Reynolds, Nadia L, Brown, Molly M, Jason, Leonard A · Evaluation & the health professions · 2009 · DOI
This study looked at whether ME/CFS symptoms change over time in predictable phases. Researchers used a questionnaire called the Fennell Phase Inventory to sort 111 patients into three groups: those in crisis (worst symptoms), stabilization (middle ground), or resolution (improving). They found that patients in the crisis phase had more depression, anxiety, worse quality of life, and used less helpful coping strategies—like avoidance—compared to those improving or stable.
Understanding whether ME/CFS progresses through distinct phases with characteristic symptom profiles could help patients recognize their disease trajectory and tailor interventions accordingly. Identifying that crisis-phase patients use maladaptive coping strategies suggests potential targets for psychological support to improve outcomes during severe periods.
This study does not prove that the Fennell phases cause specific symptoms or coping patterns—only that they are associated. It cannot determine whether patients predictably move through phases in sequence, whether interventions can accelerate phase progression, or whether the FPI accurately captures all patients' illness trajectories. The cross-sectional snapshot cannot establish causation or temporal relationships.
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 →
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