Neurasthenia: cross-cultural & conceptual issues in relation to Chronic Fatigue Syndrome (CFS)

The purpose of this study was to examine several conceptual and
cross-cultural issues in neurasthenia, particularly in terms
of their relationship to chronic fatigue syndrome. A review of
this relationship led to the conclusion that these conditions
are much more alike in Western countries than in countries
such as China, where neurasthenia could almost be regarded as
a "culture-bound syndrome." This may be a consequence of
factors such as the heterogeneous nature of neurasthenia and
different diagnostic practices in different countries, despite
the ICD-10 definition of neurasthenia, intended for worldwide
use. Likewise, there is no consensus on what the "core"
characteristics of neurasthenia are, because its clinical
presentation and key features in different countries are very

Despite the finding of relatively low comorbidity
rates between neurasthenia and other mental disorders,
clinical experience suggests that features of neurasthenia
frequently overlap with those of depression, chronic anxiety,
and somatoform disorders. There is no convincing evidence that
in cases of overlap or comorbidity, other diagnoses should
automatically have "primacy" over neurasthenia nor should the
diagnosis of neurasthenia thereby be excluded. Although some
aspects of its validity have improved recently, especially its
descriptive validity, the overall validity of the diagnosis of
neurasthenia is still not satisfactory.

Suggestions for further research, aimed at improving the diagnostic
validity of neurasthenia, are offered in this paper.

Starcevic V

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