Afari, Niloofar, Buchwald, Dedra · The American journal of psychiatry · 2003 · DOI
ME/CFS is a serious illness marked by extreme tiredness lasting at least 6 months, along with other symptoms that significantly limit daily activities. This review brings together current scientific knowledge about how ME/CFS is diagnosed, how common it is, what causes it, and how it can be treated. The evidence suggests ME/CFS is complex, likely caused by multiple factors working together, and treatment works best when tailored to each person's specific needs.
This comprehensive review established that ME/CFS is a legitimate multisystem illness distinct from psychiatric disorders, validating patient experiences and directing clinical attention toward complex biopsychosocial mechanisms. It provided important early evidence that effective management requires individualized, multidimensional approaches rather than single-cause interventions, shaping clinical practice recommendations.
This review does not prove what specifically causes ME/CFS or identify definitive biomarkers for diagnosis. It also does not establish the long-term effectiveness of treatments beyond the timeframes studied, nor does it determine whether psychological factors are primary causes versus secondary consequences of the illness.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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