Shanks, M F, Ho-Yen, D O · The British journal of psychiatry : the journal of mental science · 1995 · DOI
This study looked at 64 ME/CFS patients to understand whether psychiatric conditions (like depression or anxiety) are part of ME/CFS itself or develop separately. Researchers found that patients without pre-existing psychiatric disorders had milder illness overall, suggesting that ME/CFS can occur on its own. Most patients improved with counseling and by staying within their energy limits.
This study helps clarify whether psychiatric symptoms in ME/CFS are primary features of the illness or secondary consequences, which has important implications for treatment approaches. Understanding the relationship between psychiatric disorders and ME/CFS severity could guide more targeted clinical interventions and challenge stigma around the condition.
This study does not prove that psychiatric disorders cause ME/CFS or vice versa—it shows only associations. The observational design and lack of healthy controls mean we cannot determine whether psychiatric symptoms are unique to CFS patients or how they compare to other chronic illnesses. The study also cannot explain the underlying mechanisms linking psychiatric status to illness severity.
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
Shanks, M F & Ho-Yen, D O (1995). A clinical study of chronic fatigue syndrome.. The British journal of psychiatry : the journal of mental science. https://doi.org/10.1192/bjp.166.6.798
BibTeX
@article{mecfsatlas-shanks-1995-clinical-study,
author = {Shanks, M F and Ho-Yen, D O},
title = {A clinical study of chronic fatigue syndrome.},
journal = {The British journal of psychiatry : the journal of mental science},
year = {1995},
doi = {10.1192/bjp.166.6.798},
note = {PubMed: 7663831},
url = {https://www.mecfsatlas.com/evidence/shanks-1995-clinical-study},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/shanks-1995-clinical-study
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