Hyperventilation.

Evidence Atlas

Hyperventilation.

Paulley, J W · Recenti progressi in medicina · 1990

Quick Summary

This 1990 editorial argues that hyperventilation syndrome (rapid, shallow breathing) is often misdiagnosed as ME/CFS, and that doctors fail to recognize and properly treat it. The author suggests that many patients labeled with ME/CFS actually have hyperventilation triggered by psychological stress and unresolved emotional losses, and recommends treatment combining physiotherapy and psychological counseling.

Why It Matters

This work is historically significant as it represents a viewpoint—common in the 1980s-90s—that attributed ME/CFS symptoms primarily to psychological causes and hyperventilation, a perspective that influenced medical attitudes and delayed recognition of ME/CFS as a biological illness.

Observed Findings

- Physicians frequently misdiagnose hyperventilation syndrome as myalgic encephalomyelitis
- Diagnostic suspicion should be raised by specific clinical signs (not detailed in abstract)
- Panic attacks and hyperventilation have a bidirectional relationship
- Patients gravitate toward specialist departments where diagnosis may become less rigorous
- Underlying psychopathology related to early loss or alienation is proposed as precipitant

Inferred Conclusions

- Hyperventilation syndrome is over-represented in populations diagnosed with ME/CFS due to physician oversight
- Combined physiotherapy and psychological intervention addressing root emotional trauma is necessary for management
- Medical education inadequately prepares doctors to recognize and treat hyperventilation
- Psychological stressors and unresolved losses are the primary drivers of hyperventilation symptoms

Remaining Questions

- What objective diagnostic criteria can reliably distinguish hyperventilation syndrome from ME/CFS with post-exertional malaise?
- How many patients labeled with ME/CFS actually have primary hyperventilation versus comorbid hyperventilation?

What This Study Does Not Prove

This editorial does not establish whether hyperventilation and ME/CFS are distinct conditions or whether psychological factors are the primary cause of ME/CFS. It presents clinical opinion without empirical evidence, controlled comparisons, or objective testing data. It does not prove that the proposed psychological management actually resolves ME/CFS symptoms.

Metadata

PMID: 2263757
Review status: Machine draft
Evidence level: Early hypothesis, preprint, editorial, or weak support
Last updated: 8 April 2026

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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