Chronic fatigue syndrome is an often highly debilitating and long-term illness. Research suggests that illness duration of two years or less is a predictor of recovery from chronic fatigue syndrome (van der Werf, de Vree, Alberts, van der Meer, & Bleijenberg, 2002
). However, most patients with this illness continue to meet criteria for longer than two years. In a longitudinal study, Nisenbaum, Jones, Unger, Reyes, and Reeves (2003)
found that among a sample of participants with chronic fatigue syndrome, most continued to meet criteria for chronic fatigue syndrome during at least one follow-up assessment over a three-year period. However, the authors found that the number of core chronic fatigue syndrome symptoms as well as other somatic symptoms significantly decreased over time.
In comparing subgroups of individuals with chronic fatigue syndrome based on illness duration, Friedberg, Dechene, McKenzie, and Fontanetta (2000)
found that those with an illness duration of 10 years or longer had significantly worse cognitive functioning than those who had chronic fatigue syndrome for seven years or less. However, they found no significant differences between the two groups in terms of severity of somatic complaints or coping style. It is possible that differences in symptoms and coping may not have been detected in Friedberg, et al.
’s study because illness duration groups of up to seven years and at least 10 years may not be disparate enough for comparison. It is possible that patients are able to utilize more adaptive coping strategies as they adjust to living with a chronic illness and that a shorter illness duration cutoff is necessary to make these comparisons.
described the process of illness-specific coping as behaviors used to assist in the process of recovery and to compensate for physical limitations. This suggests that coping refers to both overcoming problems brought on by the illness, and enduring other problems. Among individuals with chronic fatigue syndrome, coping style may be related to how quickly they psychologically adapt to the illness after onset. Jason, Fennell, Klein, Fricano, and Halpert (1999)
suggest that patients with chronic fatigue syndrome experience an initial “crisis” phase characterized by entering into a state of emotional distress after the initial onset of the illness or during a period of relapse. Those in the crisis phase of the illness are more likely to use maladaptive coping styles than those in other phases of the illness (Reynolds, Brown, & Jason, 2009
). However, Reynolds, et al.,
found no relationship between illness phase and illness duration, in developing this illness phase model, Jason, et al.
recognized that patients may move out of the crisis phase and return during a relapse, suggesting that the relationship between illness duration and illness phase is not necessarily linear. Thus, although illness phase may predict the use of particular coping styles, it remains important to explore whether patients improve coping over time regardless of illness phase.
Previous research on coping strategies among individuals with chronic fatigue syndrome has shown, in general, that individuals with this illness are more likely to use coping strategies typically considered to be maladaptive when compared to healthy controls or other illness groups (Ax, Gregg, & Jones, 2001
; Creswell & Chalder, 2001
). Patients with chronic fatigue syndrome were found to use an uncommon coping strategy, Defensive High Anxious, more often than healthy individuals and those with other chronic illnesses (Creswell & Chalder, 2001
). Avoidance coping has also been reported among patients with chronic fatigue syndrome (Ax, et al., 2001
). More specifically, Moss-Morris, Petrie, and Weinman (1996)
found that people with chronic fatigue syndrome who had negative beliefs about their illness were likely to disengage themselves in stressful situations. Similarly, Heijmans (1998)
found that for patients with chronic fatigue syndrome, a sense of illness control was associated more with problem-focused coping strategies than avoidant coping strategies. Wilson, Hickie, Lloyd, Hadzi-Pavlovic, Boughton, Dwyer, et al. (1994)
even suggested that coping strategies and illness attitudes are more predictive of illness outcomes than are immunological markers.
However, it is likely that there is variability in coping styles within samples with chronic fatigue syndrome. Moreover, specific symptoms, such as postexertional malaise, must be considered when interpreting coping mechanisms. Individuals with this illness may be more likely to use avoidance because engaging in some activities may, in fact, cause postexertional malaise, a symptom characterized by exacerbation of symptoms following exertion which generally worsen 12 to 48 hours after the mental or physical activity. Thus, patients with chronic fatigue syndrome may preserve their functional ability by engaging in coping strategies that would be interpreted as maladaptive for other groups. Further, some inconsistencies exist as to how people with this illness are differentiated from other groups in terms of coping, as Camacho and Jason (1998)
found that patients with chronic fatigue syndrome did not differ in terms of coping strategies compared to people who had recovered from chronic fatigue syndrome and healthy controls. Finally, another study found that participants with chronic fatigue syndrome did not differ in coping compared to a chronically fatigued control group (Nater, Wagner, Solomon, Jones, Unger, Papanicolaou, Reeves, et al., 2006
Coping style has been implicated in outcomes of overall functioning among patients with other illnesses including rheumatoid arthritis, chronic obstructive pulmonary disease, and psoriasis (Evers, Kraaimaat, Geenen, Jacobs, & Bijlsma, 2003
; Scharloo, Kaptein, Weinman, Hazes, Willems, Bergman, et al., 1998
). Previous studies have found differences among the coping strategies of chronic fatigue syndrome populations by ethnicity (Njoku, Jason, & Torres-Harding, 2005
), sex, and employment status (Jason, Taylor, Kennedy, Jordan, Song, Johnson, et al., 2000
). The use of less adaptive coping strategies may be related to increased disability among individuals with chronic fatigue syndrome (Ax, et al., 2001
; Moss-Morris, et al., 1996
; Ray, Jefferies, & Weir, 1995
), although a causal direction between coping and disability has not been established.
Previous studies of coping among individuals with chronic fatigue syndrome have not explored whether illness duration is predictive of coping style. It is possible that coping skills may develop or change the longer an individual has chronic fatigue syndrome. The present study evaluated coping strategies in a group of participants with chronic fatigue syndrome with a longer illness duration (>2 yr.) and those with a shorter illness duration (≤2 yr.). It was hypothesized that adaptive coping strategies would be utilized more often among those with longer illness duration. The relationship between illness duration and functional status was also explored.