Van Houdenhove, Boudewijn, Van Hoof, Elke, Becq, Katrien et al. · The Journal of nervous and mental disease · 2009 · DOI
This study compared ME/CFS patients from two Belgian clinics—one focused on biological causes and one on psychological/social factors. Researchers found that patients at both clinics were actually quite similar in terms of fatigue levels, mood problems, and confidence in managing their illness. However, patients who experienced a sudden illness onset and believed their condition was physical in nature were more likely to attend the biologically-focused clinic.
This study challenges the assumption that ME/CFS patients can be neatly divided into 'biological' versus 'psychological' groups based on clinic choice. Understanding that patients at different clinics share core illness features may help reduce stigma and encourage integrated care approaches that address both biological and psychosocial aspects of the condition.
This study does not prove that clinic ideology causes different patient presentations; it only shows associations. The cross-sectional design cannot establish whether patients self-select into clinics matching their beliefs, whether clinic approach influences patient attributions, or whether unmeasured factors drive the observed differences. Correlation between sudden onset and biological attribution does not prove causation.
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 Houdenhove, Boudewijn, Van Hoof, Elke, Becq, Katrien, Kempke, Stefan, Luyten, Patrick, & De Meirleir, Kenny (2009). A comparison of patients with chronic fatigue syndrome in two "ideologically" contrasting clinics.. The Journal of nervous and mental disease. https://doi.org/10.1097/NMD.0b013e3181a2081f
BibTeX
@article{mecfsatlas-van-houdenhove-2009-comparison-patients,
author = {Van Houdenhove, Boudewijn and Van Hoof, Elke and Becq, Katrien and Kempke, Stefan and Luyten, Patrick and De Meirleir, Kenny},
title = {A comparison of patients with chronic fatigue syndrome in two "ideologically" contrasting clinics.},
journal = {The Journal of nervous and mental disease},
year = {2009},
doi = {10.1097/NMD.0b013e3181a2081f},
note = {PubMed: 19440108},
url = {https://www.mecfsatlas.com/evidence/van-houdenhove-2009-comparison-patients},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/van-houdenhove-2009-comparison-patients
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