Creswell, Cathy, Chalder, Trudie · Journal of psychosomatic research · 2002 · DOI
This study looked at whether people with ME/CFS have low self-esteem, using two different types of tests. When asked directly, people with ME/CFS reported lower self-esteem than healthy people and those with other chronic illnesses. However, a special test that measures unconscious reactions suggested their true underlying self-esteem was even lower than what they reported, possibly because they use mental defense mechanisms to protect themselves.
This research highlights that people with ME/CFS may experience deeper psychological challenges than they consciously report, which could affect treatment approaches and psychological support strategies. Understanding the gap between conscious and unconscious self-perception may help clinicians develop more targeted interventions for this population.
This study does not prove that low self-esteem causes ME/CFS or that it is a primary driver of the illness; the cross-sectional design cannot establish causality. It also does not establish whether the defense mechanisms identified are adaptive, maladaptive, or a direct consequence of living with chronic illness rather than an underlying trait.
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
Creswell, Cathy & Chalder, Trudie (2002). Underlying self-esteem in chronic fatigue syndrome.. Journal of psychosomatic research. https://doi.org/10.1016/s0022-3999(02)00329-x
BibTeX
@article{mecfsatlas-creswell-2002-underlying-self,
author = {Creswell, Cathy and Chalder, Trudie},
title = {Underlying self-esteem in chronic fatigue syndrome.},
journal = {Journal of psychosomatic research},
year = {2002},
doi = {10.1016/s0022-3999(02)00329-x},
note = {PubMed: 12217449},
url = {https://www.mecfsatlas.com/evidence/creswell-2002-underlying-self},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/creswell-2002-underlying-self
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