The specificity of the CDC-1994 criteria for chronic fatigue syndrome: comparison of health status in three groups of patients who fulfill the criteria

Ann Epidemiol. 2004 Feb;14(2):95-100. doi: 10.1016/j.annepidem.2003.10.004.


Purpose: The Centers for Disease Control (CDC)-1994 definition of chronic fatigue syndrome (CFS) is very broad, and there have been suggestions that it lacks specificity. To test this, we have compared three groups of patients, all of whom fulfill the criteria but self-report different etiologies.

Methods: Patients with self-reported symptoms which developed sporadically (sCFS, n=48); after Gulf War service (GW, n=24); and following exposure to organophosphate insecticides (OP, n=25) underwent a clinical examination, completed the MOS SF-36 quality of life and Hospital Anxiety and Depression scales, and were assessed for major and minor criteria for CDC-1994 CFS.

Results: Significant differences in simple clinical measures and outcome measures were observed between groups. The GW group had significantly more severe physical symptoms-fatigue, muscle and multi-joint pain-than OP or sCFS, and the sCFS group was significantly less impaired than the other two groups in terms of role emotional and mental health. In all three groups, a majority of patients exhibited muscle weakness in the lower limbs, and significant numbers of patients had absent or abnormal reflexes.

Conclusions: Differences in simple, easily performed clinical outcome measurements can be observed between groups of patients, all of whom fulfill the CDC-1994 criteria for CFS. It is likely that their response to treatment may also vary. The specificity of the CFS case definition should be improved to define more homogeneous groups of patients for the purposes of treatment and research.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Centers for Disease Control and Prevention, U.S.
  • Environmental Exposure / adverse effects
  • Fatigue Syndrome, Chronic / classification
  • Fatigue Syndrome, Chronic / diagnosis*
  • Fatigue Syndrome, Chronic / etiology
  • Fatigue Syndrome, Chronic / physiopathology
  • Female
  • Humans
  • Insecticides / toxicity*
  • Male
  • Middle Aged
  • Muscles / pathology
  • Organophosphorus Compounds*
  • Persian Gulf Syndrome / complications*
  • Persian Gulf Syndrome / physiopathology
  • Quality of Life
  • Self Disclosure
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Sickness Impact Profile*
  • United States


  • Insecticides
  • Organophosphorus Compounds