Symptom perceptions, illness beliefs and coping in chronic fatigue syndrome

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Chronic fatigue syndrome (CFS) is an illness characterized by disabling fatigue of at least 6 months duration. The purpose of this article is to review the empirical literature on the role of illness and symptom perceptions and coping in CFS. The studies reviewed provide good support for the cognitive behavioural formulation of CFS. There is evidence that people who go on to develop post viral chronic fatigue have a tendency to label a wide range of everyday symptoms as physical in nature, negative beliefs about their experience of the illness and an all-or-nothing coping response. There is also evidence that people who have had CFS for some time, attribute a wide range of symptoms to their condition, believe the illness is largely physical in origin, and has very serious consequences. CFS patients also tend to be hypervigilant to symptom information and to maximize the extent of their symptoms and the consequences of experiencing symptoms. They are often fearful of the aftermath of over activity which is reflected in two characteristic ways of coping with the illness including a passive disengagement response or an all-or-nothing erratic pattern of behaviour. These beliefs and coping strategics are related to disability and fatigue. The implications of these findings for treatment are discussed together with the directions for future research.