Trigwell, P, Hatcher, S, Johnson, M et al. · BMJ (Clinical research ed.) · 1995 · DOI
This study compared how patients with ME/CFS and patients with multiple sclerosis (MS) responded to questions about their illness and health beliefs. Both groups showed similar patterns of thinking about their conditions, scoring high on worry about disease and low on recognizing psychological factors. The researchers concluded that these thinking patterns alone cannot prove ME/CFS is a psychological condition, since MS patients—who have a clearly physical disease—showed the same patterns.
This study challenges the interpretation that ME/CFS patients exhibit 'abnormal illness behaviour' as evidence the condition is primarily psychological. By demonstrating that MS patients—whose neurological disease is well-established—show identical illness behaviour patterns, the research highlights how physical illness itself shapes health beliefs and behaviour, regardless of aetiology. Understanding this is crucial for reducing stigma and ensuring ME/CFS patients receive appropriate recognition and investigation.
This study does not prove that ME/CFS and MS share the same cause or pathology. It also does not establish whether the observed illness behaviour patterns are evidence of psychological pathology versus normal psychological adaptation to chronic physical illness. The identical profiles between groups suggest that illness behaviour questionnaire responses reflect the experience of chronic disease generally, not specifically abnormal psychological function.
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
Trigwell, P, Hatcher, S, Johnson, M, Stanley, P, & House, A (1995). "Abnormal" illness behaviour in chronic fatigue syndrome and multiple sclerosis.. BMJ (Clinical research ed.). https://doi.org/10.1136/bmj.311.6996.15
BibTeX
@article{mecfsatlas-trigwell-1995-abnormal-illness,
author = {Trigwell, P and Hatcher, S and Johnson, M and Stanley, P and House, A},
title = {"Abnormal" illness behaviour in chronic fatigue syndrome and multiple sclerosis.},
journal = {BMJ (Clinical research ed.)},
year = {1995},
doi = {10.1136/bmj.311.6996.15},
note = {PubMed: 7613314},
url = {https://www.mecfsatlas.com/evidence/trigwell-1995-abnormal-illness},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/trigwell-1995-abnormal-illness
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