Herrell, Richard, Goldberg, Jack, Hartman, Suzanne et al. · Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2002 · DOI
This study compared twins where one had chronic fatigue or ME/CFS and the other did not. Researchers found that fatigued twins had significantly worse quality of life and daily functioning than their healthy siblings, particularly in physical activities. The more severe the fatigue definition used, the greater the functional impairment observed.
This study demonstrates the substantial real-world impact of ME/CFS on quality of life and daily functioning, quantifying disability across multiple life domains. Using twin pairs strengthens evidence that fatigue-related disability is genuine and not explained by genetic predisposition alone, which supports the validity of CFS as a disabling condition deserving clinical attention and resources.
This study does not establish the *cause* of ME/CFS or fatigue, only that it produces measurable functional impairment. The cross-sectional design cannot determine whether fatigue causes disability or vice versa. Self-reported fatigue classification (in the 74-pair group) may not reflect clinical ME/CFS, limiting generalizability of findings to clinically confirmed cases.
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
Herrell, Richard, Goldberg, Jack, Hartman, Suzanne, Belcourt, Megan, Schmaling, Karen, & Buchwald, Dedra (2002). Chronic fatigue and chronic fatigue syndrome: a co-twin control study of functional status.. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. https://doi.org/10.1023/a:1015635113159
BibTeX
@article{mecfsatlas-herrell-2002-chronic-fatigue,
author = {Herrell, Richard and Goldberg, Jack and Hartman, Suzanne and Belcourt, Megan and Schmaling, Karen and Buchwald, Dedra},
title = {Chronic fatigue and chronic fatigue syndrome: a co-twin control study of functional status.},
journal = {Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation},
year = {2002},
doi = {10.1023/a:1015635113159},
note = {PubMed: 12113393},
url = {https://www.mecfsatlas.com/evidence/herrell-2002-chronic-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/herrell-2002-chronic-fatigue
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