What It Means to Experience 'Payback' With Chronic Fatigue Syndrome


Post-exertional malaise, or “payback,” is one of the key diagnostic criteria for myalic encephalomyelitis/chronic fatigue syndrome (ME/CFS). It is also one of the symptoms that is hardest for people who haven’t experienced the condition to understand.

I often think of it as being similar to a hangover, which is something I think most people have experienced. As a healthy person, one night you might go out and have too much to drink. During the night you generally feel fine, unless you take it too far, but the next day you experience payback in the form of a hangover. You will feel tired, nauseous, headachy and maybe feel generally unwell. For healthy people this will normally last a day, unless you’re very luck or unlucky.

With ME/CFS, any activity can cause this “hangover” or payback. For some people it might be simply getting out of bed to use the bathroom, or even just sitting up in bed. For others, it could be going for a short walk, doing cleaning, or seeing friends. Sometimes it can be caused by a bad night’s sleep, or emotional trauma. It’s not always easy to predict what will cause payback, and sometimes this can last days, weeks or even months.

Many people who live with ME/CFS experience symptoms all the time. Common symptoms include: debilitating fatigue, muscle pain, headaches, cognitive difficulties, flu-like symptoms, sensitivity to light and noise, and many more. When in payback these symptoms are intensified, and sometimes people will feel “poisoned,” not unlike the poisoned feeling one gets from a hangover.

I think it is hard for healthy people to fully grasp what it is like for those with ME/CFS to live with post-exertional malaise. I also think it is easy for people to forget that we always feel ill, especially as often we don’t look it. Most people living with ME/CFS are incredibly brave and strong people who tend to put a brave face on. People around them can’t fully see what it is they’re going through.

I hope this has helped you to understand a bit better what it is like for people living with ME/CFS. There are many different ways that people have attempted to explain the concept of payback, and this is just the one I feel is the most relatable for many. There are also explanations such as the spoon theory, and the bank balance analogy, and the phone battery analogy, which I urge to you look into if you feel like you still want to know more.

We want to hear your story. Become a Mighty contributor here.

Getty image by demaerre


Find this story helpful? Share it with someone you care about.


Related to Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

woman standing on an arrow in the street that points in two opposite directions

The Choices You Have as a Chronic Illness Warrior

Life is full of constant choices. Some are small and meaningless and others are life-changing. The key and beauty of it all is that there is an abundance of daily choices. Every day presents a fresh set of choices and it is up to each one of us to choose our day and what impact on [...]
illustration of a girl sitting cross legged

The 'Energy Bubble' Analogy That Can Help Explain Pacing With a Chronic Illness

Pacing is about energy conservation, both physical and emotional. When you’re living with a chronic illness, it’s an essential skill for preventing flare-ups or “crashes.” This “energy bubble analogy” can be useful to help you visualize and understand the limits of your energy, and help you explain them to others. The Energy Bubble Analogy Imagine [...]
illustration of a couple hugging outside in a meadow with pink hearts around them

6 Tips for How to Love and Be Loved With Chronic Illness

So, Valentine’s Day rolls around again. Maybe like me it’s not something you pay much attention to, or maybe you don’t really buy into the corporate side of it and have your own traditions. I’m a vegetarian and my husband is a big meat-eater, just one of the ways in which we are complete opposites. [...]
Young girl reading a book and drinking coffee, while holding her feet on the table.

Discovering Joy in Your Work Life as a Chronic Warrior Worker

It can feel like everything in your life changes when you suddenly have to deal with long-term illness. Some days you can’t believe how much it has changed you, the way you think, your priorities, your daily life and especially your work life. It can feel like suddenly your calling, your career, maybe the only [...]