Views on the nature of chronic fatigue syndrome: content analysis

OBJECTIVES: Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), has provoked much controversy and led to arguments between the medical profession and patient organizations. A particular focus for debate is the categorization of the condition as physical or psychological in its nature. The aim of this study was to compare how the written media, patient organizations and medical authorities regard the illness. DESIGN: Content analysis of newspaper articles, ME patient organization websites, and medical websites and textbooks were assessed by two independent assessors. SETTING: Three national UK newspapers, UK ME websites, and UK medical websites and textbooks, were accessed during 2010. PARTICIPANTS: 146 source files were scored from 36 patients' organizations, 72 media articles and 38 medical authorities. MAIN OUTCOME MEASURED: The overall opinion of an article or website was rated using a five point Likert scale, from ‘extremely psychological’ (scored as 1), ‘moderately psychological’ (2), ‘both psychological and physical’ (3), ‘moderately physical’ (4) or ‘extremely physical’ (5). RESULTS: Eighty-nine percent (32 of 36) of ME patient organizations considered the illness to be physical, compared with 58% (42/72) of newspaper articles, and 24% (9/38) of medical authorities. Sixty-three percent (24/38) of medical authorities regarded the illness as both physical and psychological. The inter-group differences of the Likert scores were statistically significant (χ(2) = 27.37, 2 df, P < 0.001). CONCLUSION: The considerable disagreement, particularly between ME patient organizations and medical authorities, may help to explain the gulf in understanding between doctors and patients and the consequent reluctance of some patients to engage in behavioural treatments.