case study definition construction

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, generate accurate citations for free.

• Knowledge Base

Methodology

• What Is a Case Study? | Definition, Examples & Methods

What Is a Case Study? | Definition, Examples & Methods

Published on May 8, 2019 by Shona McCombes . Revised on November 20, 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating and understanding different aspects of a research problem .

Table of contents

When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyze the case, other interesting articles.

A case study is an appropriate research design when you want to gain concrete, contextual, in-depth knowledge about a specific real-world subject. It allows you to explore the key characteristics, meanings, and implications of the case.

Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.

You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.

Prevent plagiarism. Run a free check.

Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:

• Provide new or unexpected insights into the subject
• Challenge or complicate existing assumptions and theories
• Propose practical courses of action to resolve a problem
• Open up new directions for future research

TipIf your research is more practical in nature and aims to simultaneously investigate an issue as you solve it, consider conducting action research instead.

Unlike quantitative or experimental research , a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.

Example of an outlying case studyIn the 1960s the town of Roseto, Pennsylvania was discovered to have extremely low rates of heart disease compared to the US average. It became an important case study for understanding previously neglected causes of heart disease.

However, you can also choose a more common or representative case to exemplify a particular category, experience or phenomenon.

Example of a representative case studyIn the 1920s, two sociologists used Muncie, Indiana as a case study of a typical American city that supposedly exemplified the changing culture of the US at the time.

While case studies focus more on concrete details than general theories, they should usually have some connection with theory in the field. This way the case study is not just an isolated description, but is integrated into existing knowledge about the topic. It might aim to:

• Exemplify a theory by showing how it explains the case under investigation
• Expand on a theory by uncovering new concepts and ideas that need to be incorporated
• Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions

To ensure that your analysis of the case has a solid academic grounding, you should conduct a literature review of sources related to the topic and develop a theoretical framework . This means identifying key concepts and theories to guide your analysis and interpretation.

There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews , observations , and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data.

Example of a mixed methods case studyFor a case study of a wind farm development in a rural area, you could collect quantitative data on employment rates and business revenue, collect qualitative data on local people’s perceptions and experiences, and analyze local and national media coverage of the development.

The aim is to gain as thorough an understanding as possible of the case and its context.

Here's why students love Scribbr's proofreading services

Discover proofreading & editing

In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.

How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis , with separate sections or chapters for the methods , results and discussion .

Others are written in a more narrative style, aiming to explore the case from various angles and analyze its meanings and implications (for example, by using textual analysis or discourse analysis ).

In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Normal distribution
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Quantitative research
• Ecological validity

Research bias

• Rosenthal effect
• Implicit bias
• Cognitive bias
• Selection bias
• Negativity bias
• Status quo bias

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

McCombes, S. (2023, November 20). What Is a Case Study? | Definition, Examples & Methods. Scribbr. Retrieved July 27, 2024, from https://www.scribbr.com/methodology/case-study/

Is this article helpful?

Shona McCombes

Other students also liked, primary vs. secondary sources | difference & examples, what is a theoretical framework | guide to organizing, what is action research | definition & examples, "i thought ai proofreading was useless but..".

I've been using Scribbr for years now and I know it's a service that won't disappoint. It does a good job spotting mistakes”

The Ultimate Guide to Qualitative Research - Part 1: The Basics

• Introduction and overview
• What is qualitative research?
• What is qualitative data?
• Examples of qualitative data
• Qualitative vs. quantitative research
• Mixed methods
• Qualitative research preparation
• Theoretical perspective
• Theoretical framework
• Literature reviews

Research question

• Conceptual framework
• Conceptual vs. theoretical framework

Data collection

• Qualitative research methods
• Focus groups
• Observational research

What is a case study?

Applications for case study research, what is a good case study, process of case study design, benefits and limitations of case studies.

• Ethnographical research
• Ethical considerations
• Confidentiality and privacy
• Power dynamics
• Reflexivity

Case studies

Case studies are essential to qualitative research , offering a lens through which researchers can investigate complex phenomena within their real-life contexts. This chapter explores the concept, purpose, applications, examples, and types of case studies and provides guidance on how to conduct case study research effectively.

Whereas quantitative methods look at phenomena at scale, case study research looks at a concept or phenomenon in considerable detail. While analyzing a single case can help understand one perspective regarding the object of research inquiry, analyzing multiple cases can help obtain a more holistic sense of the topic or issue. Let's provide a basic definition of a case study, then explore its characteristics and role in the qualitative research process.

Definition of a case study

A case study in qualitative research is a strategy of inquiry that involves an in-depth investigation of a phenomenon within its real-world context. It provides researchers with the opportunity to acquire an in-depth understanding of intricate details that might not be as apparent or accessible through other methods of research. The specific case or cases being studied can be a single person, group, or organization – demarcating what constitutes a relevant case worth studying depends on the researcher and their research question .

