What is Chronic Fatigue Syndrome?

Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME/CFS), is a serious and complex chronic condition causing profound fatigue and a wide range of other debilitating symptoms.

  • Extreme fatigue: severe, persistent fatigue that doesn't improve with rest, making even basic daily activities difficult
  • Post-exertional malaise (PEM): a worsening of symptoms after physical, mental or emotional exertion, which can last hours, days or longer
  • Other symptoms: sleep problems, cognitive difficulties, muscle and joint pain, headaches, dizziness, flu-like symptoms, sore throat, and tender lymph nodes

Possible causes

The exact cause of ME/CFS is still unknown, but research points to a combination of factors: viral infections (such as Epstein-Barr virus or cytomegalovirus), immune system dysregulation, genetic predisposition, and triggers such as stress, trauma or environmental exposures.

Diagnosis

Diagnosis is based on a careful review of symptoms and medical history, ruling out other conditions with similar presentations. An Internal Medicine physician with deep knowledge of systemic disease is best placed to make the diagnosis.

M.I.A.L.'s multidisciplinary pathway — a body-mind approach

A comprehensive, holistic Internal Medicine review with Dr Luigi De Michele, alongside a relevant diagnostic and physiotherapy programme with Dr Valentina Buscemi, across eight structured sessions:

1
The impact of CFS on life. The vicious cycle of pain and fatigue — the "boom and bust" cycle: psychoeducation. Practice: present-moment awareness, grounding.
2
CFS and stress. Mechanisms; noticing internal experience — reactions, emotions, thoughts, habits, body sensations — and their toll on energy. Window of tolerance and pacing. Body scan.
3
Checking in with yourself. The 3 Ps — planning, prioritising, pacing. Goal setting and barriers. Mindful movement.
4
Working with the mind. Defusion techniques, relaxation and self-regulation (including breathing), movement practice.
5
Values-based action. Your inner compass — choice points, goal setting towards improving physical activity levels.
6
Acceptance. Being aware, doing what matters, opening up to difficult experience. Sleep hygiene. Movement practice.
7
Kindness towards the body. Self-care and self-compassion; the compassionate-hand practice; compassionate actions and movement.
8
Communication. Summary of skills learnt and how to sustain change in the long term.