Some conditions just can't seem to get society's respect.
When chronic fatigue syndrome first came on to the scene, it was ridiculed as the "yuppie flu." Other pooh-poohed conditions got their negative associations by proxy -- "tennis elbow" became associated with country club snobbery. Irritable bowel syndrome, already embarrassing, was a perfect comedic tool for sensitive characters like Ben Stiller's portrayal of the uptight Reuben Feffer in "Along Came Polly."
Even after doctors find a genetic link, a blood test or a treatment, a number of conditions still get stuck with negative labels like "yuppie." Below is a list of 10 of the most besmirched conditions patients wish would be taken more seriously.
The plethora of health-nut "gluten-free" foods available makes it simultaneously easier for people to explain celiac disease and difficult for them to be taken seriously.
"Gluten-free now seems to be a fad diet," said Elaine Monarch, executive director of the Celiac Disease Foundation in Studio City, Calif., who added she's seen projections that gluten-free products will generate a billion dollars in food sales in the next few years.
Monarch said in 2004 the National Institutes of Health convened a consensus conference about celiac disease. The doctors estimated that 97 percent of people who have it have not been diagnosed, and that one out of 133 people likely had the condition.
"What they acknowledged was that the disease is much more prevalent than anyone thought before," Monarch said.
However, when Monarch was first suffering from symptoms of celiac disease, the public had hardly heard of gluten-free, never mind celiac disease.
"I was anemic, and everyone said, 'oh, you're female, maybe you had your period.' Or, 'oh, you have red hair.' That has nothing to do with it," she said.
Aside from anemia, celiac disease has a hodge-podge of symptoms -- from bloating, to vomiting, to constipation, to canker sores and in some cases infertility -- that are caused directly or indirectly by a genetic inability to digest a protein in wheat.
Doctors started drawing the connection between wheat and intestinal problems after the end of World War II, according to Dr. Alessio Fasano, director of the Center for Celiac Research at the University of Maryland School of Medicine in Baltimore.
Fasano said that during WWII, when bread was made with potato flour in many parts of Europe, doctors noticed that many of their patients' intestinal symptoms stopped. Then after the war, all the symptoms came back when people started making wheat flour again.
Since then doctors have found a blood test for celiac disease and evidence of damage to the small intestine.
"The fact that we know the trigger is tremendous," Fasano said. "Celiac disease is the only autoimmune disease for which we have a treatment."
Celiac disease is caused by a combination of genetic disposition and an environmental trigger, similar to diabetes and rheumatoid arthritis. But unlike those conditions, Fasano said he thinks celiac disease is less respected.
"If you have a condition that you don't die from, but it affects this part of your life so much, then it is important: You don't want to travel, you don't to go out with your friends, you don't want to go off to college," Fasano said.
"It deserves all the respect that we give to the other diseases that we spend so much time and money on," he said.
Chronic fatigue syndrome, also once known as "the yuppie flu," took years to gain a credible reputation, or even a name and diagnosis criteria.
Someone with chronic fatigue syndrome primarily feels a profound tiredness that isn't helped by sleeping and can get much worse with physical or mental activity. Initially, the disease was thought to affect only the upper class -- hence the yuppie connotation -- although they may have only been the first to seek treatment.
Now experts believe it strikes across the whole population. A major hurdle to gaining recognition was that the syndrome was so poorly understood by doctors.
By 1994, a group of international doctors convened to define the disease and create standard diagnosis criteria.
According to the U.S. Centers for Disease Control and Prevention, a patient must have severe fatigue for six months or more without another medical explanation and one or more of a whole host of symptoms that include memory problems, sore throat, joint pain, tender lymph nodes, muscle pain and more.
As of now there are no physical signs or lab tests to diagnose the syndrome. However the CDC estimates that between 1 million and 4 million Americans suffer from the disease.
The Epstein-Barr virus (or EBV) turned out to be one of the red herrings for the "yuppie flu."
Although a clear-cut blood test exists for Epstein-Barr, patients suffer a similar confusing general malaise as those with chronic fatigue syndrome.
According to the CDC, a person with the Epstein-Barr virus may have a sore throat, swollen lymph glands, fatigue and a general ill feeling. Because the symptoms of EBV and chronic fatigue syndrome are so similar, doctors may first mistake chronic fatigue syndrome for a longstanding EBV infection.
