Mariman, An, Delesie, Liesbeth, Tobback, Els et al. · Journal of psychosomatic research · 2013 · DOI
Researchers studied nearly 280 patients who came to a specialized clinic thinking they had ME/CFS, and gave them thorough medical, sleep, and mental health assessments. They found that only about 23% actually had clear-cut ME/CFS; most others had sleep problems like sleep apnea, depression or anxiety, or a combination of these conditions. This suggests that when people feel persistently exhausted, many different medical and mental health issues could be the real cause.
This study highlights a critical problem: many people initially suspected of having ME/CFS actually have treatable sleep disorders or psychiatric conditions that could explain their fatigue. For patients, this emphasizes the importance of thorough diagnostic evaluation before accepting an ME/CFS diagnosis. For researchers and clinicians, it underscores that diagnostic rigor and multidisciplinary assessment are essential to avoid misdiagnosis and ensure patients receive appropriate, targeted treatment.
This study does not prove that ME/CFS is primarily psychiatric or sleep-related; it shows only that when patients are carefully evaluated, many have coexisting conditions. The findings reflect a tertiary referral center population, which may differ significantly from primary care settings or community samples, limiting generalizability. Cross-sectional design means we cannot determine whether sleep disorders or psychiatric conditions cause fatigue, develop as a consequence of it, or are truly independent comorbidities.
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
Mariman, An, Delesie, Liesbeth, Tobback, Els, Hanoulle, Ignace, Sermijn, Erica, Vermeir, Peter, et al. (2013). Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome.. Journal of psychosomatic research. https://doi.org/10.1016/j.jpsychores.2013.07.010
BibTeX
@article{mecfsatlas-mariman-2013-undiagnosed-comorbid,
author = {Mariman, An and Delesie, Liesbeth and Tobback, Els and Hanoulle, Ignace and Sermijn, Erica and Vermeir, Peter and Pevernagie, Dirk and Vogelaers, Dirk},
title = {Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome.},
journal = {Journal of psychosomatic research},
year = {2013},
doi = {10.1016/j.jpsychores.2013.07.010},
note = {PubMed: 24182640},
url = {https://www.mecfsatlas.com/evidence/mariman-2013-undiagnosed-comorbid},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/mariman-2013-undiagnosed-comorbid
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