Chronic Fatigue, Syndrome, Anxiety

Written by Jim Folk
Medically reviewed by Marilyn Folk, BScN.
Last updated May 19, 2021

chronic fatigue syndrome anxiety

Some of the common names associated with fatigue, chronic fatigue and anxiety include:

  • Chronic fatigue syndrome
  • Chronic fatigue and anxiety disorder
  • Chronic fatigue stress
  • Chronic fatigue syndrome anxiety
  • Chronic fatigue caused by anxiety

Chronic fatigue anxiety symptom descriptions:

Here are some of the common descriptions we’ve heard for the anxiety symptom chronic fatigue:

  • You feel extremely exhausted, fatigued, burnt out, or worn out
  • A chronic fatigue feeling
  • Always feel exhausted
  • Tired all the time
  • Always have no energy to do anything
  • Chronically fatigued and dizzy or lightheaded
  • So tired that even small tasks are draining
  • So tired you can’t think or feel anything anymore
  • Feel completely burnt out
  • Have no stamina for anything
  • Could sleep all day and still feel exhausted, tired, and worn out
  • Have zero energy
  • Have to drag yourself around all day because you are so tired
  • You may feel tired all of the time and find even small tasks to be unusually tiring
  • You feel persistently fatigued, exhausted, tired, and worn out
  • You are devoid of energy and any activity is exhausting
  • Unrelenting exhaustion
  • Persistent fatigue
  • Feel completely worn out like when you have the flu
  • Wake up feeling completely exhausted as if you haven’t slept at all even though you had a good sleep
  • You feel unable to function at work or home because of feeling chronically tired and worn out
  • You feel so exhausted that you can’t handle your daily affairs
  • You feel so exhausted, worn out, tired, and have no energy that even your emotions feel too much to handle
  • You feel physically, psychologically, emotionally, and spiritually exhausted, spent, worn out, and like you can’t take anything more
  • Persistent lethargy
  • Chronically fatigued
  • Always feel exhausted
  • Chronically listless
  • So chronically fatigued that you can’t even think straight or clearly

The chronic fatigue anxiety symptom can precede, accompany, or follow an escalation of other anxiety sensations and symptoms, or occur by itself.

The chronic fatigue anxiety symptom can precede, accompany, or follow an episode of nervousness, anxiety, fear, and elevated stress, or occur ‘out of the blue’ and for no apparent reason.

This symptom can range in intensity from slight, to moderate, to severe. It can also come in waves where it feels stronger at times than at other times. Sometimes it can feel so strong that it seems overpowering.

Anxiety-caused chronic fatigue can change from day to day, and/or from moment to moment, but it’s generally experienced as persistent and unrelenting exhaustion.

All of the above combinations and variations are common.

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Why anxiety causes the chronic fatigue symptom

Medical Advisory

There are many reasons why anxiety can cause chronic fatigue, which can include feeling emotionally exhausted. Here are the most common:

1. Stress taxes the body’s energy resources harder and faster than normal

The body is an incredible machine that not only manages itself all by itself for the most part in spite of the ever changing internal and external conditions, but it also has an “enhanced emergency readiness mode” when we need a “boost of attention and energy” when being challenged by a stressor.

Stress can be defined as:

  • Anything that pushes the body beyond its balance point.
  • A state of mental or emotional strain or tension resulting from adverse or very demanding circumstances.[1]
  • Subject to pressure or tension.

In a medical or biological context: stress is a physical, mental, or emotional factor that causes bodily or mental tension. Stresses can be external (from the environment, social situations, etc.) or internal (illness, from a medical procedure, behavior, etc.). Stress can initiate the "fight or flight" response, a complex reaction of neurologic and endocrinologic systems.[2]

When stressed, the “enhanced emergency readiness mode” is produced by the stress response. The stress response causes the body to secrete stress hormones into the bloodstream where they travel to targeted spots to bring about specific physiological, psychological, and emotional changes that enhance the body’s ability to deal with stress.

