Palacios, Natalia, Molsberry, Samantha, Fitzgerald, Kathryn C et al. · Scientific reports · 2023 · DOI
This study examined whether ME/CFS is simply an extreme version of regular fatigue, or if it's a fundamentally different condition. Researchers surveyed over 41,000 nurses and found that ME/CFS and severe fatigue have different risk factors—meaning different things cause them. This suggests that ME/CFS is a distinct condition with its own underlying biology, not just 'really bad tiredness.'
This research provides evidence that ME/CFS is biologically distinct from ordinary fatigue, which could help validate ME/CFS as a unique disease entity and potentially influence clinical recognition and research priorities. Understanding that ME/CFS has different risk factors may eventually lead to more targeted diagnostic approaches and disease mechanisms.
This study does not establish causation—it only shows associations with past exposures. The non-significant finding for mononucleosis (confidence interval crossing 1.0) does not rule out infectious triggers. The research is limited to female nurses in the US, so findings may not apply to other populations or different genders.
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
Palacios, Natalia, Molsberry, Samantha, Fitzgerald, Kathryn C, & Komaroff, Anthony L (2023). Different risk factors distinguish myalgic encephalomyelitis/chronic fatigue syndrome from severe fatigue.. Scientific reports. https://doi.org/10.1038/s41598-023-29329-x
BibTeX
@article{mecfsatlas-palacios-2023-different-risk,
author = {Palacios, Natalia and Molsberry, Samantha and Fitzgerald, Kathryn C and Komaroff, Anthony L},
title = {Different risk factors distinguish myalgic encephalomyelitis/chronic fatigue syndrome from severe fatigue.},
journal = {Scientific reports},
year = {2023},
doi = {10.1038/s41598-023-29329-x},
note = {PubMed: 36774379},
url = {https://www.mecfsatlas.com/evidence/palacios-2023-different-risk},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/palacios-2023-different-risk
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