Unlike chronic fatigue, once a patient has an EBV diagnosis, they're likely to be taken very seriously. According to the National Institutes of Health, EBV is a prime contributor to mono, also known as mononucleosis or the "kissing disease" because it is highly contagious by saliva transmission even months after symptoms subside.
Most patients with an active EBV infection begin to feel better in a couple of months. However the virus has been known to cause anemia, ruptured spleens and death in rare cases, according to the NIH.
Social Phobia and Social Anxiety Disorder
Out of many anxiety disorders, experts say those with social anxiety disorder are likely the most affected by a negative reaction to their problem.
"For a long time there were a lot of naysayers saying, 'oh, this isn't a condition, it's made up,'" said Jerilyn Ross, a clinical social worker and president and CEO of the Anxiety Disorders Association of America in Silver Spring, Md.
"Because you can't measure it on an X-ray, or a blood test, a lot of people will say things like 'was this made up by the drug companies?'" said Ross, who is also the director of the Ross Center for Anxiety and Related Disorders in Washington, D.C.
"That just perpetuates the stigma for those who have it and it perpetuates their fear of getting help," she said.
Shy is one thing, but the mental health world never really considered social anxiety a full-blown disorder until 1985 when Dr. Michael R. Liebowitz from Columbia University published a review calling "social phobia" a neglected disorder.
"That article really put it on the map," said Ross. Before then, Ross said, "Society treated it as, 'oh, it's really not that big a deal.' ... In a woman, it's 'oh, how cute she blushes.'"
Ross says because the disorder got full recognition in the 1990s and a lot of press from media and direct-to-consumer advertising, people with what's now called "social anxiety disorder" felt empowered to seek help.
According to Ross, when one of the estimated 5 million to 10 million people with social anxiety disorder in the United States comes forward to seek treatment, the line between a disorder and "shy" is as clear as day.
"For 30 years they've never gone into town because they can't talk to anybody," Ross said. "Or they may say: 'I dropped out of school, I'm suicidal, I've never had a date in my life, I can't go out to a restaurant and I can't call for tickets to a show.'"
There's no misnomer about how one can get tennis elbow, but many non-yuppie activities such as using a screwdriver, weaving, yard work or other maintenance work can cause tennis elbow.
According to the Mayo Clinic, the pain of a tennis elbow is similar to the "golfer's elbow," except that it occurs on the outside of the elbow instead of the crook of the arm.
Tennis elbow may be inflammation, soreness and/or pain on the outside of the upper arm near the elbow. According to the NIH, the injury can include a partial tear of a tendon near the elbow as well.
Besides pain near the elbow, signs that you've got tennis elbow include the inability to hold beverages like a cup of coffee (a good source for jokes about yuppies), forearm weakness and pain that shoots from the elbow to forearm and the back of the hand when the person tries to twist something.
Luckily, most people with tennis elbow can resolve the issue in time by resting the muscle, icing it and learning to play with better tennis technique. However, according to the Mayo Clinic, about one out of 10 people with the condition will require surgery.
People with generalized anxiety disorder face many of the same dilemmas attempting to explain their condition to a skeptic as people with social anxiety disorder.
Just as there's a difference between shy and an "intense paralyzing fear of social performance situations and fear of being negatively valued and judged in those situations," there's anxiety and intense worry, and then there's pathology, Ross said.
Ross likes to use the analogy of a mother suffering from anxiety severe enough to cause insomnia.
On the one hand, Ross said she could see a family where the prime breadwinner has been out of work, the bills are piling up and the children are having problems in school so much so that the mother is losing sleep and it's affecting her health.
Ross said this family might need help with anxiety, but it's not a disorder.
But, Ross said, take "a young mother where finances aren't really a problem, the parents have secure jobs, they have a great marriage, the kids are doing well, but she's up worrying every night that they are going to lose their house, or someone's going to lose their job."
"They know this is a problem, they know that they're different from other people," Ross said. "They often say: 'I feel as if I just can't turn it off.'"
Although Ross said professionals have begun to diagnose generalized anxiety disorder much more accurately in the last decade, she has seen estimates that as many as three-fourths of people with the disorder have yet to be diagnosed.
