, L.B., Straus, S.E., Zegans, L.S., Gantz, M.M. et al. (1988). Definition of the chronic fatigue syndrome . Annals of Internal Medicine, 109, 512.
14.
Jason, L.A., Richman, J.A., Rademaker, A.W., Jordan, K.M., Plioplys, A.V., Taylor, R.R. et al. (1999). A community-based study of chronic fatigue syndrome. Archives of Internal Medicine, 159, 2129-2137.
15.
Kang, H.K., Natelson, B.H., Mahan, C.M., Lee, K.Y., & Murphy, F.M. (2003). Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: A population-based survey of 30,000 veterans. American Journal of Epidemiology, 157, 141-148.
16.
Marcus, S., Robins, L.N., & Bucholz, K. (1990). Quick Diagnostic Interview Schedule 3R version 1. St Louis, MO: Washington University School of Medicine.
17.
McCauley, L.A., Joos, B.K., Barkhuizen, A., Shuell, T., Tyree, W.A., & Bourdette, D.N. (2002). Chronic fatigue in a population-based study of Gulf War veterans. Archives of Environmental Health , 57, 340-348.
18.
Pollet, C., Natelson, B.H., Lange, G., Tiersky, L., DeLuca, J., Policastro, T. et al. (1998). Medical evaluation of Persian Gulf veterans with fatigue and/or chemical sensitivity. Journal of Medicine , 29, 101-113.
19.
Reid, S., Hotopf, M., Hull, L., Ismail, K., Unwin, C., & Wessely, S. (2001). Multiple chemical sensitivity and chronic fatigue syndrome in British Gulf War veterans. American Journal of Epidemiology, 153, 604-609.
20.
Robins, L.N., & Helzer, J.E. (1985). Diagnostic Interview Schedule (DIS): Version III-R . St Louis, MO: Washington University School of Medicine.
21.
Schluederberg, A., Straus, S.E., Peterson, P., Blumenthal, S., Komaroff, A.L., Spring, S.B. et al. (1992). Chronic fatigue syndrome research: Definition and medical outcome assessment. Annals of Internal Medicine , 117, 325-331.
22.
Sherman, J.J., Turk, D.C., & Okifuji, A. (2000). Prevalence and impact of posttraumatic stress disorder-like symptoms on patients with fibromyalgia syndrome. Clinical Journal of Pain, 16, 127-134.
23.
Taylor, R., & Jason, L.A. (2001). Sexual abuse, physical abuse, chronic fatigue, and chronic fatigue syndrome: A community-based study. Journal of Nervous and Mental Disease, 189, 709-715.
24.
Ware, J.E., Jr, Snow, K.K., Kosinski, M., & Gandek, B. (1993). SF-36 Health Survey: Manual and interpretation guide, 1st edn. Boston: The Health Institute, New England Medical Center.
25.
Wolfe, F., Smythe, H.A., Yunus, M.B., Bennett, R.M., Bombardier, C., Goldenberg, D.L. et al. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: Report of the Multicenter Criteria Committee. Arthritis and Rheumatism, 33, 160-172.
26.
Zhang, Q., Natelson, B.H., Ottenweller, J.E., Servatius, R.J., Nelson, J.J., DeLuca, J. et al. (2000). Chronic fatigue syndrome beginning suddenly occurs seasonally over the year. Chronobiology International , 17, 95-99.
