Vercoulen, J H, Swanink, C M, Galama, J M et al. · Journal of psychosomatic research · 1998 · DOI
This study tested whether thoughts, behaviors, and emotions affect how severe fatigue becomes and stays in ME/CFS patients. Researchers found that when patients believe their symptoms are purely physical, they tend to be less active, which makes fatigue worse. They also found that how much control patients felt they had over symptoms and how much they focused on body sensations directly affected fatigue levels. Importantly, the patterns that explained fatigue in ME/CFS were different from those in MS patients.
This study provides early evidence that cognitive and behavioral factors actively perpetuate fatigue in ME/CFS, suggesting these may be legitimate treatment targets. The finding that the mechanisms differ between ME/CFS and MS supports the idea that ME/CFS involves distinct pathophysiological processes, helping distinguish it from other fatiguing illnesses.
This cross-sectional study cannot establish true causality—only associations. The finding that cognition and behavior correlate with fatigue severity does not prove they cause fatigue rather than resulting from it. The study does not identify the underlying biological mechanisms driving fatigue in ME/CFS and cannot determine whether cognitive-behavioral interventions will reduce fatigue.
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
Vercoulen, J H, Swanink, C M, Galama, J M, Fennis, J F, Jongen, P J, Hommes, O R, et al. (1998). The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: development of a model.. Journal of psychosomatic research. https://doi.org/10.1016/s0022-3999(98)00023-3
BibTeX
@article{mecfsatlas-vercoulen-1998-persistence-fatigue,
author = {Vercoulen, J H and Swanink, C M and Galama, J M and Fennis, J F and Jongen, P J and Hommes, O R and van der Meer, J W and Bleijenberg, G},
title = {The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: development of a model.},
journal = {Journal of psychosomatic research},
year = {1998},
doi = {10.1016/s0022-3999(98)00023-3},
note = {PubMed: 9859853},
url = {https://www.mecfsatlas.com/evidence/vercoulen-1998-persistence-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/vercoulen-1998-persistence-fatigue
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