Original ArticlesIllness Trajectories in the Chronic Fatigue Syndrome A Longitudinal Study of Improvers Versus Non-ImproversCiccone, Donald S. PhD*; Chandler, Helena K. PhD†; Natelson, Benjamin H. MD‡ Author Information *Department of Psychiatry, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ; †Department of Veterans Affairs, War Related Illness and Injury Study Center (WRIISC), New Jersey Health Care System, East Orange, NJ; and ‡Pain and Fatigue Study Center, Beth Israel Medical Center, New York, NY. Supported by the National Institute for Allergy and Infectious Disease (grant 5U01AI032247). Send reprint requests to Donald S. Ciccone, PhD, Department of Psychiatry, New Jersey Medical School, BHSB F-1432, 183 S Orange Avenue, Newark, New Jersey 07103. E-mail: [email protected]. The Journal of Nervous and Mental Disease: July 2010 - Volume 198 - Issue 7 - p 486-493 doi: 10.1097/NMD.0b013e3181e4ce0b Buy Metrics Abstract The natural progression of chronic fatigue syndrome (CFS) in adults is not well established. The aims of this longitudinal study were to (a) compare CFS Improvers and Non-Improvers; (b) determine whether an initial diagnosis of fibromyalgia (FM) was associated with CFS nonimprovement; and (c) determine whether this effect could be explained by the presence of nonspecific physical symptoms. Consecutive referrals to a tertiary clinic that satisfied case criteria for CFS were invited to enroll in a longitudinal study. After an initial on-site physical examination and psychiatric interview, a total of 94 female care-seekers completed biannual telephone surveys, including the Short Form-36 physical functioning (PF) scale, over a period of 2½ years. There were very few differences between Improvers and Non-Improvers at baseline but at final assessment Improvers had less disability, less fatigue, lower levels of pain, fewer symptoms of depressed mood, and fewer nonspecific physical complaints. Participants with FM at baseline were 3.23 times (p < 0.05) more likely to become Non-Improvers than those without FM. Participants identified initially as Somatizers were 3.33 times (p < 0.05) more likely to become Non-Improvers. Patients with CFS who bear the added burden of FM are at greater risk of a negative outcome than patients with CFS alone. This effect could not be explained by the presence of multiple, nonspecific symptoms. © 2010 Lippincott Williams & Wilkins, Inc.