Demitrack, M A · The Psychiatric clinics of North America · 1998 · DOI
This article reviews what we know about ME/CFS and fibromyalgia, two conditions that cause severe tiredness and pain and are often misunderstood. The authors explain that these illnesses involve both physical and mental health factors working together, rather than being purely 'in your head' or purely physical. They provide doctors with practical guidelines for better diagnosis and treatment of these challenging conditions.
This work addresses the fundamental challenge that ME/CFS and fibromyalgia patients face: medical skepticism and diagnostic uncertainty. By proposing an integrated psychobiological model that acknowledges real physical changes alongside psychological factors, it helps legitimize these conditions and encourages healthcare providers to take them seriously and manage them effectively.
As a review article, this does not present original experimental data or prove specific biological mechanisms of ME/CFS. It does not establish causation for any particular factor in disease development, and its conclusions reflect 1998-era understanding—many findings have since been updated. The pragmatic management recommendations are expert opinion rather than evidence from clinical trials.
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
Demitrack, M A (1998). Chronic fatigue syndrome and fibromyalgia. Dilemmas in diagnosis and clinical management.. The Psychiatric clinics of North America. https://doi.org/10.1016/s0193-953x(05)70031-9
BibTeX
@article{mecfsatlas-demitrack-1998-chronic-fatigue,
author = {Demitrack, M A},
title = {Chronic fatigue syndrome and fibromyalgia. Dilemmas in diagnosis and clinical management.},
journal = {The Psychiatric clinics of North America},
year = {1998},
doi = {10.1016/s0193-953x(05)70031-9},
note = {PubMed: 9774804},
url = {https://www.mecfsatlas.com/evidence/demitrack-1998-chronic-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/demitrack-1998-chronic-fatigue
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