--- - |2+ Abstract Objective The process of somatization in chronic fatigue syndrome (CFS) was investigated using the concept of illusory mental health (IMH). IMH involves self‐reporting low emotional distress alongside performance‐based assessment of distress. Method We studied IHM and physical symptoms in 175 women across four groups: (a) CFS plus depression; (b) CFS with no depression (CFS‐ND); (c) depressive disorder without CFS; and (d) healthy controls (HC). IMH was assessed using a self‐report measure plus the performance‐based Early Memory Index (EMI). Results CFS‐NDs were no more likely to have IMH compared with HCs. Among the CFS‐NDs, IMH was associated with more physical symptoms. For CFS‐NDs, EMI added meaningfully beyond self‐reported mental health in predicting physical symptoms. Conclusion Findings refute reducing CFS to somatization, but there is a subgroup of CFS whose lacking access to emotional distress is associated with heightened physical symptomatology. - Journal of Clinical Psychology, EarlyView.