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Always Tired? It Could Be Chronic Fatigue Syndrome

27 Jun 2024

Dr Serena In, Clinical Psychologist and Head of Department at IMU University sheds some light on this lesser-known condition and how to find help.

“Why am I so tired even though I had a full night’s sleep?”
“Everybody thinks I’m being lazy, but I’m just exhausted all the time.”
“No amount of coffee seems to help; how am I supposed to work?”


Thoughts like these are constant companions for people with Chronic Fatigue Syndrome (CFS), a debilitating condition that defies conventional diagnostic efforts, with no specific tests or symptoms that definitively identify the condition.


As a result, CFS remains shrouded in mystery and those affected are often left to figure things out on their own. To help raise awareness of this condition,  International Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Awareness Day is celebrated annually to highlight its impact on day-to-day life and empower individuals to seek help.

Dr Serena In - Master of Clinical Psychology

“There is little data on CFS in Malaysia, not because it does not exist here but because there is low awareness among the general public. Because of this, few people know to seek treatment for it, leading to it being under-reported and poorly understood,” said Dr Serena In, Clinical Psychologist and Head of Department, Psychology & Counselling at School of Psychology and Social Sciences in IMU University.

If you or someone you know is suffering from prolonged and unexplained fatigue that does not improve with rest, here’s what you need to know.

Possible Signs of CFS

Medically known as Myalgic Encephalomyelitis (ME), experts are uncertain what causes CFS. It can sometimes develop after viral infections such as COVID-19, though it is not associated with any specific infection. Other related factors – though not necessarily causal in nature – include inflammatory diseases such as arthritis, psychological conditions such as depression, and hormonal changes such as menopause.


Symptoms may come and go, and vary greatly from person to person.

Most Patients Report Symptoms such as:







fatigue that is not relieved with rest or sleep

difficulty concentrating

muscle weakness

hypersensitivity to smells, chemicals, light or noise

digestive problems like irritable bowel syndrome

joint and muscle pain without exertion, swelling or redness

The Long Road to Diagnosis

CFS can only be diagnosed based on a combination of symptoms, alongside a series of tests to rule out other possible causes.


However, before jumping to CFS as an answer, Dr Serena cautions, “Listen to your body and what it is trying to tell you. Address the basic needs first – get sufficient rest and eat a balanced diet. If you get the basics right, you should feel better in a few weeks. However, if you have tried this with no relief, then you may need medical advice.”


A family physician can help to identify and rule out other possible health issues, from autoimmune conditions like lupus, burnout, depression or other health problems. This may involve blood tests, journal-keeping to track symptoms, and weeks or even months of observation. Where relevant, your doctor may also refer you to one or more specialists for further insights.

Living with CFS

“CFS is different for everyone. It is a multifaceted condition, and while its severity can vary from person to person, being constantly fatigued, in pain or feeling unwell on a daily basis can be debilitating. Some have also reported not being well understood by their own physician, employers, or loved ones when describing their symptoms. This can be particularly difficult for those who are used to being active and social, who are now forced to cut back on certain responsibilities, physical activities, social gatherings and more,” said Dr Serena.


There is no specific treatment or cure for CFS, though pain management can play an important role in relieving symptoms, alongside lifestyle adjustments. In addition, Dr Serena also suggests seeing a clinical psychologist or counsellor for support in processing the vast changes to your life.


“For some, the process of adjusting to life with CFS can feel like grief, as it may mean losing the healthier version of yourself that you used to be. Your therapist can also help to address your fears for the future, as many patients may also feel a sense of hopelessness. It is possible to work through acceptance and still lead a meaningful and fulfilling life after having learnt to effectively manage these symptoms on a daily basis,” she explained.


However, it is important not to give up hope, she said.


“CFS is challenging to diagnose and there is no quick fix, but it is important to persist in your efforts to find an answer. Engaging a supportive team of a medical specialist to manage your symptoms along with a therapist to process the unpredictable challenges, could greatly enhance your quality of life.”


US Centers for Disease Control. Symptoms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Accessed 20 May 2024.

US Centers for Disease Control. ME/CFS Basics. Accessed 20 May 2024.

US Centers for Disease Control. What Causes Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Accessed 20 May 2024.

Healthline. CFS (Chronic Fatigue Syndrome). Accessed 21 May 2024.

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