Jones, James F, Lin, Jin-Mann S, Maloney, Elizabeth M et al. · BMC medicine · 2009 · DOI
This study looked at whether people diagnosed with ME/CFS who also have other medical or psychiatric conditions (like depression or thyroid disease) are actually sicker than those with ME/CFS alone. Researchers surveyed over 5,600 people in Georgia and clinically evaluated 781 of them. They found that about one-third of people had additional conditions, but surprisingly, people with and without these extra conditions reported similar levels of fatigue and disability.
This research challenges the assumption that excluding people with comorbid conditions from CFS studies produces a 'purer' population—it suggests that comorbid conditions may not substantially change how sick someone is. Understanding whether exclusionary criteria actually improve research validity has important implications for how future ME/CFS studies define their participants and interpret results.
This study does not prove that exclusionary conditions are unimportant for ME/CFS diagnosis or management. The cross-sectional design cannot establish causation or temporal relationships. Additionally, the study uses self-reported diagnoses and telephone screening rather than standardized biological measures, so the true prevalence and impact of comorbidities may differ.
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
Jones, James F, Lin, Jin-Mann S, Maloney, Elizabeth M, Boneva, Roumiana S, Nater, Urs M, Unger, Elizabeth R, et al. (2009). An evaluation of exclusionary medical/psychiatric conditions in the definition of chronic fatigue syndrome.. BMC medicine. https://doi.org/10.1186/1741-7015-7-57
BibTeX
@article{mecfsatlas-jones-2009-evaluation-exclusionary,
author = {Jones, James F and Lin, Jin-Mann S and Maloney, Elizabeth M and Boneva, Roumiana S and Nater, Urs M and Unger, Elizabeth R and Reeves, William C},
title = {An evaluation of exclusionary medical/psychiatric conditions in the definition of chronic fatigue syndrome.},
journal = {BMC medicine},
year = {2009},
doi = {10.1186/1741-7015-7-57},
note = {PubMed: 19818157},
url = {https://www.mecfsatlas.com/evidence/jones-2009-evaluation-exclusionary},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/jones-2009-evaluation-exclusionary
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