Terman, Julia M, Cotler, Joseph, Jason, Leonard A · Community psychology in global perspective · 2019 · DOI
This study looked at how ME/CFS patients feel when their doctors refer them to psychiatrists or psychologists. Researchers found that patients who received these referrals were more likely to feel stigmatized (judged or looked down upon) and to feel isolated from others. The experience was different in the United States and United Kingdom, suggesting that healthcare systems and culture play a role in how these referrals affect patients.
This research highlights how medical decision-making—specifically psychiatric referrals—can negatively impact patients' psychological well-being and social relationships. Understanding these dynamics is crucial for improving care delivery and reducing harm, as stigma and isolation can worsen health outcomes in ME/CFS patients who already face significant challenges.
This study does not prove that psychiatric referrals cause stigma or estrangement; it only shows these experiences occur together. The study cannot determine whether referrals increase stigma, or whether patients already experiencing stigma are more likely to receive referrals. It also does not evaluate whether psychiatric support itself is harmful—only how referrals are perceived.
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
Terman, Julia M, Cotler, Joseph, & Jason, Leonard A (2019). HOW PSYCHIATRIC REFERRALS INFLUENCE STIGMATIZATION IN PATIENTS WITH MYALGIC ENCEPHALOMYELITIS AND CHRONIC FATIGUE SYNDROME: AN EXAMINATION OF AMERICAN AND BRITISH MODELS.. Community psychology in global perspective. https://doi.org/10.2466/pr0.1986.58.3.683
BibTeX
@article{mecfsatlas-terman-2019-how-psychiatric,
author = {Terman, Julia M and Cotler, Joseph and Jason, Leonard A},
title = {HOW PSYCHIATRIC REFERRALS INFLUENCE STIGMATIZATION IN PATIENTS WITH MYALGIC ENCEPHALOMYELITIS AND CHRONIC FATIGUE SYNDROME: AN EXAMINATION OF AMERICAN AND BRITISH MODELS.},
journal = {Community psychology in global perspective},
year = {2019},
doi = {10.2466/pr0.1986.58.3.683},
note = {PubMed: 33628951},
url = {https://www.mecfsatlas.com/evidence/terman-2019-how-psychiatric},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/terman-2019-how-psychiatric
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