A NATURALISTIC STUDY OF THE CHRONIC-FATIGUE-SYNDROME AMONG WOMEN IN PRIMARY-CARE

Chronic fatigue syndrome (CFS), a controversial illness without clear etiology, causes profound debilitation in its sufferers. This study ex plored subjects' perceptions of the variables that mediated the course of their illness and identified coping strategies in 15 women with CF S referred from the practice of a primary care physician. Exploratory semistructured interviews were adapted from Kleinman's Illness Narrati ves. Pour instruments were used: the Beck Depression Inventory, the Si ckness Impact Profile, a modified Karnofsky scale, and the Defense Mec hanism Rating Scale. Of the 15 women, 60% reported improvement and/or recovery at the time of the interview. Improvement was associated with social support and lower levels of depressive symptoms. Health status was influenced by how subjects perceived their illness, their future, and the doctor's prognosis; and by the physician's early diagnosis, v alidation of the CFS, and intensive medical follow-up. Obsessional and healthy neurotic defense levels predominated, which differs from hist orical comparison groups with dysthymia and panic disorder. Psychologi cal adaptation to CFS is similar to adaptive coping in other chronic i llnesses: subjective perceptions of health status can predict function al status. Physician validation is particularly important given the co ntroversial status of CFS. Maintaining relationships with others-docto r, work, family, and group/spiritual activities reflected healthy copi ng strategies that promoted hope and attitudinal shifts. The finding o f a mixture of neurotic and healthy defenses and a law proportion of d efenses associated with personality disorders has not been previously reported in the CFS literature and war rants further investigation. (C ) 1998 Elsevier Science Inc.