Nes, Lise Solberg, Ehlers, Shawna L, Whipple, Mary O et al. · Journal of pain research · 2013 · DOI
This study created a new questionnaire to measure a specific type of mental tiredness called self-regulatory fatigue—the exhaustion that comes from having to constantly manage your thoughts, emotions, and behaviors. Researchers gave this 18-question test to nearly 300 people with chronic illnesses like fibromyalgia and ME/CFS, along with standard fatigue and self-control tests. They found that this mental tiredness is related to, but distinct from, physical fatigue—suggesting it's a separate problem worth measuring and understanding.
ME/CFS patients often report severe cognitive and emotional difficulties alongside physical fatigue, yet these mental regulatory challenges are poorly characterized in clinical practice. This study proposes a validated instrument to separately measure self-regulatory fatigue from physical fatigue, potentially helping clinicians and researchers better understand and address the cognitive-emotional burden of ME/CFS and similar conditions.
This study does not prove that self-regulatory fatigue causes physical fatigue or vice versa—the strong correlation (r = 0.75) suggests they co-occur but does not establish causality. The cross-sectional design means we cannot determine whether self-regulatory problems precede or result from chronic illness. Additionally, the scale's validation is preliminary and requires replication in independent samples before clinical adoption.
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
Nes, Lise Solberg, Ehlers, Shawna L, Whipple, Mary O, & Vincent, Ann (2013). Self-regulatory fatigue in chronic multisymptom illnesses: scale development, fatigue, and self-control.. Journal of pain research. https://doi.org/10.2147/JPR.S40014
BibTeX
@article{mecfsatlas-nes-2013-self-regulatory,
author = {Nes, Lise Solberg and Ehlers, Shawna L and Whipple, Mary O and Vincent, Ann},
title = {Self-regulatory fatigue in chronic multisymptom illnesses: scale development, fatigue, and self-control.},
journal = {Journal of pain research},
year = {2013},
doi = {10.2147/JPR.S40014},
note = {PubMed: 23526193},
url = {https://www.mecfsatlas.com/evidence/nes-2013-self-regulatory},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/nes-2013-self-regulatory
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