Walter Bradford Cannon, M.D. (October 19, 1871 – October 1, 1945), an American physiologist, professor and chairman of the Department of Physiology at Harvard Medical School called the stress response the “fight or flight response” (or Acute Stress Response). Since then, it’s also been referred to as the emergency response or the fight, flight, or freeze response (because some people freeze like a “deer caught in headlights” when they feel overly stressed).[3][4][5]

Dr. Hans Selye, a 20th century Vienna-born scientist well-known for his work on stress and author of the book, “The Stress Of Life,” coined the term “General Adaptation Syndrome” (GAS) for the three stages of the stress response.[6] They are:

  • Alarm - when the sense of danger/threat triggers the stress response
  • Resistance – when the active ingredients of the stress response give us the energy we need to fight or flee
  • Exhaustion – the recovery phase after the stressor has ended

chronic fatigue anxiety symptom stress response

Members can read Chapter 3 in the Recovery Support area for more information about the many changes caused by the stress response.

Due to the many physiological, psychological, and emotional changes caused by the stress response, stress responses stress the body.

Stress hormones create their stimulating effect in a number of ways, such as causing the body to convert its energy stores into immediate energy. One way it does this is by causing the liver to quickly convert glycogen (stored form of glucose) into blood sugar so the body has a good supply of fuel to deal with the stressor, such as getting a project done on time, taking an important test, or when a long list of tasks need to be done right away.

As long as the body is stressed, the body will produce stress responses to keep the body going until the stressor has passed. Consequently, the body will continue to convert stored energy into usable energy as long as needed. The longer the period of stress, the more stored energy is consumed.

Stress responses place a high demand on the body’s energy resources so that we have the needed “boost” in energy when stressed.[7] Consequently, stress responses use up the body’s energy resources more quickly than normal.

When stress is acute, we might not notice feeling lethargic as the body depletes its energy stores. But prolonged stress can drain the body of its energy. Feeling chronically exhausted is a common indication of chronic stress as the body struggles to rally enough energy to deal with the stressor.

2. The after effects of stress

Just as chronic fatigue can occur as the body tries to deal with chronic stress, it can also occur AFTER the stress has passed and during the recovery phase.

After the stress has passed, the body needs time to recover and rebuild its depleted energy stores. During this recovery period, we can feel worn out, exhausted, and emotionally spent. The length of recovery time is proportional to the degree and amount of time the body was stressed.

For example, if you experienced an episode of brief stress, your body can recover relatively quickly. If the episode of stress was prolonged, however, your body will need much longer to recover. Again, during this recovery phase, you can feel completely exhausted until your body has had sufficient time to recover.

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3. The after effects of an episode of anxiety

Apprehensive behavior (worry, anxiousness, fretting, etc.) is motivated by the perception of potential danger. Believing you could be in danger also activates the stress response, which is the reason it is called the fight or flight response. As long as you think you are in danger, your body will produce the stress response as if you really are in danger. The more you engage in apprehensive behavior, the more stress responses the body produces. As the frequency and degree of stress responses increase, the amount of energy depletion also increases.

If you’ve had an episode of anxiety, and especially if the anxious episode was prolonged, your body will need time to recover afterward. During this recovery phase, you can feel completely exhausted until your body has had sufficient time to recover and restore its energy stores.

Remember, exhaustion is a normal part of the Stress Response cycle.

Rather than rebelling against feeling exhausted, we want to engage it and for as long as it takes for the body to recover. This ensures the body completes the recovery phase.

4. The after effects of an anxiety attack (panic attack)

Anxiety attacks are high degree stress responses caused by high degree fears or by the involuntary actions of an overly stressed body.  

High degree stress responses, which cause high degree energy mobilization, can deplete the body’s energy resources quickly leaving the body exhausted after the anxiety attack has ended.

If you’ve had an anxiety attack, or series of them, your body will need time to recover and rebuild its energy stores. In the meantime, you can feel exhausted, completely worn out, and emotionally spent until your body has completed its recovery phase.

5. The adverse effects of hyperstimulation (chronic stress)

When stress responses occur infrequently, the body can recover relatively quickly from the physiological, psychological, and emotional changes the stress response brings about. When stress responses occur too frequently, however, such as from overly apprehensive behavior or a major stressor, the body has a more difficult time recovering, which can result in the body remaining in a state of semi stress response readiness. We call this state “stress-response hyperstimulation” since stress hormones are stimulants (also often referred to as "hyperarousal").[8][9] Hyperstimulation can keep the survival mechanism somewhat engaged, which can prevent the body from recovering.

