In Reply. —The above letters raise essential and unsolved issues about the relationships between physical illness, psychological distress, and chronic fatigue. Treadwell and Metzger note that patients complaining of chronic fatigue are given different labels by different specialists. To fibromyalgia and rhinitis/postnasal discharge we would add chronic viral or fungal illness, hypoglycemia, irritable bowel syndrome, and sleep disorders. The unifying assumption is that a primary physical disorder causes chronic fatigue, with resultant psychological distress.
Fibromyalgia and chronic fatigue have fascinating parallels. Chronic fatigue can be elicited as a complaint in about 20% of medical outpatients1,2; Treadwell and Metzger report fibromyalgia in about 30% of rheumatology patients. Psychiatric diagnoses derived from the Diagnostic Interview Schedule are similar in patients with chronic fatigue and patients with fibromyalgia, with a preponderance of mood disorders, anxiety disorders, and somatization.3,4 We agree that evaluation of patients with chronic fatigue for fibromyalgia is important,