Litzenburger, Alexandra, Rothacher, Yannick, Hanusch, Kay-Uwe et al. · Journal of psychosomatic research · 2025 · DOI
This study looked at how symptoms cluster together in people with functional somatic syndromes (like ME/CFS, fibromyalgia, and others). Researchers surveyed over 3,000 young adults and used network analysis to map which symptoms tend to appear together. They found that fatigue and depression are particularly important symptoms that connect different symptom groups, and identified ten distinct clusters of related symptoms.
Understanding how symptoms interconnect in ME/CFS and related conditions could guide treatment priorities and design of more effective interventions. The finding that fatigue and depression act as network hubs suggests these may be leverage points for therapeutic intervention across multiple functional somatic syndromes.
This study does not establish causality—it cannot determine whether fatigue causes depression, depression causes fatigue, or both arise from a shared underlying mechanism. The cross-sectional design captures associations at a single time point and does not track how symptom networks evolve or respond to treatment. The findings in young adults may not apply to older individuals or those with more severe disease.
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
Litzenburger, Alexandra, Rothacher, Yannick, Hanusch, Kay-Uwe, Ehlert, Ulrike, Nater, Urs M, & Fischer, Susanne (2025). Network structure of functional somatic symptoms.. Journal of psychosomatic research. https://doi.org/10.1016/j.jpsychores.2024.111968
BibTeX
@article{mecfsatlas-litzenburger-2025-network-structure,
author = {Litzenburger, Alexandra and Rothacher, Yannick and Hanusch, Kay-Uwe and Ehlert, Ulrike and Nater, Urs M and Fischer, Susanne},
title = {Network structure of functional somatic symptoms.},
journal = {Journal of psychosomatic research},
year = {2025},
doi = {10.1016/j.jpsychores.2024.111968},
note = {PubMed: 39532031},
url = {https://www.mecfsatlas.com/evidence/litzenburger-2025-network-structure},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/litzenburger-2025-network-structure
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