Chronic activation of the survival mechanism can deplete the body’s energy resources resulting in a chronic state of exhaustion. As long as the body is prevented from recovering and rebuilding its energy stores, you can feel chronically exhausted and without energy.

6. Stress can disrupt sleep

When we’re anxious and stressed, stress hormones give us the fuel we need to take action. While this “extra energy” is welcome when we need it to take action, it can also override the body’s ability to rest and sleep.[10]

Sleep disruption causes the body to tire more quickly. Feeling chronically exhausted is also a common symptom of sleep deprivation.

Combine chronic stress with sleep disruption and you have the makings for chronic fatigue.

7. Your diet might need adjusting

Since stress taxes the body’s energy resources harder and faster than normal, chronic stress, such as that caused by overly apprehensive behavior, can deplete the body of important nutrients (vitamins and minerals, such as vitamin B, magnesium, iron, etc.).[11][12] This is especially true if you aren’t eating properly or regularly enough to replenish these nutrients. Being deficient in important nutrients can cause episodes of low energy. A visit to your doctor or Nutritional Practitioner can help determine if you have a deficiency, and if so, what those deficiencies are.

Moreover, if you haven’t adjusted your eating patterns to accommodate the rapid energy consumption, you might become tired or exhausted as your body runs out of fuel. Physical fatigue can also affect our emotional health.

Not eating correctly to accommodate the extra demand for fuel and being deficient in certain nutrients can cause episodes of low energy and fatigue.

8. Chronic pain

Pain stresses the body.[13][14] If you are dealing with chronic pain, your body can be chronically stressed. As the level of chronic pain increases, so can the body’s level of stress.

As mentioned earlier, chronic stress can tax the body’s energy resources much harder than normal. A body that is chronically stressed, such as from chronic pain, can experience chronic fatigue UNTIL the body’s stress is relieved and the body has had sufficient time to recover and rebuild its energy stores.

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How to get rid of the chronic fatigue anxiety symptom

1. Increasing rest and good sleep

Offsetting the adverse effects of stress with increased rest and good sleep can restore normal energy. The more you offset your stress with rest and good sleep, the faster the body can recover from the adverse effects of stress and return to normal energy.

Six to eight hours of sleep per night is considered healthy. Anything less than six restful hours of sleep per night is considered sleep deprivation.

2. Change your diet and eat more frequently when under stress

To avoid feeling tired, and especially when the body is stressed, eat smaller more frequent meals, as well as include more protein. Since protein takes longer to metabolize, the energy derived from it will sustain the body longer than carbohydrate-based foods that metabolize faster. Eating more frequently and increasing protein can provide a constant supply of energy. Feeling energized can elevate mood.

Furthermore, avoid high sugar, high fat, and fast foods that also stress the body, which can contribute to low mood. Since the body uses the foods we eat as fuel, we want to give the body the best fuel possible. Just as low-grade gasoline provides low-grade engine performance, low-grade food provides low-grade health and energy performance.

Eating a well-balanced diet can help prevent or alleviate deficiencies. Better yet, discuss your nutritional needs with a Nutritional Practitioner. You might be surprised at how your present diet might be adversely affecting your overall physical, psychological, and emotional health.

3. Reduce chronic pain

Reducing chronic pain can reduce chronic stress.

For more information, see our article on “Anxiety, Pain, and Chronic Pain.”

4. Eliminate stress, chronic stress and hyperstimulation

Reducing and eliminating unhealthy stress is an important remedy for hyperstimulation and its symptoms, including chronic fatigue. Removing the primary source of energy depletion – stress - eliminates chronic fatigue in time.

There are many natural ways to reduce stress, such as regular deep relaxation, regular exercise, cutting back on work hours, increasing rest, getting good sleep, and spending more time in nature.

Chapters 4 and 14 in the Recovery Support area list a great many ways we can reduce stress. They also explain why recovering from hyperstimulation can take more time than most people expect and what you can do about it.

5. Therapy

Unidentified and unaddressed underlying factors that cause issues with anxiety and stress is the number one reason why anxiety disorder and its symptoms, including chronic fatigue, persist. Dealing with your anxiety issues is the most important overall.

