Kato, Kenji, Sullivan, Patrick F, Pedersen, Nancy L · Journal of psychosomatic research · 2010 · DOI
This study looked at how people with chronic fatigue and multiple physical symptoms cluster into different groups. Researchers studied over 28,000 twins and found five distinct groups: those with no symptoms, those mainly tired, those with stomach problems, those with pain, and those with many symptoms across all areas. The study suggests that while genes play a small role, environmental factors (like stress, infections, or lifestyle) are much more important in determining who develops these symptoms.
This study provides an empirically-derived classification system for functional somatic syndromes that may better reflect the heterogeneous presentation of conditions like ME/CFS. By demonstrating that environmental factors dominate genetic influences, it highlights the importance of researching modifiable triggers and protective factors. The identification of a multisymptomatic class is particularly relevant for understanding severe ME/CFS presentations.
This study does not establish causation or identify specific environmental triggers responsible for symptom development. The cross-sectional design cannot determine whether environmental exposures precede symptom onset or whether classification is temporally stable. It also does not provide mechanistic insights into how environmental factors lead to symptom manifestation in susceptible individuals.
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
Kato, Kenji, Sullivan, Patrick F, & Pedersen, Nancy L (2010). Latent class analysis of functional somatic symptoms in a population-based sample of twins.. Journal of psychosomatic research. https://doi.org/10.1016/j.jpsychores.2010.01.010
BibTeX
@article{mecfsatlas-kato-2010-latent-class,
author = {Kato, Kenji and Sullivan, Patrick F and Pedersen, Nancy L},
title = {Latent class analysis of functional somatic symptoms in a population-based sample of twins.},
journal = {Journal of psychosomatic research},
year = {2010},
doi = {10.1016/j.jpsychores.2010.01.010},
note = {PubMed: 20403503},
url = {https://www.mecfsatlas.com/evidence/kato-2010-latent-class},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/kato-2010-latent-class
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