Types of Malaise
Malaise is more than feeling “blah.” It is a significant symptom that healthcare providers use when making a diagnosis or describing a response to a treatment or chronic illness. It even has its own International Classification of Diseases (ICD) code (R53; Malaise and Fatigue) used for reporting by practitioners, health insurers, and public health officials.
When malaise occurs as part of a diagnosed illness or condition, a healthcare provider typically will record it “general malaise.” Aside from that, there are two other types of malaise:
Isolated general malaise (IGM): An episode of malaise, either short-lived or persistent, with no known etiology (cause). IGM is not meant to suggest a symptom is “all in your head” and is rarely used.
Post-exertional malaise (PEM): An imprecise term used to describe a feeling of unwellness after physical activity.
PEM is a characteristic of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) but can occur on its own without any clear etiology. Underlying causes range from subclinical hypothyroidism and obstructive sleep apnea to polymyalgia rheumatica and bipolar depression.
Associated Conditions
Malaise is a non-specific symptom associated with nearly all infectious, metabolic, and systemic diseases and may also be a side effect of certain medications:
Acute infections, including influenza, Lyme disease, and pneumonia Autoimmune diseases, including rheumatoid arthritis and systemic lupus erythematosus Blood abnormalities, including anemia and neutropenia Cancers, including colon cancer, lymphoma, and leukemia Chronic infection, including HIV (especially if untreated) and chronic hepatitis C Endocrine or metabolic diseases, including diabetes and thyroid disease Heart and lung diseases, including congestive heart failure and chronic obstructive pulmonary disease (COPD) Medications, including antihistamines, beta-blockers, antidepressants, and antipsychotics Malnutrition or malabsorption disorders like celiac disease Untreated depression
Causes
There are many theories for why malaise occurs. One is that it is the body’s subtle response to proteins known as cytokines that regulate how the body reacts to disease. Although the body produces a multitude of cytokines, their function remains the same: to coordinate cells to repair tissues, maintain tissues, and fight infection or disease.
When cytokines are produced in response to disease, it is believed they affect a structure deep in the brain called the basal ganglia, making it less receptive to the “feel-good” hormone dopamine. The deprivation of dopamine in the brain can result in anhedonia (the inability to feel pleasure) and psychomotor slowing (sluggish thoughts and movements).
When to Call a Healthcare Provider
You should see your healthcare provider if malaise persists for more than a week with or without accompanying symptoms. During your appointment, they will review your symptoms and medical history to help pinpoint the underlying cause. It can be helpful to have ready answers to some of the questions you may be asked, such as:
How long have you had malaise?What other symptoms do you have?Do you have any chronic health conditions?Does the malaise come and go, or is it constant?What prescription or over-the-counter medications do you take?Have you taken a trip overseas lately?
You also will likely have a physical exam to check for signs of infection (such as swollen glands) or evidence of anemia (pale skin, brittle nails, or cold hands or feet). Additional tests may be ordered based on these preliminary findings.
Although it may take time to pinpoint the cause, try to be patient and honest with your healthcare provider. The more information you can give, the sooner they can pin down what’s causing your malaise and how to treat it.