Since the majority of stress comes from behavior (the ways we think and act), addressing the core reasons for anxiety disorder can reduce and eliminate the unhealthy stress that often leads to hyperstimulation and symptoms.

Keep in mind that eliminating anxiety symptoms doesn’t necessarily mean you’ve overcome issues with anxiety. Anxiety symptoms are symptoms of stress. Eliminating anxiety symptoms means you’ve eliminated the unhealthy stress. But if the underlying factors that cause issues with anxiety aren’t addressed, it’s just a matter of time until the body is overly stressed and symptomatic again.

Rebounds of symptoms and a return to a struggle with anxiety are caused for this very reason: the core issues that cause problematic anxiety haven’t been successfully addressed.

To eliminate issues with anxiety and symptoms once and for all, we need to eliminate the cause of problematic anxiety – the underlying factors that cause issues with anxiety. When you eliminate the cause of the problem, the problem and its symptoms disappear.

Moreover, eliminating unhealthy anxiety and the stress it causes can also reduce chronic pain, since there is a connection between our emotions, stress, and pain.

If you have been struggling with chronic fatigue, we recommend connecting with an experienced anxiety disorder therapist to help you overcome your anxiety issues. Research has shown that working with an experienced therapist is an effective treatment for anxiety disorder.[15][16][17]

Moreover, getting therapy via teletherapy, distanced therapy, or e-therapy (telephone or online therapy) is as effective, if not more so, than in-person therapy.[18][19]

For a more detailed explanation about anxiety symptoms including this one, why symptoms can persist long after the stress response has ended, common barriers to recovery and symptom elimination, and more recovery strategies and tips, we have many chapters that address this information in the Recovery Support area of our website.

The combination of good self-help information and working with an experienced anxiety disorder therapist, coach, or counselor is the most effective way to address anxiety and its many symptoms. Until the core causes of anxiety are addressed – which we call the underlying factors of anxiety – a struggle with anxiety unwellness can return again and again. Dealing with the underlying factors of anxiety is the best way to address problematic anxiety.

Additional Resources

Return to our anxiety disorders signs and symptoms page. Information, support, and therapy for anxiety disorder and its symptoms, including the symptom chronic fatigue anxiety.



2. Jr, William C. Shiel. “Definition of Stress.” MedicineNet, 2019.

3. Lucassen, Paul J., et al. “Neuropathology of stress.” NCBI PubMed, 8 Dec. 2013.

4. "Understanding the Stress Response - Harvard Health." Harvard Health. N.p., n.d. Web. 23 May 2016.

5. "The Physiology of Stress: Cortisol and the Hypothalamic-Pituitary-Adrenal Axis." DUJS Online. N.p., 03 Feb. 2011. Web. 19 May 2016.

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10. Sun Han, Kuem, et al. "Stress and Sleep Disorder." Experimental Neurobiology, 21 Dec. 2012.

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12. van de Lagemaat, Erik, et al. "Vitamin B12 in Relation to Oxidative Stress: A Systematic Review." Nutrients, 11 Feb. 2019.

13. Geva, N, et al. “Acute Psychosocial Stress Reduces Pain Modulation Capabilities in Healthy Men.Advances in Pediatrics., U.S. National Library of Medicine, Nov. 2014.

14. Hannibal, Kara E., and Mark D. Bishop. “Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation.Advances in Pediatrics., U.S. National Library of Medicine, Dec. 2014.

15. Hofmann, Stefan G., et al. “The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-Analyses.” Cognitive Therapy and Research, U.S. National Library of Medicine, 1 Oct. 2012.

16. Leichsenring, Falk. “Is Cognitive Behavioral Therapy the Gold Standard for Psychotherapy?” JAMA, American Medical Association, 10 Oct. 2017.

17. Driessen, Ellen, et al. "Cognitive Behavioral Therapy for Mood Disorders: Efficacy, Moderators and Mediators." Psychiatry Clinics of North America, Sep. 2010.

18. Thompson, Ryan Baird, "Psychology at a Distance: Examining the Efficacy of Online Therapy" (2016). University Honors Theses. Paper 285.

19. Kingston, Dawn. “Advantages of E-Therapy Over Conventional Therapy.” Psychology Today, Sussex Publishers, 11 Dec. 2017.