van de Putte, E M, Engelbert, R H H, Kuis, W et al. · Archives of disease in childhood · 2006 · DOI
This study compared how fatigue and other body symptoms are connected in healthy teens versus teens with ME/CFS. Researchers found that both groups experience the same types of symptoms—like headaches, muscle pain, and dizziness—but teens with ME/CFS report them as more severe. The study suggests fatigue and these other symptoms are related and exist on a spectrum, rather than being completely separate problems.
Understanding that ME/CFS symptoms exist on a spectrum rather than as discrete categories helps normalize the experience of adolescent patients and may guide clinicians toward recognizing early symptom patterns. This work challenges the false dichotomy between 'healthy' and 'sick' and suggests that interventions addressing fatigue may improve associated somatic symptoms.
This study does not establish causation—it cannot determine whether fatigue causes somatic symptoms, somatic symptoms cause fatigue, or both are caused by an underlying biological process. The cross-sectional design captures only one point in time and cannot track how symptoms develop or change. It also does not explain the biological mechanisms underlying the fatigue-symptom relationship.
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
van de Putte, E M, Engelbert, R H H, Kuis, W, Kimpen, J L L, & Uiterwaal, C S P M (2006). How fatigue is related to other somatic symptoms.. Archives of disease in childhood. https://doi.org/10.1136/adc.2006.094623
BibTeX
@article{mecfsatlas-van-de-putte-2006-how-fatigue,
author = {van de Putte, E M and Engelbert, R H H and Kuis, W and Kimpen, J L L and Uiterwaal, C S P M},
title = {How fatigue is related to other somatic symptoms.},
journal = {Archives of disease in childhood},
year = {2006},
doi = {10.1136/adc.2006.094623},
note = {PubMed: 16754655},
url = {https://www.mecfsatlas.com/evidence/van-de-putte-2006-how-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/van-de-putte-2006-how-fatigue
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