Sunnquist, Madison, Jason, Leonard A, Brown, Abigail et al. · Journal of prevention & intervention in the community · 2015 · DOI
This study looked at whether people who have felt tired their whole lives should be excluded from ME/CFS diagnoses. Researchers asked patients detailed questions about lifelong fatigue and found it was very difficult to determine who truly had it. Importantly, people with and without lifelong fatigue had similar ME/CFS symptoms, suggesting this exclusion rule may not be helpful.
ME/CFS case definitions are critical for ensuring patients receive appropriate diagnosis and care. If the lifelong fatigue exclusion criterion is unclear and doesn't actually distinguish between patients, it may be incorrectly excluding people who have ME/CFS, leading to missed diagnoses and delayed treatment. This study provides evidence supporting revision of diagnostic criteria to be more inclusive and scientifically sound.
This study does not prove that lifelong fatigue does not exist as a clinical phenomenon, only that it is difficult to measure reliably and may not be a valid exclusionary criterion. The study's findings about symptom similarity do not establish causation or definitively explain why lifelong fatigue should be removed beyond operational difficulties. This is a methods paper, not a large-scale validation study across diverse populations.
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
Sunnquist, Madison, Jason, Leonard A, Brown, Abigail, Evans, Meredyth, & Berman, Andrew (2015). Complications in operationalizing lifelong fatigue as an exclusionary criterion.. Journal of prevention & intervention in the community. https://doi.org/10.1080/10852352.2014.973238
BibTeX
@article{mecfsatlas-sunnquist-2015-complications-operationalizing,
author = {Sunnquist, Madison and Jason, Leonard A and Brown, Abigail and Evans, Meredyth and Berman, Andrew},
title = {Complications in operationalizing lifelong fatigue as an exclusionary criterion.},
journal = {Journal of prevention & intervention in the community},
year = {2015},
doi = {10.1080/10852352.2014.973238},
note = {PubMed: 25584527},
url = {https://www.mecfsatlas.com/evidence/sunnquist-2015-complications-operationalizing},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/sunnquist-2015-complications-operationalizing
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