| Six (or more) of the following symptoms have been present every day or nearly every day during the same two-week period in the past month, and at least one of the symptoms is (A1) significant fatigue. | |
| A1. | Significant fatigue, diminished energy, or increased need to rest, disproportionate to any recent change in activity level |
| A2. | Complaints of generalized weakness or limb heaviness |
| A3. | Diminished concentration or attention |
| A4. | Decreased motivation or interest to engage in usual activities |
| A5. | Insomnia or hypersomnia |
| A6. | Experience of sleep as unrefreshing or nonrestorative |
| A7. | Perceived need to struggle to overcome inactivity |
| A8. | Marked emotional reactivity (eg, sadness, frustration, or irritability) to feeling fatigued |
| A9. | Difficulty completing daily tasks attributed to feeling fatigued |
| A10. | Perceived problems with short-term memory |
| A11. | Postexertional malaise lasting several hours |
| B. | The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning |
| C. | There is evidence from the history, physical examination, or laboratory findings that the symptoms are a consequence of cancer or cancer therapy |
| D. | The symptoms are not primarily a consequence of comorbid psychiatric disorders such as major depression, somatization disorder, somatoform disorder, or delirium |
