Persistent burnout theory of ME/CFS

There is no agreement on the etiology of myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS), and the main theories (behavioural and viral/immune) do not satisfactorily explain the condition. A growing body of evidence suggests that ME/CFS may be caused by a dysfunction of the stress system—the autonomic nervous system (ANS) and hypothalamic–pituitary–adrenal (HPA) axis in particular—as a result of chronic stress. ME/CFS shares many similarities to occupational burnout and overtraining syndrome, including similar symptoms, physiological abnormalities, and triggers.After a brief review of the science of stress, burnout, overtraining, central fatigue, and ME/CFS, we propose a model of ME/CFS based on 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 ANS and HPA axis, behavioural factors, and negative feedback from the illness itself.