Malato, João, Graça, Luís, Sepúlveda, Nuno · Diagnostics (Basel, Switzerland) · 2023 · DOI
This study examined how misdiagnosis affects ME/CFS research results. The researchers found that when patients are incorrectly diagnosed with ME/CFS (or vice versa), it becomes much harder for studies to find real connections between potential causes and the disease. To get reliable results, studies need to include at least 500-1000 people per group, which is larger than many current ME/CFS studies.
This research directly addresses why ME/CFS findings are often difficult to reproduce—misdiagnosis substantially reduces a study's ability to detect real biological associations. Understanding these limitations helps guide future research design and encourages more rigorous diagnostic approaches, ultimately improving the quality of evidence that may lead to better treatments.
This study does not identify which current ME/CFS studies contain misdiagnosed cases or quantify actual misdiagnosis rates in existing literature. It uses theoretical simulations rather than analyzing real patient cohorts, so it cannot determine how often misdiagnosis actually occurs in clinical practice or how much it has affected specific past findings.
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
Malato, João, Graça, Luís, & Sepúlveda, Nuno (2023). Impact of Misdiagnosis in Case-Control Studies of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.. Diagnostics (Basel, Switzerland). https://doi.org/10.3390/diagnostics13030531
BibTeX
@article{mecfsatlas-malato-2023-impact-misdiagnosis,
author = {Malato, João and Graça, Luís and Sepúlveda, Nuno},
title = {Impact of Misdiagnosis in Case-Control Studies of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.},
journal = {Diagnostics (Basel, Switzerland)},
year = {2023},
doi = {10.3390/diagnostics13030531},
note = {PubMed: 36766636},
url = {https://www.mecfsatlas.com/evidence/malato-2023-impact-misdiagnosis},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/malato-2023-impact-misdiagnosis
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