van der Werf, Sieberen P, de Vree, Berna, Alberts, Maurice et al. · Journal of psychosomatic research · 2002 · DOI
This study followed 79 people with ME/CFS who had been ill for less than 2 years to see what happened over the next year without treatment. About 46% of these patients reported feeling better after one year, which is much higher than the 20% improvement rate seen in people who had been ill for longer. The study found that people who didn't improve tended to have worse concentration problems, fewer social supports, and didn't believe their illness had a physical cause.
This study suggests that ME/CFS has better natural recovery prospects in the first 2 years of illness compared to longer-standing disease, which has important prognostic implications for newly diagnosed patients. The identification of modifiable psychosocial predictors (social support, attributional beliefs) offers potential targets for early intervention. The finding that spontaneous recovery becomes rare after 15 months underscores the importance of early assessment and support.
This study does not prove that psychosocial factors cause ME/CFS or that changing beliefs or social support will alter disease course, only that these factors are associated with outcomes. The lack of a control group and reliance on self-reported improvement without objective measures (e.g., exercise capacity) limits definitive conclusions about true recovery rates. The study does not address whether early intervention based on these predictors would improve outcomes.
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 der Werf, Sieberen P, de Vree, Berna, Alberts, Maurice, van der Meer, Jos W M, Bleijenberg, Gijs, & Netherlands Fatigue Research Group Nijmegen (2002). Natural course and predicting self-reported improvement in patients with chronic fatigue syndrome with a relatively short illness duration.. Journal of psychosomatic research. https://doi.org/10.1016/s0022-3999(02)00324-0
BibTeX
@article{mecfsatlas-van-der-werf-2002-natural-course,
author = {van der Werf, Sieberen P and de Vree, Berna and Alberts, Maurice and van der Meer, Jos W M and Bleijenberg, Gijs and Netherlands Fatigue Research Group Nijmegen},
title = {Natural course and predicting self-reported improvement in patients with chronic fatigue syndrome with a relatively short illness duration.},
journal = {Journal of psychosomatic research},
year = {2002},
doi = {10.1016/s0022-3999(02)00324-0},
note = {PubMed: 12217448},
url = {https://www.mecfsatlas.com/evidence/van-der-werf-2002-natural-course},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/van-der-werf-2002-natural-course
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