Afari, N, Schmaling, K B, Herrell, R et al. · Journal of psychosomatic research · 2000 · DOI
This study looked at how twins handle stress when one twin has chronic fatigue or ME/CFS and the other doesn't. Researchers found that twins with fatigue tend to cope by avoiding problems more often than their healthy siblings do. While both groups used similar overall coping methods, the fatigued twins relied more heavily on avoidance strategies rather than trying to solve problems directly.
Understanding coping mechanisms in ME/CFS is important because stress management significantly impacts quality of life and symptom burden. This research suggests that avoidance coping may be linked to chronic fatigue, which could inform behavioral interventions and help distinguish between adaptive and potentially counterproductive coping strategies for these patients.
This study does not prove that avoidance coping causes ME/CFS or chronic fatigue—it only shows an association. The research cannot determine whether increased avoidance is a response to having the illness or a contributing factor. Additionally, findings from twin pairs may not fully apply to all ME/CFS patients with different genetic or environmental backgrounds.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Afari, N, Schmaling, K B, Herrell, R, Hartman, S, Goldberg, J, & Buchwald, D S (2000). Coping strategies in twins with chronic fatigue and chronic fatigue syndrome.. Journal of psychosomatic research. https://doi.org/10.1016/s0022-3999(00)00093-3
BibTeX
@article{mecfsatlas-afari-2000-coping-strategies,
author = {Afari, N and Schmaling, K B and Herrell, R and Hartman, S and Goldberg, J and Buchwald, D S},
title = {Coping strategies in twins with chronic fatigue and chronic fatigue syndrome.},
journal = {Journal of psychosomatic research},
year = {2000},
doi = {10.1016/s0022-3999(00)00093-3},
note = {PubMed: 11033373},
url = {https://www.mecfsatlas.com/evidence/afari-2000-coping-strategies},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/afari-2000-coping-strategies
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