Komaroff, A L, Buchwald, D S · Annual review of medicine · 1998 · DOI
This review examines chronic fatigue syndrome (ME/CFS), a serious condition where people experience extreme tiredness and other symptoms that last at least six months. The authors explain that ME/CFS is not simply depression or a mental health problem, but rather involves real physical changes in the body including immune system activation and issues with hormone-regulating glands. Understanding these biological features helps validate that ME/CFS is a genuine medical illness deserving proper research and treatment.
This review was influential in shifting the medical understanding of ME/CFS from a psychiatric diagnosis to a recognized biomedical illness with measurable immune and endocrine abnormalities. For patients, it provided crucial validation that their symptoms reflect real biological dysfunction rather than psychological causes, which has implications for how the condition is researched and treated.
This review does not establish causation or identify specific pathogenic mechanisms—it summarizes associations between ME/CFS and various biological abnormalities without proving which factors cause the illness. The review cannot quantify the prevalence of these abnormalities in ME/CFS populations or establish how they relate to symptom severity. It also does not provide definitive guidance on diagnosis or treatment.
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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