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Br J Gen Pract. 2001 Jul;51(468):553-8.

Frequency of attendance in general practice and symptoms before development of chronic fatigue syndrome: a case-control study.

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North and East Devon Health Authority, Exeter.



Chronic fatigue syndrome (CFS) research has concentrated on infective, immunological, and psychological causes. Illness behaviour has received less attention, with most research studying CFS patients after diagnosis. Our previous study on the records of an insurance company showed a highly significant increase in illness reporting before development of CFS.


To investigate the number and type of general practitioner (GP) consultations by patients with CFS for 15 years before they develop their condition.


Case-control study in 11 general practices in Devon.


Forty-nine patients with CFS (satisfying the Centers for Disease Control criteria), 49 age, sex, and general practice matched controls, and 37 patients with multiple sclerosis (MS) were identified from the general practices' computerised databases.


The number of general practice consultations and symptoms recorded in three five-year periods (quinquennia) were counted before development of the patients' condition.


The median number of consultations was significantly higher for CFS patients than that of matched controls in each of the quinquennia: ratios for first quinquennium = 1.88, P = 0.01; second quinquennium = 1.70, P = 0.005; last quinquennium = 2.25, P < 0.001. More CFS patients than controls attended for 13 of the 18 symptoms studied. Significant increases were found for upper respiratory tract infection (P < 0.001), lethargy (P < 0.001), and vertigo (P = 0.02). Similar results were found for CFS patients when compared with MS.


CFS patients consulted their GP more frequently in the 15 years before development of their condition, for a wide variety of complaints. Several possibilities may explain these findings. The results support the hypothesis that behavioural factors have a role in the aetiology of CFS.

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