E2 ModerateModerate confidencePEM ✗Cross-SectionalPeer-reviewedMachine draft
Differences in alexithymia and emotional awareness in exhaustion syndrome and chronic fatigue syndrome.
Maroti, Daniel, Molander, Peter, Bileviciute-Ljungar, Indre · Scandinavian journal of psychology · 2017 · DOI
Quick Summary
This study looked at how people with Exhaustion Syndrome and ME/CFS differ in how they experience and identify their emotions. Researchers tested 31 people with Exhaustion Syndrome, 38 with ME/CFS, and 30 healthy people using emotion-recognition tests and questionnaires about emotional awareness. The results showed that both groups had some difficulty with emotions, but in slightly different ways—people with ME/CFS had more trouble actually identifying what they were feeling in a performance test, while people with Exhaustion Syndrome mainly reported difficulty on a self-assessment questionnaire.
Why It Matters
Distinguishing between Exhaustion Syndrome and ME/CFS is clinically challenging due to symptom overlap; identifying emotional processing differences could help clinicians differentiate these conditions and tailor treatment approaches. The finding that ME/CFS involves actual measurable difficulties in emotional awareness (not just self-perception) suggests emotional processing dysfunction may be a biological feature worth investigating further. Understanding these emotional differences can guide both clinical assessment and psychotherapeutic interventions.
Observed Findings
- Exhaustion Syndrome patients reported higher self-perceived difficulty identifying emotions (TAS-20) but performed normally on objective emotional awareness testing (LEAS).
- Chronic Fatigue Syndrome patients showed measurable deficits in both identifying emotions and performing the emotional awareness test, with slower completion times compared to healthy controls.
- Depression and anxiety were positively correlated with reported alexithymia scores in both patient groups.
- Age and diagnostic group (ES vs CFS vs HC) were the primary predictors of performance on objective emotional awareness testing.
- CFS patients performed significantly worse on LEAS-total scores compared to both ES patients and healthy controls.
Inferred Conclusions
- Emotional processing differs between ES and CFS, with CFS involving demonstrable cognitive/emotional awareness deficits beyond self-reported difficulty.
- Self-reported emotional difficulty (alexithymia) is not the same as measurable emotional processing capacity, suggesting these are distinct constructs.
- Depression and anxiety contribute to self-reported emotional difficulty but do not fully explain the objective emotional awareness deficits seen in CFS.
- Emotional assessment and targeted emotional/psychological intervention should be incorporated into clinical care for both ES and CFS patients.
What This Study Does Not Prove
This study does not prove that emotional difficulties cause ME/CFS or Exhaustion Syndrome—only that these conditions differ in how emotional processing is affected. The cross-sectional design cannot establish temporal relationships or determine whether emotional changes develop before or after symptom onset. Correlation between depression/anxiety and alexithymia does not establish whether mood disorders drive emotional awareness problems or vice versa.
Tags
Symptom:Cognitive DysfunctionFatigue
Method Flag:PEM Not DefinedWeak Case DefinitionSmall Sample
Metadata
- DOI
- 10.1111/sjop.12332
- PMID
- 27686801
- Review status
- Machine draft
- Evidence level
- Single-study or moderate support from human research
- Last updated
- 8 April 2026