THEORETICAL FRAMEWORK
The Theoretical Framework writing group (Moss-Morris, Crawley, Vollmer-Conna, Wensaas) reviewed the factors known, or hypothesized, to play a role in chronic fatigue following infection, namely:
Predisposing factors
–
age, sex, genetic variation, acquired vulnerability
(e.g. sensitisation, stress reactivity),
family adversity,
functional social support,
environment,
psychology (negative mood),
personality (negative perfectionism, introversion, neuroticism, somatosensory amplification)
.
Precipitating factors
–
severity of acuteinfection phase, other stressors.
Perpetuating factors
–
psychological resilience and behaviours
(illness behaviour, cognitions, coping skills, fear avoidance, activity, boom-bust, somatic focus, sleep, etc.),
psychoneuroimmunologicaland biological factors (microglia, TGF-ß, cortisol, POTS, etc.)
.
It was acknowledged that interactions between some of these factors were likely, and that the roles and relative contributions of the different factors have yet to be quantified, e.g. ‘other’ stressors as predisposing or precipitating factors.