Somatization, illness attribution & the sociocultural psychiatry of Chronic Fatigue Syndrome (CFS)

In addition to epidemiological and neurobiological perspectives on

the relationship between chronic fatigue syndrome (CFS) and

psychiatric disorders there has been increasing interest in

the role of cognitive-behavioural, psychological,

psychodynamic and social factors in the psychiatric aspects of

this syndrome. These factors may be important in the

initiation and/or maintenance of CFS and play important roles

in the misdiagnosis of primary psychopathology as CFS. They

may be important targets for intervention and treatment. This

paper examines the relevance of the following issues for

better understanding the relationship between CFS and the

results of psychiatric studies: (1) the concepts of

somatization and abnormal illness behaviour; (2) the role of

patients’ illness attributions; (3) psychological and

psychodynamic constructs such as depressive vulnerability

occurring in individuals dependent upon achievement for the

maintenance of self-esteem and euthymic mood, perfectionism,

and helplessness; (4) the role of personality characteristics

and styles; (5) the potential iatrogenic role of the health

care system in producing disability in individuals with a

diagnosis of CFS; (6) the role of the media and other

sociocultural forces in the patient’s choice of the CFS label;

and (7) the impact of the CFS label on the patient. The

importance of differentiating between initiating and

maintaining or perpetuating factors is emphasized.

Abbey SE

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