It has been estimated that 836,000 to 2.5 million Americans and 250,000 to 1,250,000 people in the United Kingdom have CFS. CFS occurs 1.5 to 2 times as often in women as in men. It most commonly affects adults between ages 40 and 60 years; it can occur at other ages, including childhood. Other studies suggest that about 0.5% of children have CFS, and that it is more common in adolescents than in younger children. : 182  Chronic fatigue syndrome is a major cause of school absence. : 183  CFS reduces health, happiness, productivity, and can also cause socio-emotional disruptions such as loneliness and alienation. However, there is controversy over many aspects of the disorder. Physicians, researchers, and patient advocates promote different names and diagnostic criteria. Results of studies of proposed causes and treatments are often poor or contradictory. Signs and symptoms
The United States Centers for Disease Control and Prevention (CDC) recommends these criteria for diagnosis:
Greatly lowered ability to do activities that were usual before the illness. This drop in activity level occurs along with fatigue and must last six months or longer. Worsening of symptoms after physical or mental activity that would not have caused a problem before the illness. The amount of activity that might aggravate the illness is difficult for a person to predict, and the decline often presents 12 to 48 hours after the activity. The relapse, or crash, may last days, weeks or longer. This is known as post-exertional malaise (PEM).
The civilian population is the center of gravity—the deciding factor in the struggle.... Civilian deaths create an extended family of enemies—new insurgent recruits or informants—and erode support of the host nation." Sewall sums up the books key points on how to win this battle: "Sometimes, the more you protect your force, the less secure you may be.... Sometimes, the more force is used, the less effective it is.... The more successful the counterinsurgency is, the less force can be used and the more risk must be accepted.... Sometimes, doing nothing is the best reaction." This strategy, often termed "courageous restraint", has certainly led to some success on the Middle East battlefield. However, it does not address the fact that terrorists are mostly homegrown. Mass media
Mass media exposure may be a primary goal of those carrying out terrorism, to expose issues that would otherwise be ignored by the media. Some consider this to be manipulation and exploitation of the media.The Internet has created a new way for groups to spread their messages. This has created a cycle of measures and counter measures by groups in support of and in opposition to terrorist movements. The United Nations has created its own online counter-terrorism resource.The mass media will, on occasion, censor organizations involved in terrorism (through self-restraint or regulation) to discourage further terrorism. This may encourage organizations to perform more extreme acts of terrorism to be shown in the mass media.