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1) 1) Interesting interview of Dr. Audrey Ryback by David Tuller. Her recent study showed that there are likely two age peaks for when people get ME/CFS. It helps to characterise ME/CFS as a unique clinical entity.

3) One is that there are two different paths leading to ME/CFS, one for the early onset in late teens, and a different path for the second onset in your mid 30s. So, two different disease that look the same but are different under the hood.

4) The second possibility is that there is one biological process that has vulnerabilities at those particular ages. For example, the peaks might correspond to hormonal changes (puberty and peri-menopause).

5) They are confident the bimodal onset pattern exists because they found it in multiple data sources: the Norwegian healthcare data, the European survey and the DecodeME study. These have different biases, yet the pattern remained the same.