Oxford criteria was used in Norweigan 4-day study

The study « A 4-Day Mindfulness-Based Cognitive Behavioral Intervention Program for CFS/ME. An Open Study, With 1-Year Follow-Up » by Stubhaug, Lier, Aßmus, Rongve and Kvale (Bergen, Norway) (2018) [ref. 1] is made on patients with the so called “Oxford criteria”, which is nothing else than the symptom “chronic fatigue”, as no other symptoms are required. It is very unfortunate that the term ME/CFS is used, as ME/CFS is a more strict diagnosis requiring for example relapse (worsening of symptoms) after mental or physical activity (commonly called post-exertional malaise), cognitive impairment and dysfunctional autonomic nervous system [3].

It is of uttermost importance that readers of the article understand that the Oxford criteria was used, and it selects a much broader patient group. I do not know why the researchers chose to use the Oxford critera. It is seldom used now a days, except by some researchers who (probably) want to do harm by spreading misleading information, as there is no reason to use the term ME/CFS for something that can simply be called “chronic fatigue”.

The research article also refer to the CDC Fukuda (1994) criteria for CFS, which does for example not require post-activity relapse (post-exertional malaise), a symptom that is regarded as a sheet anchor in the diagnosis of ME (myalgic encephalomyelitis). Post-exertional malaise has also been showed to exist on a physiological basis (gene expression, signal molecules, muscle cell metabolism, oxygen consumption), which further validates that this symptom is important in the pathophysiology of ME. For more information, see research articles by for example Alan Light, Kathleen Light, Julia Newton, Staci Stevens, Christopher Snell, Mark VanNess, and more specifically the articles Twisk FN (2014) [ref. 2], Twisk FN (2015) [ref. 3].

The “Oxford criteria” was basically created by a group of phychiatrists that did not acknowledge ME as a somatic disease, and their use of the term “ME” for what is no more than the symptom “chronic fatigue” has created a lot of misunderstandings and confusion over time. Myalgic Encephalomyelitis has historically been described by for example A Melvin Ramsay, Ernest Donald Acheson and Andrew Wallis from the 1950’s and forward. The “best” current ME criteria would be the International Concensus Criteria (2011) [ref. 5], the Canadian Concensus Criteria (2003) [ref. 4] or the London Criteria  (1994, 2114) [ref. 6].

Scientific journals are urged to disallow the use of the term “ME” (myalgic encephalomylitis) if cardinal symptoms are not present in the patients. In other words, no scientific article should be allowed to label patients selected with the Oxford criteria as having “ME”.


  1. Stubhaug B, Lier HO, Aßmus J, Rongve A and Kvale G (2018). A 4-Day Mindfulness-Based Cognitive Behavioral Intervention Program for CFS/ME. An Open Study, With 1-Year Follow-Up. Front. Psychiatry 9:720. doi: 10.3389/fpsyt.2018.00720 (link)
  2. Twisk FN. The status of and future research into Myalgic Encephalomyelitis and Chronic Fatigue Syndrome: the need of accurate diagnosis, objective assessment, and acknowledging biological and clinical subgroups. Front Physiol 2014; 5: 109 doi: 10.3389/fphys.2014.00109 (link)
  3. Twisk FN. Accurate diagnosis of myalgic encephalomyelitis and chronic fatigue syndrome based upon objective test methods for characteristic symptoms. World J Methodol 2015 June 26; 5(2): 68-87 doi: 10.5662/wjm.v5.i2.68 (link)
  4. Canadian Concensus Criteria for ME/CFS 2003 (link)
  5. International Concensus Criteria for ME 2011 (link)
  6. London Criteria 1994, revised 2014 (link)