Kleinstäuber, Maria, Schröder, Andreas, Daehler, Sarah et al. · Clinical psychology in Europe · 2023 · DOI
This study reviewed hundreds of scientific articles about ME/CFS, fibromyalgia, and irritable bowel syndrome to understand what researchers think causes these conditions. The researchers found that most studies focus on biological factors like immune system problems, while far fewer examine psychological or social causes. The review suggests that the best understanding comes from looking at multiple factors together—biological, psychological, and social—rather than just one type of cause.
This comprehensive overview reveals significant gaps in how ME/CFS research is currently conducted and reported. By showing that biological factors dominate the literature while psychological and social dimensions are understudied, it highlights the need for more balanced, integrated research approaches that could lead to better understanding and treatment of ME/CFS.
This umbrella review does not identify the actual cause of ME/CFS or prove that any specific factor causes the condition. It only surveys what has been published in scientific literature, which may reflect research funding patterns and biases rather than the true relative importance of different aetiological factors. The review cannot establish causation versus correlation for any identified risk factors.
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
Kleinstäuber, Maria, Schröder, Andreas, Daehler, Sarah, Pallesen, Karen Johanne, Rask, Charlotte U, Sanyer, Mathias, et al. (2023). Aetiological Understanding of Fibromyalgia, Irritable Bowel Syndrome, Chronic Fatigue Syndrome and Classificatory Analogues: A Systematic Umbrella Review.. Clinical psychology in Europe. https://doi.org/10.32872/cpe.11179
BibTeX
@article{mecfsatlas-kleinstuber-2023-aetiological-understanding,
author = {Kleinstäuber, Maria and Schröder, Andreas and Daehler, Sarah and Pallesen, Karen Johanne and Rask, Charlotte U and Sanyer, Mathias and Van den Bergh, Omer and Weinreich Petersen, Marie and Rosmalen, Judith G M},
title = {Aetiological Understanding of Fibromyalgia, Irritable Bowel Syndrome, Chronic Fatigue Syndrome and Classificatory Analogues: A Systematic Umbrella Review.},
journal = {Clinical psychology in Europe},
year = {2023},
doi = {10.32872/cpe.11179},
note = {PubMed: 38356902},
url = {https://www.mecfsatlas.com/evidence/kleinstuber-2023-aetiological-understanding},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/kleinstuber-2023-aetiological-understanding
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