Maloney, Elizabeth M, Boneva, Roumiana, Nater, Urs M et al. · Psychosomatic medicine · 2009 · DOI
This study looked at whether people with ME/CFS have higher levels of 'allostatic load'—a measure of how much stress and wear-and-tear their bodies have accumulated over time. Researchers compared 83 people with ME/CFS, 202 people with some symptoms but not full ME/CFS, and 109 healthy controls in Georgia. They found that people with ME/CFS did have significantly higher allostatic load than healthy people, suggesting their bodies may be under greater physiological stress.
This study provides biological support for the experience of ME/CFS patients by demonstrating measurable physiological dysregulation (allostatic load) associated with the disease. Understanding that ME/CFS involves cumulative physiological stress helps validate patient experiences and may inform future therapeutic approaches targeting stress response systems. The finding that this association holds independent of depression strengthens the case for ME/CFS as a distinct biological condition.
This study does not establish causation—high allostatic load may result from ME/CFS rather than cause it, or both may be caused by a third factor. The cross-sectional design means we cannot determine whether allostatic load accumulates *before* ME/CFS onset or *because of* having ME/CFS. The study also does not prove that reducing allostatic load would improve ME/CFS outcomes.
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
Maloney, Elizabeth M, Boneva, Roumiana, Nater, Urs M, & Reeves, William C (2009). Chronic fatigue syndrome and high allostatic load: results from a population-based case-control study in Georgia.. Psychosomatic medicine. https://doi.org/10.1097/PSY.0b013e3181a4fea8
BibTeX
@article{mecfsatlas-maloney-2009-chronic-fatigue,
author = {Maloney, Elizabeth M and Boneva, Roumiana and Nater, Urs M and Reeves, William C},
title = {Chronic fatigue syndrome and high allostatic load: results from a population-based case-control study in Georgia.},
journal = {Psychosomatic medicine},
year = {2009},
doi = {10.1097/PSY.0b013e3181a4fea8},
note = {PubMed: 19414615},
url = {https://www.mecfsatlas.com/evidence/maloney-2009-chronic-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/maloney-2009-chronic-fatigue
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