Kirvin-Quamme, Andrew, Kirke, Karen D, Junge, Oscar et al. · Frontiers in psychology · 2025 · DOI
This study examined how people with ME/CFS perform on effort-based tasks and what their performance reveals about the condition. Researchers investigated whether people with ME/CFS struggle with these tasks because they are unable to exert effort (due to physical limitations) or unwilling to do so (due to motivation or other psychological factors). Understanding this distinction is important for interpreting test results and designing appropriate treatments.
This research addresses a critical misunderstanding in ME/CFS assessment: whether poor performance on effort tasks indicates low motivation (a psychological interpretation) or genuine physical inability from the disease itself. Clarifying this distinction helps prevent misdiagnosis, inappropriate psychiatric framing, and ensures patients receive appropriate medical rather than purely psychological interventions.
This study does not provide novel experimental data from patient testing, so it cannot definitively prove which mechanism predominates in any given patient. It is a theoretical/interpretive paper rather than an empirical study with new outcome measurements. The analysis may not account for individual variation in ME/CFS presentations across different patient populations.
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
Kirvin-Quamme, Andrew, Kirke, Karen D, Junge, Oscar, Edwards, Jonathan C W, & Holmes, Kevin J (2025). Unwilling or unable? Interpreting effort task performance in myalgic encephalomyelitis/chronic fatigue syndrome.. Frontiers in psychology. https://doi.org/10.3389/fpsyg.2025.1593269
BibTeX
@article{mecfsatlas-kirvin-quamme-2025-unwilling-unable,
author = {Kirvin-Quamme, Andrew and Kirke, Karen D and Junge, Oscar and Edwards, Jonathan C W and Holmes, Kevin J},
title = {Unwilling or unable? Interpreting effort task performance in myalgic encephalomyelitis/chronic fatigue syndrome.},
journal = {Frontiers in psychology},
year = {2025},
doi = {10.3389/fpsyg.2025.1593269},
note = {PubMed: 40584062},
url = {https://www.mecfsatlas.com/evidence/kirvin-quamme-2025-unwilling-unable},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/kirvin-quamme-2025-unwilling-unable
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