Development of third order constructs
| Third-order constructs (developed by the synthesis team) | Second-order constructs (original author themes) | Studies that include the second-order construct |
|---|---|---|
| Disruption and loss: physical—the illness | Physical experience of CFS/ME | Fisher and Crawley48 |
| The body, the illness and me | Winger et al51 | |
| Superordinate theme—feeling unwell | Patel52 | |
| Symptoms | Patel52 | |
| Physical changes | Patel52 | |
| Adolescent CFS experienced as having to adapt to debilitating physical symptoms | Williams-Wilson53 | |
| Being constantly exhausted | Williams-Wilson53 | |
| Some level of cognitive disruption | Williams-Wilson53 | |
| Learning to accommodate the boom bust cycle | Williams-Wilson53 | |
| Physical subsystem: physical exhaustion | Lombard50 | |
| Physical subsystems: sleep disturbances | Lombard50 | |
| Intrapsychic subsystem: general cognitive dysfunction | Lombard50 | |
| Intrapsychic subsystem: neurological signs | Lombard50 | |
| Disruption and loss: social—loss of a normal adolescent life | Superordinate theme—activity | Patel52 |
| Limiting and limited activity | Patel52 | |
| Hobbies and interests | Patel52 | |
| Stories of loss | Jelbert et al47 | |
| Social loss and adjustment | Fisher and Crawley48 | |
| The loss of normal adolescent life | Fisher and Crawley48 | |
| On the side of life—locked in and shut out | Winger et al51 | |
| Adapting to a life put on hold | Williams-Wilson53 | |
| Feeling life has been put on hold | Williams-Wilson53 | |
| A loss of social knowledge regarding norms and mores due to peer segregation | Williams-Wilson53 | |
| Overarching theme—impact of feeling unwell | Patel52 | |
| Superordinate theme—social life | Patel52 | |
| Friends | Patel52 | |
| Isolation and loneliness—a demise in peer relationships | Williams-Wilson53 | |
| Ecological subsystem: socialising | Lombard50 | |
| Disruption and loss: social—increased dependence | The need for adjustments to family relationships | Fisher and Crawley48 |
| Superordinate theme—family life | Patel52 | |
| Adolescent CFS experienced as living with changes in family relationships and member's life experiences | Williams-Wilson53 | |
| Needing to alter family life to accommodate one member's physical limitations | Williams-Wilson53 | |
| A cause of friction within parent–adolescent relationships | Williams-Wilson53 | |
| Ecological subsystem: family relationships | Lombard50 | |
| Feeling confused, guilty, fearful and powerless | Williams-Wilson53 | |
| Disruption and loss: change in self | Increased worries about school work | Fisher and Crawley48 |
| A major cause of academic disruption | Williams-Wilson53 | |
| The difficult emotional experience | Jelbert et al47 | |
| Increased emotionality | Fisher and Crawley48 | |
| Superordinate theme—emotional well-being | Patel52 | |
| Anxiety and mood | Patel52 | |
| Intrapsychic subsystem: depression | Lombard50 | |
| Intrapsychic subsystem: personality changes | Lombard50 | |
| The forced need to adapt to constraints of diminished energy | Williams-Wilson53 | |
| Needing to relinquish extracurricular activities and hobbies | Williams-Wilson53 | |
| The vulnerable self- internal, individual experience of CFS/ME | Fisher and Crawley48 | |
| Identity confusion | Fisher and Crawley48 | |
| The body, the illness and me | Winger et al51 | |
| Uncertainty about the future | Fisher and Crawley48 | |
| Barriers: problems with diagnosis | Seeking understanding | Jelbert et al47 |
| Negative medical encounters | Hareide et al54 | |
| Dealing with ignorance from ‘gate keepers’ of further medical assistance | Williams-Wilson53 | |
| Rest also increased fatigue | Hareide et al54 | |
| Overextension made it worse | Hareide et al54 | |
| Barriers: uncertainty, disbelief and stigma | Uncertainty of the validity of CFS/ME: feeling disbelieved | Fisher and Crawley48 |
| Feeling uncertain about how to explain CFS/ME | Fisher and Crawley48 | |
| Adolescent CFS experienced as feeling misunderstood and judged | Williams-Wilson53 | |
| Feeling self-conscious in public places | Williams-Wilson53 | |
| Negative psychosocial influences | Jelbert et al47 | |
| School. Negative: | Patel52 | |
| Difficult reintegration | Jelbert et al47 | |
| Friendships were put to the test | Fisher and Crawley48 | |
| Enduring teasing and misunderstanding from classmates | Williams-Wilson53 | |
| Emotional bullying | Patel52 | |
| If the illness is not visible to others, does it exist? | Winger et al51 | |
| Introduction of uncertainty and unpredictability | Fisher and Crawley48 | |
| Facilitators: credible illness narratives | Attribution: psychological or somatic? Initial somatic attributions | Hareide et al54 |
| Additional psychological attributions | Hareide et al54 | |
| Triggered by some physical condition, although these vary greatly | Williams-Wilson53 | |
| Understanding of CFS, including factors important in its development | Ashby et al49 | |
| Psychological stress discourse used to account for the development of the illness | Crix et al46 | |
| Simple illness profile | Hareide et al54 | |
| Complex illness profile | Hareide et al54 | |
| Individual differences | Fisher and Crawley48 | |
| Content of anxiety | Fisher and Crawley48 | |
| Onset of anxiety | Fisher and Crawley48 | |
| The construction of a ‘genuine illness’ account | Crix et al46 | |
| The construction of the illness as ‘intentionally used for advantage’ | Crix et al46 | |
| The negotiation of CFS/ME's status as a genuine physical illness | Crix et al46 | |
| Facilitators: diagnosis, advice and increasing awareness | Experiencing a sense of relief on achieving a diagnosis | Williams-Wilson53 |
| Recognition and progress—taking the next steps | Beasant et al55 | |
| Influences on the illness | Jelbert et al47 | |
| Positive psychosocial influences | Jelbert et al47 | |
| Coping: activity or rest? Rest experienced as beneficial | Hareide et al54 | |
| Contributions towards recovery | Fisher and Crawley48 | |
| Investigating alternative therapies and medications | Williams-Wilson53 | |
| Awareness of CFS/ME | Fisher and Crawley48 | |
| Facilitators: supportive relationships | School Positive (support from schools): | Patel52 |
| Ecological subsystem: management of schooling | Lombard50 | |
| Good relationships | Fisher and Crawley48 | |
| Feeling reassured when in contact with others in a similar situation | Williams-Wilson53 | |
| Hope and personal growth | Personal growth | Jelbert et al47 |
| Sharing experience and knowledge | Jelbert et al47 | |
| Hope | Fisher and Crawley48 | |
| Most informants used a flexible coping strategy | Hareide et al54 | |
| Hope, meaning and learning as a part of psychological coping | Hareide et al54 | |
| Handling life while hoping for a better future | Winger et al51 | |
| Recovery | Superordinate theme—feeling well | Patel52 |
| Doing more | Patel52 | |
| Feeling different | Patel52 | |
| How I am now: personal growth, caution and optimism | Jelbert et al47 | |
| Positive changes in recovery | Jelbert et al47 |
CFS/ME, chronic fatigue syndrome/myalgic encephalomyelitis.