Chronic Fatigue Syndrome (CFS): a qualitative investigation of patients’ beliefs about the illness

The chronic fatigue syndrome is a disabling chronic condition
of uncertain cause. Previous studies have found that patients
seen in hospital clinics with the syndrome often strongly
believe that their illness is physical in nature and minimize
the role of psychological and social factors. There is also
evidence that patients cope by avoiding activity. However,
almost all of these studies have assessed illness beliefs only
by questionnaire. The aim of this study was to explore the
nature and origin of illness beliefs in more detail using
in-depth interviews and a qualitative analysis of patient

Sixty-six consecutive referrals meeting Oxford
criteria for chronic fatigue syndrome were recruited. Analysis
of responses indicated that, whereas the most commonly
described explanation for the illness was a physical one, more
than half the patients also believed "stress" had played a
role. Patients believed that they could partially control the
symptoms by reducing activity but felt helpless to influence
the physical disease process and hence the course of the
illness. Patients reported that they had arrived at these
beliefs about the illness after prolonged reflection on their
own experience combined with the reading of media reports,
self help books, and patient group literature. The views of
health professionals played a relatively small role.

There is potentially a considerable opportunity to help patients
arrive at a wider and more enabling explanation of their illness
when they first present to primary care.

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