Bram, Anthony D, Gottschalk, Kiley A, Leeds, William M · Journal of the American Psychoanalytic Association · 2018 · DOI
This study looked at how women with ME/CFS and depression process and manage their emotions differently than healthy women. Researchers tested 186 women in four groups—those with ME/CFS and high depression, ME/CFS with lower depression, depression alone, and healthy controls—to see if difficulty expressing emotions psychologically might lead to more physical symptoms. The findings suggest that some people with ME/CFS, particularly those with both ME/CFS and depression, may have more trouble managing emotions, but not all patients show this pattern.
This study addresses the long-standing clinical challenge of distinguishing ME/CFS from depression and understanding why some patients experience more severe or persistent symptoms. By identifying emotional regulation patterns in ME/CFS subgroups, the research suggests that personalized assessment and targeted depression treatment may improve outcomes for some patients, while recognizing that ME/CFS is not merely a somatic expression of untreated depression.
This study does not establish that emotional dysregulation causes ME/CFS; it only shows an association in some patient subgroups. The cross-sectional design cannot determine temporal relationships or causality. The study does not prove that psychological treatment alone will resolve ME/CFS symptoms, and it does not establish whether observed emotional regulation differences are primary, secondary to chronic illness, or reflections of individual resilience differences.
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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Primary citation
Bram, Anthony D, Gottschalk, Kiley A, & Leeds, William M (2018). Emotional Regulation in Women with Chronic Fatigue Syndrome and Depression: Internal Representations and Adaptive Defenses.. Journal of the American Psychoanalytic Association. https://doi.org/10.1177/0003065118798043
BibTeX
@article{mecfsatlas-bram-2018-emotional-regulation,
author = {Bram, Anthony D and Gottschalk, Kiley A and Leeds, William M},
title = {Emotional Regulation in Women with Chronic Fatigue Syndrome and Depression: Internal Representations and Adaptive Defenses.},
journal = {Journal of the American Psychoanalytic Association},
year = {2018},
doi = {10.1177/0003065118798043},
note = {PubMed: 30249136},
url = {https://www.mecfsatlas.com/evidence/bram-2018-emotional-regulation},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/bram-2018-emotional-regulation
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