E2 ModerateModerate confidencePEM not requiredCross-SectionalPeer-reviewedReviewed
Anxiety in children with CFS/ME.
Crawley, Esther, Hunt, Linda, Stallard, Paul · European child & adolescent psychiatry · 2009 · DOI
Quick Summary
This study looked at anxiety in children with ME/CFS and found that anxiety is common, especially in teenage girls. Researchers compared anxiety levels in 164 children with ME/CFS to healthy European children and found that 38% of teenage girls with ME/CFS had unusually high anxiety symptoms. Interestingly, anxiety levels did not seem to be connected to how much school the children attended or how severe their physical symptoms were.
Why It Matters
Understanding the types and prevalence of anxiety in children with ME/CFS is crucial for appropriate clinical assessment and treatment. This study challenges the assumption that anxiety drives school absence or disability in pediatric ME/CFS, suggesting that anxiety and functional limitation may be independent features of the illness that require separate clinical attention.
Observed Findings
- 38% of teenage girls with ME/CFS scored above the anxiety cut-off (top 10% of normal European population), compared to lower rates in other age/gender groups
- Separation anxiety affected 37% of younger girls and social phobia affected 39% of younger girls with ME/CFS
- No statistically significant association was found between total anxiety symptoms and school attendance, time to assessment, or pain
- Associations between anxiety and fatigue or physical function were reduced when adjusted for other variables
Inferred Conclusions
- Anxiety symptoms are elevated in pediatric ME/CFS, particularly in teenage girls, but appear to be independent of disease severity and school attendance patterns
- Separation anxiety and social phobia are the most prominent anxiety subtypes in children with ME/CFS
- The presence of anxiety in ME/CFS should not be automatically attributed to reduced school attendance or assumed to be the primary driver of disability
Remaining Questions
- Why are teenage girls disproportionately affected by anxiety in ME/CFS compared to younger girls and boys?
- Does anxiety in ME/CFS respond differently to treatment compared to anxiety in other pediatric populations?
- What is the longitudinal course of anxiety symptoms in children with ME/CFS, and does it change over time or with disease progression?
What This Study Does Not Prove
This study does not establish causation between anxiety and ME/CFS symptoms; it only documents that they co-occur. The cross-sectional design cannot determine whether anxiety develops as a response to having ME/CFS, is a primary feature of the condition, or represents a separate comorbidity. The study also does not examine treatment response or whether addressing anxiety improves other ME/CFS symptoms.
Tags
Symptom:Fatigue
Phenotype:Pediatric
Method Flag:Weak Case DefinitionNo ControlsSex-Stratified
Metadata
- DOI
- 10.1007/s00787-009-0029-4
- PMID
- 19452195
- Review status
- Editor reviewed
- Evidence level
- Single-study or moderate support from human research
- Last updated
- 12 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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