Creswell, Catharine; (2000) Self-esteem, coping and attribution in chronic fatigue syndrome. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Chronic Fatigue Syndrome describes a disorder characterised by a principal complaint of fatigue accompanied by substantial functional impairment. The aetiology of CFS has been investigated from various perspectives, in particular with regards the presence of infectious diseases, immune system dysfunction, muscular dysfunction, neuropsychology and neurophysiology. Few consistent findings have, however, been reported. The high prevalence of psychiatric disorder amongst people with CFS, particularly of depression, has led investigators to examine the relationship between these factors. A cognitive behavioral model of CFS has been proposed (Sharpe, 1997) although evidence to support the various claims of the model is sparse, in particular relating to the hypothesis that people with CFS have low underlying levels of self-esteem which are protected by rigid defence mechanisms. The present study investigates the hypothesis that CFS occurs in people who have low levels of self-esteem and an underlying depressogenic attribution style when they are confronted with a life stressor which is incompatible with their defence mechanisms, in particular a defensive coping style. A comparison group of people with a different chronic illness is included in the present study as well as a comparison group of healthy people. Evidence was found to suggest that participants with CFS had lower underlying levels of self-esteem than was accounted for by depression and overtly expressed self-esteem. Physical illness attributions did not appear to be a likely candidate for a defensive mechanism, however a greater proportion of participants with CFS than comparison groups held a Defensive High Anxious coping style. Those who had never experienced a Major Depressive Episode were more likely to hold a Repressive Coping style. These findings are consistent with the suggestion that individuals with CFS attempt to defend against low self-esteem but those who had experienced depression had been unable to do so completely. Implications for clinical practice and future research are discussed. In particular, the findings highlight important similarities between neuroendocrinological findings in the study of defensive coping and CFS and emphasise the importance of a multi-disciplinary approach to understanding and treatment of CFS.

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