Differences in alexithymia and emotional awareness in exhaustion syndrome and chronic fatigue syndrome.

Evidence Atlas

Maroti, Daniel, Molander, Peter, Bileviciute-Ljungar, Indre · Scandinavian journal of psychology · 2017 · DOI

Quick Summary

This study looked at how people with Exhaustion Syndrome and ME/CFS differ in how they experience and identify their emotions. Researchers tested 31 people with Exhaustion Syndrome, 38 with ME/CFS, and 30 healthy people using emotion-recognition tests and questionnaires about emotional awareness. The results showed that both groups had some difficulty with emotions, but in slightly different ways—people with ME/CFS had more trouble actually identifying what they were feeling in a performance test, while people with Exhaustion Syndrome mainly reported difficulty on a self-assessment questionnaire.

Why It Matters

Distinguishing between Exhaustion Syndrome and ME/CFS is clinically challenging due to symptom overlap; identifying emotional processing differences could help clinicians differentiate these conditions and tailor treatment approaches. The finding that ME/CFS involves actual measurable difficulties in emotional awareness (not just self-perception) suggests emotional processing dysfunction may be a biological feature worth investigating further. Understanding these emotional differences can guide both clinical assessment and psychotherapeutic interventions.

Observed Findings

Exhaustion Syndrome patients reported higher self-perceived difficulty identifying emotions (TAS-20) but performed normally on objective emotional awareness testing (LEAS).
Chronic Fatigue Syndrome patients showed measurable deficits in both identifying emotions and performing the emotional awareness test, with slower completion times compared to healthy controls.
Depression and anxiety were positively correlated with reported alexithymia scores in both patient groups.
Age and diagnostic group (ES vs CFS vs HC) were the primary predictors of performance on objective emotional awareness testing.
CFS patients performed significantly worse on LEAS-total scores compared to both ES patients and healthy controls.

Inferred Conclusions

Emotional processing differs between ES and CFS, with CFS involving demonstrable cognitive/emotional awareness deficits beyond self-reported difficulty.
Self-reported emotional difficulty (alexithymia) is not the same as measurable emotional processing capacity, suggesting these are distinct constructs.
Depression and anxiety contribute to self-reported emotional difficulty but do not fully explain the objective emotional awareness deficits seen in CFS.
Emotional assessment and targeted emotional/psychological intervention should be incorporated into clinical care for both ES and CFS patients.

What This Study Does Not Prove

This study does not prove that emotional difficulties cause ME/CFS or Exhaustion Syndrome—only that these conditions differ in how emotional processing is affected. The cross-sectional design cannot establish temporal relationships or determine whether emotional changes develop before or after symptom onset. Correlation between depression/anxiety and alexithymia does not establish whether mood disorders drive emotional awareness problems or vice versa.

Metadata

DOI: 10.1111/sjop.12332
PMID: 27686801
Review status: Editor reviewed
Evidence level: Single-study or moderate support from human research
Last updated: 12 April 2026

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 →

Evidence Atlas

Differences in alexithymia and emotional awareness in exhaustion syndrome and chronic fatigue syndrome.

Quick Summary

Why It Matters

Observed Findings

Inferred Conclusions

What This Study Does Not Prove

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