Kroenke, K · Postgraduate medicine · 1991 · DOI
This 1991 editorial discusses what doctors understood about ME/CFS at that time. The author suggests that ME/CFS is likely connected to depression, mild immune system problems, or a combination of both, rather than being caused by Epstein-Barr virus alone. The article recommends that doctors use careful patient interviews, physical exams, and basic blood tests to diagnose the condition, and that supportive, hopeful care is important for treatment.
This editorial is historically important for understanding how ME/CFS was conceptualized in early clinical practice and the shift away from purely viral explanations. However, it also reflects the era when psychiatric attribution was common, which influenced clinical approaches for decades and may have delayed investigation into biological mechanisms now being documented in modern ME/CFS research.
This editorial does not establish causality between psychiatric disorders and ME/CFS through empirical data. It represents expert opinion from 1991 and does not prove that psychiatric factors are primary rather than secondary consequences of the disease. The dismissal of EBV's role was premature, as subsequent research has shown post-viral mechanisms may be relevant in some ME/CFS cases.
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
Kroenke, K (1991). Chronic fatigue syndrome: is it real?. Postgraduate medicine. https://doi.org/10.1080/00325481.1991.11700814
BibTeX
@article{mecfsatlas-kroenke-1991-chronic-fatigue,
author = {Kroenke, K},
title = {Chronic fatigue syndrome: is it real?},
journal = {Postgraduate medicine},
year = {1991},
doi = {10.1080/00325481.1991.11700814},
note = {PubMed: 1990396},
url = {https://www.mecfsatlas.com/evidence/kroenke-1991-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/kroenke-1991-chronic-fatigue
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