Not only does the condition have a vague name, but patients who suffer from restless leg syndrome may have a hard time describing the vague symptoms to other people.
At its essence, restless leg syndrome (or RLS) is exactly what it sounds like: the urge to move your legs.
According to the Mayo Clinic, "sometimes the sensations seem to defy description," but often numbness or burning, crawling, jittery, tingling and aching sensations well up in the legs as the sufferer feels the need to move them.
While medicines can reduce the symptoms, there is no known cause for all RLS, according to the NIH. Pregnancy can bring on symptoms, as can vices -- caffeine, tobacco and alcohol.
A good way to immediately reduce RLS symptoms is to simply move your legs, stand up or walk around. However symptoms can become more problematic when people try to sleep.
As RLS gets worse in the evening and nighttime hours, the condition can interfere with sleep, turning a nuisance twitch into serious insomnia and daytime drowsiness.
People with irritable bowel syndrome (or IBS) have it hard enough dealing with the embarrassing bathroom symptoms, but according to gastroenterologists, they also have to deal with a poorly understood condition that has no quick treatment.
"There's actually nothing wrong with the physical gut; it's what we call a functional disorder," said Fasano, who is also the director of the Mucosal Biology Research Center at the University of Maryland School of Medicine.
IBS has all the intestinal symptoms of celiac disease and many of the symptoms of Chron's disease: abdominal pain, diarrhea, constipation, cramps and spasms.
Fasano said it was only in the 1970s that a series of experts got together in Rome and drafted what is known as the "Rome Criteria" for diagnosing IBS. Research since has uncovered a connection between IBS and the "intestinal pacemaker" responsible for creating the wave contraction of the intestine to digest food.
Have a faulty "intestinal pacemaker," and a person can have spasms and intense digestive pain. Other research has uncovered links between IBS and an imbalance of good bacteria in the gut.
Still, Fasano said an IBS diagnosis is often one of exclusion, meaning doctors must run a myriad tests to see whether another cause is behind the IBS symptoms before coming to a conclusion.
"IBS is embarrassing, IBS is not socially acceptable," said Fasano. "You may discuss diabetes or cancer, but what is amazing in all this is that IBS and even celiac disease are much more frequent than diabetes."
According to Fasano, gastroenterologists estimate "IBS affects easily, 20 [percent] to 25 percent of the population."
There's absolutely nothing new about the drop in daylight hours during winter months, but researchers in the later half of the 20th century managed to find, name and diagnose a condition related to it: seasonal affective disorder or SAD.
Like many suffering pathologies that are extremes of normal feelings, sufferers of SAD often face explaining why their "cabin fever" or "wintertime blues" is different.
According to the Mayo Clinic, SAD is a type of depression that can seriously affect someone's life. Sufferers of SAD show signs of hopelessness, anxiety, depression, oversleeping and difficulty concentrating. SAD sufferers may also crave food, particularly starchy or sugary food.
Since researchers noted the cause may be a lack of sunlight, it was quite easy to come up with a treatment: light therapy. According to the Mayo Clinic, people afflicted with SAD may find some relief in a special form of light therapy after a consultation with a mental health therapist.
Much like chronic fatigue syndrome, fibromyalgia is a condition associated with a myriad symptoms that once confounded doctors.
People with fibromyalgia feel fatigue, muscle pain at specific "tender points," headaches, insomnia, morning stiffness and memory problems.
"I think one of the reasons why people have skepticism about it, is because it's been very hard to pinpoint what causes it," said Dr. Roger Chou, an associate professor of medicine at Oregon Health and Science University in Portland.
Chou said the term fibromyalgia was coined in the 1970s. Ever since, doctors have theorized that the condition may be caused by a single underlying infection, as is the case in Lyme disease, or by an autoimmune disorder or a muscle disorder.
"None of that stuff has panned out," Chou said.
Although pharmaceutical companies have recently marketed treatments for fibromyalgia, Chou said the medication only helps some pain symptoms.
"It can be a really devastating disease," Chou said. "It can be so severe, that people can't get out of bed."
"Clinicians don't like to feel helpless, and we do feel like that with this condition," he said.
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