Making sense of chronic fatigue syndrome: Patients' accounts of onset

Sixty patients with chronic fatigue syndrome were interviewed about the onset of their illness, and the factors which they felt had contributed to that onset. Common themes in these qualitative data were episodes of infection, "doing too much" and stressful circumstances; in two-thirds of cases, accounts encompassed physical, behavioural and psychological factors. Patients described a gradual, sharp or phased onset, the latter involving a sharp onset but with a short term lifting of symptoms before worsening into chronic illness. A gradual onset was associated with longer duration of illness. Particular themes played a different role in patients' accounts, depending upon onset pattern. With a sharp or phased onset the most common perceived bigger for the abrupt change in health status was an episode of infection, but preceding factors were often invoked to explain the effect that this had had. With a phased onset, subsequent compounding factors (typically overdoing things) were similarly cited to explain worsening and the long term effect of the trigger. Thus, patients provided complex and dynamic accounts of illness onset, incorporating interacting factors.