The authors examined symptoms of neurasthenia in the context of trauma through a survey conducted 10 months post-earthquake, among a sample of earthquake survivors in rural Taiwan. An algorithm closely resembling neurasthenia as defined in ICD-10 was designed a priori. Three diagnostic groups were identified, including those with "pure" neurasthenia (n=27) who did not exhibit any Axis I disorder, those with an Axis I disorder but without neurasthenia (n=46) and controls who were without neurasthenia or an Axis I disorder (n=152). Those with neurasthenia were demographically similar to non-psychiatrically disordered controls and did not differ with respect to impact of trauma. Greater severity of intrusive and avoidant/numbing posttraumatic stress disorder (PTSD) symptoms and less resilience characterized neurasthenia relative to controls. Morbidity was similar for neurasthenia and Axis I disorders, except for the presence of less resilience in the neurasthenia group. Thus, "pure" neurasthenia appears to be independent from other psychopathology in a significant number of earthquake survivors, and was not closely related to the impact of earthquake trauma. The meaningful number of subjects meeting criteria for our algorithm of neurasthenia suggests that further study of this syndrome employing exact ICD-10 diagnostic criteria is warranted.