Wyller, Vegard B, Eriksen, Hege R, Malterud, Kirsti · Behavioral and brain functions : BBF · 2009 · DOI
This study proposes that ME/CFS may be caused by the body getting stuck in a constant state of high alert, similar to being continuously stressed. This sustained arousal could develop after infections or emotional stress, especially in people with certain genetic traits or personality types. The researchers suggest this constant activation creates harmful cycles affecting the immune system, hormones, muscles, and thinking—ultimately leading to the overwhelming fatigue that defines ME/CFS.
This study matters because it provides a unifying framework that attempts to explain the diverse and sometimes contradictory findings across ME/CFS research—bridging immunology, neurology, endocrinology, and psychology. Understanding ME/CFS as a condition rooted in sustained arousal may help guide more targeted treatments and inform both biological and behavioral interventions. The model legitimizes the physiological nature of ME/CFS while acknowledging psychological stress factors, potentially reducing stigma and directing research toward mechanisms that maintain the illness.
This is a theoretical model, not a study testing empirical data, so it does not prove that sustained arousal actually causes ME/CFS or that the proposed vicious cycles operate as described. The paper does not establish which precipitating factors are necessary or sufficient, nor does it demonstrate that treating sustained arousal would resolve ME/CFS. The model correlates observed dysregulation patterns with a proposed mechanism but cannot prove causality without prospective or experimental validation.
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
Wyller, Vegard B, Eriksen, Hege R, & Malterud, Kirsti (2009). Can sustained arousal explain the Chronic Fatigue Syndrome?. Behavioral and brain functions : BBF. https://doi.org/10.1186/1744-9081-5-10
BibTeX
@article{mecfsatlas-wyller-2009-can-sustained,
author = {Wyller, Vegard B and Eriksen, Hege R and Malterud, Kirsti},
title = {Can sustained arousal explain the Chronic Fatigue Syndrome?},
journal = {Behavioral and brain functions : BBF},
year = {2009},
doi = {10.1186/1744-9081-5-10},
note = {PubMed: 19236717},
url = {https://www.mecfsatlas.com/evidence/wyller-2009-can-sustained},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/wyller-2009-can-sustained
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