Muller, Ashley Elizabeth, Tveito, Kari, Bakken, Inger Johanne et al. · Journal of translational medicine · 2020 · DOI
Researchers reviewed over 1,100 studies published between 1979 and 2019 to understand what might cause ME/CFS. They found that scientists have studied many different potential causes, including immune system problems, psychological factors, infections, and hormonal imbalances. However, most of these studies were small and only suggested ideas rather than proving what actually causes ME/CFS—we need larger, better-designed studies to get real answers.
This comprehensive overview of the research landscape reveals that ME/CFS is being studied from multiple angles, which validates the complexity patients experience. However, it also highlights a critical gap: we lack large, well-designed studies that can definitively identify what causes ME/CFS, which is essential for developing better treatments and prevention strategies.
This review does not establish which factors actually cause ME/CFS—it only maps what researchers have studied. The predominance of small case-control studies means most published work identifies associations rather than causal relationships. This scoping review itself cannot determine which hypotheses are correct or most important.
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
Muller, Ashley Elizabeth, Tveito, Kari, Bakken, Inger Johanne, Flottorp, Signe A, Mjaaland, Siri, & Larun, Lillebeth (2020). Potential causal factors of CFS/ME: a concise and systematic scoping review of factors researched.. Journal of translational medicine. https://doi.org/10.1186/s12967-020-02665-6
BibTeX
@article{mecfsatlas-muller-2020-potential-causal,
author = {Muller, Ashley Elizabeth and Tveito, Kari and Bakken, Inger Johanne and Flottorp, Signe A and Mjaaland, Siri and Larun, Lillebeth},
title = {Potential causal factors of CFS/ME: a concise and systematic scoping review of factors researched.},
journal = {Journal of translational medicine},
year = {2020},
doi = {10.1186/s12967-020-02665-6},
note = {PubMed: 33317576},
url = {https://www.mecfsatlas.com/evidence/muller-2020-potential-causal},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/muller-2020-potential-causal
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