Stigma 381Ferrans, 1997; David et al., 1991; Friedberg & Jason, 1998;
Twemlow, Bradshaw, Coyne, & Lerma, 1997) may, in large
part, be explained by this observed tendency among medical
professionals to not recognize and to underdiagnose CFS. For
example, a study by Anderson and Ferrans (1997) found that
77% of individuals with CFS reported past negative experi-
ences with health care providers, and 35% indicated that they
no longer sought treatment because of minimal bene“ts. In
addition to these issues, the contrasting “ndings for a low fre-
quency of CFS diagnoses despite a relatively high rate of
consultation for fatigue-related problems (65.6%) may ex-
plain some of the previous “ndings of clinic-based studies
(Bombardier & Buchwald, 1996; Twemlow et al., 1997) for
higher rates of medical utilization among individuals with
CFS. Individuals possessing social and economic resources
often have to be persistent to obtain appropriate diagnoses
and treatment. This persistence may manifest in high rates of
medical utilization because these individuals know that they
need medical care, but medical professionals are unable to
provide an appropriate diagnosis or treatment.
Treatment Attributions
Taylor, Jason, Kennedy, and Friedberg (2001) evaluated
whether differing orientations toward treating CFS in”uence
attributions about the illness. A group of mental health pro-
fessionals was randomly assigned to one of three conditions.
All groups read the same case study of a person diagnosed
with CFS, with the only difference between groups being in
the type of treatment described. The three treatment condi-
tions were cognitive-behavior therapy with graded activity,
cognitive coping skills therapy, and intravenous ampligen in-
fusion. Participants then answered a questionnaire assessing
their attributions about certain aspects of the illness, includ-
ing its cause, severity, prognosis, and the effectiveness of the
proposed treatment. Findings indicated that participants who
read the case study proposing treatment with Ampligen were
more likely to report that the patient was correctly diagnosed
with CFS and to perceive the patient as more disabled than
those whose case study described cognitive-behavioral ther-
apy with graded activity as the treatment.
Describing the use of Ampligen as a treatment for CFS
seems to have in”uenced people to perceive the patient as
more disabled than if another type of treatment was used.
This supports the hypothesis that the use of a more medical-
sounding treatment in”uences perceptions that the illness
may be more medically legitimate and disabling. The “nding
that individuals in this condition also believed the patient
was more likely to have been correctly diagnosed may indi-
cate that accurate perceptions of CFS are more likely to be
generated when a more medical-sounding treatment is pro-
posed. Results and conclusions of this study do not imply that
physicians should not recommend cognitive-behavior ther-
apy interventions in treating individuals with CFS. However,
they do highlight the salience of physician opinion and orien-
tation toward CFS in in”uencing the attributions of other
health care providers, such as mental health practitioners.
Results point to the potentially negative impact of psycho-
logically based recommendations upon the attitudes and attri-
butions about CFS of associated mental health practitioners,
particularly in the absence of recommendations for medical
forms of intervention. It is possible that such attributions can
in”uence the level of empathy and validation for CFS symp-
toms among mental health practitioners, two components of
psychotherapy that are highly important to treatment ef“cacy
(Friedberg & Jason, 1998). Future research is necessary to
demonstrate the role of attributions about CFS in in”uencing
the strength of the therapeutic relationship and the overall
effectiveness of psychotherapy with this illness population.STIGMACFS is a serious and complex illness that affects many differ-
ent body systems, and it is characterized by incapacitating fa-
tigue (experienced as profound exhaustion and extremely
poor stamina), neurocognitive problems, and other somatic
symptoms (Jason et al., 1997). The actual term CFS was
adopted in 1988 in the original case de“nition published in
theAnnals of Internal Medicine(Holmes et al., 1988). The
authors, many of whom were connected with the CDC, se-
lected this diagnostic label based on the limited knowledge
about the illness and the fact that the most common symp-
tom among patients was debilitating, prolonged fatigue.
Unfortunately, the patient community has felt that this label
trivializes the seriousness of this illness because fatigue is
commonly experienced by many people in our society. In
addition, CFS is frequently confused as solely chronic fa-
tigue, a symptom of many illnesses. Thus, the name places
too great an emphasis on the single symptom of fatigue
(Hoh, 1997).
Although it was expected that the name CFS would even-
tually be replaced, this term became the most commonly used
label and has remained for several years. Another label,
Myalgic Encephalomyelitis, is a medically based term used to
characterize CFS in the United Kingdom and proposed for
use in the United States by various patient groups. Some pa-
tients have suggested changing the label to an eponym, a
name given to characterize an illness by associating it with a
well-known person who either had the illness or discovered it.