Afari, Niloofar, Ahumada, Sandra M, Wright, Lisa Johnson et al. · Psychosomatic medicine · 2014 · DOI
This large analysis of 71 studies found that people who have experienced psychological trauma are about 2.7 times more likely to develop functional somatic syndromes like ME/CFS, fibromyalgia, and irritable bowel syndrome. The connection was even stronger in people with PTSD (post-traumatic stress disorder). This suggests that traumatic experiences are linked to increased risk of developing these chronic conditions.
This meta-analysis provides robust evidence that trauma exposure is epidemiologically associated with ME/CFS and related conditions, supporting clinical recognition of trauma history in these populations. Understanding this link may guide more trauma-informed clinical care and highlight the need for studies examining the biological mechanisms connecting trauma and ME/CFS pathophysiology.
This study demonstrates statistical association but does not prove that trauma directly causes ME/CFS or establish the direction of causality—it is possible that ME/CFS or early symptoms increase vulnerability to trauma, or that unmeasured confounders explain the association. The meta-analysis includes mostly cross-sectional studies, limiting causal inference. Findings also reflect reported trauma, which may be subject to recall bias and social desirability bias.
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 →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Afari, Niloofar, Ahumada, Sandra M, Wright, Lisa Johnson, Mostoufi, Sheeva, Golnari, Golnaz, Reis, Veronica, et al. (2014). Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis.. Psychosomatic medicine. https://doi.org/10.1097/PSY.0000000000000010
BibTeX
@article{mecfsatlas-afari-2014-psychological-trauma,
author = {Afari, Niloofar and Ahumada, Sandra M and Wright, Lisa Johnson and Mostoufi, Sheeva and Golnari, Golnaz and Reis, Veronica and Cuneo, Jessica Gundy},
title = {Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis.},
journal = {Psychosomatic medicine},
year = {2014},
doi = {10.1097/PSY.0000000000000010},
note = {PubMed: 24336429},
url = {https://www.mecfsatlas.com/evidence/afari-2014-psychological-trauma},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/afari-2014-psychological-trauma
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