How have selection bias and disease misclassification undermined the validity of myalgic encephalomyelitis/chronic fatigue syndrome studies?

J Health Psychol. 2019 Oct;24(12):1765-1769. doi: 10.1177/1359105317695803. Epub 2017 Mar 1.


Myalgic encephalomyelitis/chronic fatigue syndrome has been a controversial diagnosis, resulting in tensions between patients and professionals providing them with care. A major constraint limiting progress has been the lack of a 'gold standard' for diagnosis; with a number of imperfect clinical and research criteria used, each defining different, though overlapping, groups of people with myalgic encephalomyelitis or chronic fatigue syndrome. We review basic epidemiological concepts to illustrate how the use of more specific and restrictive case definitions could improve research validity and drive progress in the field by reducing selection bias caused by diagnostic misclassification.

Keywords: chronic fatigue syndrome; diagnosis; epidemiology; misclassification; myalgic encephalomyelitis/chronic fatigue syndrome; selection bias.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Fatigue Syndrome, Chronic / classification*
  • Fatigue Syndrome, Chronic / diagnosis*
  • Humans
  • Male
  • Reproducibility of Results
  • Research Design / statistics & numerical data*
  • Selection Bias