Wyller, Vegard Bruun, Fagermoen, Even, Sulheim, Dag et al. · BioPsychoSocial medicine · 2014 · DOI
When people with ME/CFS stand up or imagine standing, their body's nervous system responds differently than in healthy people. This study found that teenagers with ME/CFS have higher resting heart rate and blood pressure, and their nervous system shows stronger stress responses when they think about standing upright, even though their actual physical response to tilting was similar to healthy peers. This suggests that both the physical challenge of gravity and a person's expectations or anxiety about standing may contribute to the symptoms they experience.
Understanding whether orthostatic intolerance in ME/CFS is driven solely by physical deconditioning or also by anticipatory anxiety and expectancies opens new therapeutic avenues. If expectancies play a significant role, interventions targeting illness beliefs, anxiety management, or reframing autonomic symptoms might complement or enhance standard treatments. This finding validates the importance of biopsychosocial approaches in ME/CFS management.
This study does not establish that expectancies cause orthostatic intolerance or that psychological interventions alone will resolve it. The identical tilt responses between groups suggest the gravitational component remains important. The small sample size and adolescent-only cohort limit generalizability to adults with ME/CFS. Correlation between expectancies and autonomic responses 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
Wyller, Vegard Bruun, Fagermoen, Even, Sulheim, Dag, Winger, Anette, Skovlund, Eva, & Saul, Jerome Philip (2014). Orthostatic responses in adolescent chronic fatigue syndrome: contributions from expectancies as well as gravity.. BioPsychoSocial medicine. https://doi.org/10.1186/1751-0759-8-22
BibTeX
@article{mecfsatlas-wyller-2014-orthostatic-responses,
author = {Wyller, Vegard Bruun and Fagermoen, Even and Sulheim, Dag and Winger, Anette and Skovlund, Eva and Saul, Jerome Philip},
title = {Orthostatic responses in adolescent chronic fatigue syndrome: contributions from expectancies as well as gravity.},
journal = {BioPsychoSocial medicine},
year = {2014},
doi = {10.1186/1751-0759-8-22},
note = {PubMed: 25237387},
url = {https://www.mecfsatlas.com/evidence/wyller-2014-orthostatic-responses},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/wyller-2014-orthostatic-responses
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