Neurasthenia: Unexplained Tiredness

Extreme tiredness, headaches, a feeling of weakness... Neurasthenia is a clinical reality described more than a century ago that continues to baffle the medical profession.

Written and verified by the psychologist Valeria Sabater.

Last update: 21 December, 2022

Extreme exhaustion, headache, dizziness, low blood pressure, stomach pain, nausea. Neurasthenia was first described in 1829 to define a weakness of the nerves. In fact, for more than a century it had great relevance in the clinical and psychopathological fields. Furthermore, there were many people who apparently suffered from it.

The old ‘alienists’ were doctors who specialized in psychiatry. They pointed out that this disorder appeared in several specific groups. The first were farmers’ wives, who used to spend long periods alone while their husbands worked the land. Businessmen also exhibited these symptoms. Indeed, the condition became so common that William James sarcastically named it ‘Americanitis’.

With this term, he was referring to the state of stress and overload suffered by a large part of American society. Nowadays, Asian countries tend to suffer from this clinical reality. So much so that they’ve cataloged it in their Chinese classification of mental disorders (similar to our DSM-V). They call it shenjing shuairuo, a psychological dimension linked to pronounced fatigue.

Neurasthenia: definition, symptoms, and causes

Neurasthenia is an obsolete concept. Consequently, it isn’t included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). However, the World Health Organization continues to recognize it, as well as the ICD-10 and countries such as China. To understand the complexity of this disorder, it’s worth taking a closer look at certain aspects.

Throughout the nineteenth century, psychiatrists became extremely interested in neurasthenia. George Miller Beard was the neurologist who popularized this term in 1869. He defined it as an unusual and irritating weakness manifesting as chronic idiopathic fatigue (with an unknown cause).

Associated symptoms

Neurasthenia appears after exertion. It’s then that the body enters a state of excessive physical and psychological exhaustion. Nevertheless, the task performed isn’t intense enough for this excessive tiredness.

The condition occurs with the following manifestations:

• Severe headaches that sometimes lead to migraines.
• Muscle pain.
• Extreme exhaustion. However, the person feels unable to lie down and fall asleep. Therefore, insomnia can be a constant.
• Stomach aches and intestinal disturbances (flatulence, diarrhea ) appear.
• Fainting or vomiting may occur.
• Hypersomnia (excessive sleep) in some cases.
• Irritability.
• Panic disorders.
• Trouble thinking clearly.
• Memory failures.

All of these symptoms have a minimum duration of six months. Some occur with greater or lesser intensity. Also, some symptoms may appear and not others.

The causes

Neurasthenia, epidemic neuromyasthenia, Akureyri disease, Royal Free Hospital outbreak, atypical poliomyelitis,  Da Costa syndrome, and irritable heart syndrome. This condition has many names and, although it’s true that it doesn’t appear in the diagnostic manuals of mental disorders, many countries recognize it.

The University of the Basque Country (Spain) conducted a study of this disorder in 2019. They claimed that symptoms are frequently diagnosed in primary care. In fact, it’s suspected that we may be facing a disease with multisystemic repercussions as there are many variables that can come together in neurasthenia.

As a rule, two clinical conditions are usually diagnosed in this disorder: depression and chronic fatigue. In 2015, the National Academy of Sciences of the United States of America (Institute of Medicine) defined neurasthenia as a disease of effort intolerance. In other words, there are people who, when carrying out any activity, no matter how insignificant, exhibit adverse physical and psychological symptoms.

Treatment of neurasthenia

As a rule, the treatment of neurasthenia is directed at its causes. That said, the underlying pathology varies from person to person.

From a psychological perspective, sufferers are usually recommended to go to a psychologist and take a pharmacological support treatment. These are usually antidepressants. In addition, working on emotional and stress management is often helpful for patients.

A somatoform disorder

As we mentioned earlier, neurasthenia is a term that’s no longer used by a large part of the scientific community. Although the ICD-10 (International Classification of Diseases) continues to recognize it, they see it as linked to somatoform disorders.

A somatoform disorder is a clinical picture in which various diseases or symptoms appear that can’t be explained by underlying organic alterations. Extreme fatigue and low energy are two of the elements that make up this clinical category.

We can continue to accept neurasthenia as a condition because clinical labeling is largely unimportant. The most important aspect from a psychological and medical point of view is to know what triggers the symptoms.

Sigmund Freud spoke of depression and alienists of the early 19th century described their patients as having many worries. On the other hand, and given the organic manifestations, it’s been found that many people also suffer from hormonal problems, depressed immune systems, or even anemia.

Organic diseases can’t be separated from psychological problems. States of stress and anxiety are often behind somatoform disorders. Hence, approaches such as cognitive-behavioral therapy and, in certain cases, the administration of anxiolytics usually give good results.

Finally, beyond the terminologies, are the needs. Therefore, we should never hesitate to seek expert help with every problem, annoyance, anguish, or concern that clouds our lives.