Issa, Anindita, Lin, Jin-Mann S, Chen, Yang et al. · Journal of clinical medicine · 2025 · DOI
This study found that people with ME/CFS experience much higher levels of autonomic nervous system problems—which control things like heart rate, blood pressure, and digestion—compared to healthy people. Nearly all ME/CFS patients (97%) had at least one autonomic symptom, with common complaints including dizziness, cold hands and feet, and difficulty standing up. The more autonomic symptoms someone had, especially in certain areas like blood pressure regulation and stomach problems, the more severe their overall illness tended to be.
This large, multi-site study provides robust evidence that autonomic dysfunction is a core feature of ME/CFS affecting nearly all patients, not just a coincidental finding. By demonstrating that specific autonomic domains directly correlate with illness severity, the findings support the development of targeted dysautonomia assessments and interventions as potential pathways to improve symptoms and quality of life for ME/CFS patients.
This study cannot establish whether autonomic dysfunction causes ME/CFS severity, is caused by it, or develops independently alongside it. The cross-sectional design captures only a single timepoint, so it cannot track how autonomic symptoms change over disease course or in response to treatment. The findings describe associations in seven specialty clinics and may not represent all ME/CFS patients, particularly those with milder disease who may not seek specialty care.
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
Issa, Anindita, Lin, Jin-Mann S, Chen, Yang, Attell, Jacob, Brimmer, Dana, Bertolli, Jeanne, et al. (2025). Autonomic Dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Findings from the Multi-Site Clinical Assessment of ME/CFS (MCAM) Study in the USA.. Journal of clinical medicine. https://doi.org/10.3390/jcm14176269
BibTeX
@article{mecfsatlas-issa-2025-autonomic-dysfunction,
author = {Issa, Anindita and Lin, Jin-Mann S and Chen, Yang and Attell, Jacob and Brimmer, Dana and Bertolli, Jeanne and Natelson, Benjamin H and Lapp, Charles W and Podell, Richard N and Kogelnik, Andreas M and Klimas, Nancy G and Peterson, Daniel L and Bateman, Lucinda and Unger, Elizabeth R and MCAM Study Group},
title = {Autonomic Dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Findings from the Multi-Site Clinical Assessment of ME/CFS (MCAM) Study in the USA.},
journal = {Journal of clinical medicine},
year = {2025},
doi = {10.3390/jcm14176269},
note = {PubMed: 40944028},
url = {https://www.mecfsatlas.com/evidence/issa-2025-autonomic-dysfunction},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/issa-2025-autonomic-dysfunction
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