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There is no agreement on the etiology of chronic fatigue syndrome (CFS), and the main theories (behavioural and viral/immune) do not satisfactorily explain all findings. A growing body of evidence shows that CFS appears to be a dysfunction of the stress system—and the hypothalamic–pituitary–adrenal (HPA) axis in particular—as a result of chronic stress. CFS shares many similarities to occupational burnout, including similar symptoms, physiological abnormalities and triggers. After a review of the available evidence, I hypothesize that CFS is a state of persistent burnout that remains after the initial stressors have been removed. This persistence may be due to a combination of a dysregulation of the HPA axis and behavioural factors.
This is a revised and updated version of a hypothesis that was first published in October 2004 (http://www.mind-body-health.net/persistent_burnout_theory_2004.html).
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