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Prognosis for myalgic encephalomyelitis and chronic fatigue syndrome
(section)
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=== Fennell's 4 stages === Others have subdivided the course of ME/CFS into different stages. For example, in the 1990s, [[Patricia Fennell]] suggested four distinct stages.<ref>{{Cite journal | last = Fennell | first = Patricia A. | date = Jan 1995 | title = The Four Progressive Stages of the CFS Experience|url=https://www.tandfonline.com/doi/abs/10.1300/J092v01n03_11|journal=Journal of Chronic Fatigue Syndrome|language=en|volume=1|issue=3-4 | pages = 69–79|doi=10.1300/j092v01n03_11|issn=1057-3321}}</ref> :The first phase is about the process of getting sick, giving up hobbies or work, and looking for an explanation of symptoms. :In the second phase, the diagnosis has provided a kind of relief, while the disease usually stabilizes. :In the third phase, patients understand that they will not recover quickly and that their disease is chronic. At this stage patients go through a mourning process as they realize that their old self is gone and they have to adapt to a new identity. Although the illness is stable, they still experience relapses. :In the fourth phase, the patients reintegrate with their new identity; they set new goals and value a new way of living. Some experience improvement. [[Leonard Jason|Jason]] et al. tested this model in 65 ME/CFS patients. Though analysis showed a three-factor solution that corresponded with Fennell's stages, almost none of the patients were in the fourth stage.<ref>{{Cite journal | last= Jason | first = L. A. | last2 = Fricano | first2 = G. | last3 = Taylor | first3 = R.R. | last4 = Halpert | first4 = J. | last5 = Fennell | first5 = P.A. | last6 = Klein | first6 = S. | last7 = Levine | first7 = S. | date = Dec 2000 | title = Chronic fatigue syndrome: an examination of the phases|url=https://www.ncbi.nlm.nih.gov/pubmed/11132566|journal=Journal of Clinical Psychology|volume=56|issue=12|pages=1497–1508|doi=10.1002/1097-4679(200012)56:123.0.CO;2-Z|issn=0021-9762|pmid=11132566}}</ref> This was probably because participants were selected in a clinic and were still actively seeking health care. The analysis also showed that patients experiencing the first phase, the crisis phase, were sick for a longer time than patients in other stages. This suggests Fennell's subdivisions should not be seen as a linear development in time, but rather the progression patients make in dealing with illness and disability.
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