A Twin Study of Chronic Fatigue

Objective: The etiology of chronic fatigue syndrome is unknown, but genetic influences may be important in its expression. Our objective was to assess the role of genetic and environmental factors in unexplained chronic fatigue. Methods: A classic twin study was conducted using 146 female-female twin pairs, of whom at least one member reported 6 months of fatigue. After completing questionnaires on symptoms, zygosity, physical health, and a psychiatric interview, twins were classified using three increasingly stringent definitions: 1) chronic fatigue for 6 months, 2) chronic fatigue not explained by exclusionary medical conditions, and 3) idiopathic chronic fatigue not explained by medical or psychiatric exclusionary criteria of the chronic fatigue syndrome case definition. Concor-dance rates in monozygotic and dizygotic twins were calculated for each fatigue definition along with estimates of the relative magnitude of genetic and environmental influences on chronic fatigue. Results: The concordance rate was higher in monozygotic than dizygotic twins for each definition of chronic fatigue. For idiopathic chronic fatigue, the concordance rates were 55 % in monozygotic and 19 % in dizygotic twins (p .042). The estimated heritability in liability was 19 % (95 % confidence interval 0–56) for chronic fatigue 6 months, 30 % (95% confidence interval 0–81) for chronic fatigue not explained by medical conditions, and 51 % (95 % confidence interval 7–96) for idiopathic chronic fatigue. Conclusions: These results provide evidence supporting the familial aggregation of fatigue and suggest that genes may play a role in the etiology of chronic fatigue syndrome. Key words: chronic fatigue, twins, concordance, genetics. CDC Centers for Disease Control and Prevention; CFS chronic fatigue syndrome; CI confidence