Roberts, Amanda D L, Wessely, Simon, Chalder, Trudie et al. · The British journal of psychiatry : the journal of mental science · 2004 · DOI
This study tested how well the body's stress response system (controlled by the brain and hormones) works in ME/CFS patients. Researchers measured cortisol, a stress hormone, in saliva when people first woke up and for an hour afterward. They found that people with ME/CFS had a weaker cortisol response compared to healthy people, suggesting their stress-response system may not be working properly.
This study provides objective biological evidence of a specific physiological abnormality in ME/CFS—HPA axis dysfunction—which could help validate the condition as a biological disorder rather than purely psychological. Understanding this mechanism may eventually inform treatment approaches targeting hormonal regulation and stress response.
This study does not prove that HPA axis dysfunction causes ME/CFS symptoms or that restoring cortisol levels will improve the condition. It demonstrates association, not causation, and does not explain whether this dysfunction is primary to the disease, secondary to chronic illness, or contributes meaningfully to patient disability.
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
Roberts, Amanda D L, Wessely, Simon, Chalder, Trudie, Papadopoulos, Andrew, & Cleare, Anthony J (2004). Salivary cortisol response to awakening in chronic fatigue syndrome.. The British journal of psychiatry : the journal of mental science. https://doi.org/10.1192/bjp.184.2.136
BibTeX
@article{mecfsatlas-roberts-2004-salivary-cortisol,
author = {Roberts, Amanda D L and Wessely, Simon and Chalder, Trudie and Papadopoulos, Andrew and Cleare, Anthony J},
title = {Salivary cortisol response to awakening in chronic fatigue syndrome.},
journal = {The British journal of psychiatry : the journal of mental science},
year = {2004},
doi = {10.1192/bjp.184.2.136},
note = {PubMed: 14754825},
url = {https://www.mecfsatlas.com/evidence/roberts-2004-salivary-cortisol},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/roberts-2004-salivary-cortisol
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