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This study categorized participants with ME\/CFS who met PEM criteria into four groups based on severity of physical and mental PEM: severe physical PEM (Physical group), severe mental PEM (Mental group), both severe (Both group), or neither severe (Neither group). A control group was also included. The Both group exhibited the highest symptom severity, while the Neither group displayed lower scores. The Neither group experienced less disability than other ME\/CFS subtypes but was significantly more disabled than Controls. Health assessments revealed that Controls had the highest functioning, followed by the Neither group, with the Both group showing greatest impairment. These results indicate distinct PEM subtypes, emphasizing the need to recognize different manifestations of this complex symptom. Future research should include diverse control groups, longitudinal data, and biological measures to further understand PEM subtypes.<\/jats:p>","DOI":"10.1177\/13591053261420598","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T09:08:46Z","timestamp":1772269726000},"page":"5039-5050","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Identifying post-exertional malaise subtypes: Differentiating physical and mental PEM manifestations"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1606-784X","authenticated-orcid":false,"given":"Katherine","family":"Tuzzolino","sequence":"first","affiliation":[{"name":"Sociology Department of Indiana University, Bloomington, IN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9972-4425","authenticated-orcid":false,"given":"Leonard A.","family":"Jason","sequence":"additional","affiliation":[{"name":"DePaul University, Chicago, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1015-6290","authenticated-orcid":false,"given":"Jacob","family":"Furst","sequence":"additional","affiliation":[{"name":"DePaul University, Chicago, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"key":"e_1_3_4_2_1","first-page":"167","article-title":"Two age peaks in the incidence of chronic fatigue syndrome\/myalgic encephalomyelitis: A population-based registry study from Norway 2008\u20132012","volume":"12","author":"Bakken IJ","year":"2014","unstructured":"Bakken IJ, Tveito K, Gunnes N, et al. 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