(CDC, 1994; Mayo Clinic staff, 2011; National Collaborating Centre for Primary Care, 2007). It is clear that CFS is not depression, but it may be associated with depression.

Multivitamins can be useful for patients who do not have a balanced diet. Clinicians may offer recommendations to reduce stress and improve sleep, such as relaxation techniques and limitation of caffeine intake. Such relaxation techniques as visualization can be used to manage pain, sleep problems, and comorbid anxiety. Alternative therapies (for example, yoga, Tai Chi, acupuncture, and massage) may help to lessen pain and increase energy (CDC, 1994; Mayo Clinic staff, 2011; National Collaborating Centre for Primary Care, 2007).


There appears to be a tendency to experience and communicate psychologic distress in the form of physical symptoms and to seek medical attention for these symptoms (Katon and Walker, 1998; Shorter, 1993). Often, the physical symptoms remain medically unexplained and are associated with increased medical visits and unnecessary medical tests, which may result in iatrogenic complications. Among the many terms used in the literature to label these somatic presentations, somatization symptoms was the most common for decades. That designation has been gradually replaced with more descriptive terms, such as medically unexplained symptoms, unexplained symptoms, and functional somatic symptoms.

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the new criteria being developed by the American Psychiatric Association, those syndromes are classified under the heading “Somatic Symptom Disorders” (SSDs). Their key characteristic is the presence of or preoccupation with physical symptoms that suggest a medical condition but cannot be satisfactorily explained with traditional physical and laboratory assessments (APA, 2012). DSM-5’s SSDs include illness anxiety disorder, functional neurologic disorder (conversion disorder), psychologic problems that affect a medical condition, and disorders not elsewhere classified. A distinctive characteristic of patients who have SSDs is not a somatic symptom itself but how a patient experiences it, interprets it, and presents it to a clinician. Despite the relevance of these somatic presentations in medicine, their definition and classification remain difficult and controversial, and this has led to frequent revisions of nomenclatures that move the target used to designate “cases” and complicate the clinical recognition and management of the syndromes.

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