van Houdenhove, B, Heijnen, C J · Tijdschrift voor psychiatrie · 2009
This review explores how stress, the immune system, and the brain interact in ME/CFS. The authors suggest that both physical and emotional stress may contribute to developing and maintaining the illness. While some research shows that people with ME/CFS have unusual stress responses and immune activity, the results haven't been fully consistent, indicating we still need more research to understand exactly what's happening.
This work highlights that ME/CFS likely involves complex biological interactions between stress systems and immunity rather than being purely psychological or purely physical. Understanding these mechanisms could lead to better diagnostic approaches and targeted treatments that address the underlying biological dysfunction rather than viewing the illness reductively.
This review does not establish causation—it identifies associations between stress, immune function, and ME/CFS symptoms. The acknowledged inconsistencies across studies mean individual findings require confirmation, and this framework does not prove that stress causes ME/CFS or that psychological interventions alone will resolve the illness. The review cannot determine which comes first: immune dysfunction or stress response abnormalities.
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 →
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