Katon, W, Russo, J · Archives of internal medicine · 1992 · DOI
This study looked at 285 people with chronic fatigue to understand whether having many physical symptoms was linked to psychiatric conditions like depression and anxiety. Researchers found that patients reporting more unexplained physical symptoms were significantly more likely to have current or past psychiatric diagnoses. The authors suggest that ME/CFS diagnostic criteria should be changed to include people with fatigue and few physical symptoms, and potentially exclude those with many physical complaints.
This study directly challenges how ME/CFS is currently defined and diagnosed, suggesting that requiring multiple physical symptoms may inadvertently select for patients with primarily psychiatric illness rather than a distinct biological condition. Understanding whether ME/CFS case definitions need revision is critical for ensuring patients receive appropriate diagnosis and treatment targeting the correct underlying disease.
This study does not prove that psychiatric symptoms cause ME/CFS or vice versa—it only shows correlation. The cross-sectional design cannot establish causation or temporal relationships. The study also does not address whether the relationship between symptoms and psychiatric diagnoses reflects misdiagnosis, legitimate comorbidity, or psychiatric responses to chronic illness.
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
Katon, W & Russo, J (1992). Chronic fatigue syndrome criteria. A critique of the requirement for multiple physical complaints.. Archives of internal medicine. https://doi.org/10.1001/archinte.152.8.1604
BibTeX
@article{mecfsatlas-katon-1992-chronic-fatigue,
author = {Katon, W and Russo, J},
title = {Chronic fatigue syndrome criteria. A critique of the requirement for multiple physical complaints.},
journal = {Archives of internal medicine},
year = {1992},
doi = {10.1001/archinte.152.8.1604},
note = {PubMed: 1497394},
url = {https://www.mecfsatlas.com/evidence/katon-1992-chronic-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/katon-1992-chronic-fatigue
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