Among qualitative research methods , a case study relies on multiple sources of evidence, such as documents, artifacts, interviews , or observations , to present a complete and nuanced understanding of the phenomenon under investigation. The objective is to illuminate the readers' understanding of the phenomenon beyond its abstract statistical or theoretical explanations.

Characteristics of case studies

Case studies typically possess a number of distinct characteristics that set them apart from other research methods. These characteristics include a focus on holistic description and explanation, flexibility in the design and data collection methods, reliance on multiple sources of evidence, and emphasis on the context in which the phenomenon occurs.

Furthermore, case studies can often involve a longitudinal examination of the case, meaning they study the case over a period of time. These characteristics allow case studies to yield comprehensive, in-depth, and richly contextualized insights about the phenomenon of interest.

The role of case studies in research

Case studies hold a unique position in the broader landscape of research methods aimed at theory development. They are instrumental when the primary research interest is to gain an intensive, detailed understanding of a phenomenon in its real-life context.

In addition, case studies can serve different purposes within research - they can be used for exploratory, descriptive, or explanatory purposes, depending on the research question and objectives. This flexibility and depth make case studies a valuable tool in the toolkit of qualitative researchers.

Remember, a well-conducted case study can offer a rich, insightful contribution to both academic and practical knowledge through theory development or theory verification, thus enhancing our understanding of complex phenomena in their real-world contexts.

What is the purpose of a case study?

Case study research aims for a more comprehensive understanding of phenomena, requiring various research methods to gather information for qualitative analysis . Ultimately, a case study can allow the researcher to gain insight into a particular object of inquiry and develop a theoretical framework relevant to the research inquiry.

Why use case studies in qualitative research?

Using case studies as a research strategy depends mainly on the nature of the research question and the researcher's access to the data.

Conducting case study research provides a level of detail and contextual richness that other research methods might not offer. They are beneficial when there's a need to understand complex social phenomena within their natural contexts.

The explanatory, exploratory, and descriptive roles of case studies

Case studies can take on various roles depending on the research objectives. They can be exploratory when the research aims to discover new phenomena or define new research questions; they are descriptive when the objective is to depict a phenomenon within its context in a detailed manner; and they can be explanatory if the goal is to understand specific relationships within the studied context. Thus, the versatility of case studies allows researchers to approach their topic from different angles, offering multiple ways to uncover and interpret the data .

The impact of case studies on knowledge development

Case studies play a significant role in knowledge development across various disciplines. Analysis of cases provides an avenue for researchers to explore phenomena within their context based on the collected data.

This can result in the production of rich, practical insights that can be instrumental in both theory-building and practice. Case studies allow researchers to delve into the intricacies and complexities of real-life situations, uncovering insights that might otherwise remain hidden.

Types of case studies

In qualitative research , a case study is not a one-size-fits-all approach. Depending on the nature of the research question and the specific objectives of the study, researchers might choose to use different types of case studies. These types differ in their focus, methodology, and the level of detail they provide about the phenomenon under investigation.

Understanding these types is crucial for selecting the most appropriate approach for your research project and effectively achieving your research goals. Let's briefly look at the main types of case studies.

Exploratory case studies

Exploratory case studies are typically conducted to develop a theory or framework around an understudied phenomenon. They can also serve as a precursor to a larger-scale research project. Exploratory case studies are useful when a researcher wants to identify the key issues or questions which can spur more extensive study or be used to develop propositions for further research. These case studies are characterized by flexibility, allowing researchers to explore various aspects of a phenomenon as they emerge, which can also form the foundation for subsequent studies.

Descriptive case studies

Descriptive case studies aim to provide a complete and accurate representation of a phenomenon or event within its context. These case studies are often based on an established theoretical framework, which guides how data is collected and analyzed. The researcher is concerned with describing the phenomenon in detail, as it occurs naturally, without trying to influence or manipulate it.

Explanatory case studies

Explanatory case studies are focused on explanation - they seek to clarify how or why certain phenomena occur. Often used in complex, real-life situations, they can be particularly valuable in clarifying causal relationships among concepts and understanding the interplay between different factors within a specific context.

Intrinsic, instrumental, and collective case studies

These three categories of case studies focus on the nature and purpose of the study. An intrinsic case study is conducted when a researcher has an inherent interest in the case itself. Instrumental case studies are employed when the case is used to provide insight into a particular issue or phenomenon. A collective case study, on the other hand, involves studying multiple cases simultaneously to investigate some general phenomena.

Each type of case study serves a different purpose and has its own strengths and challenges. The selection of the type should be guided by the research question and objectives, as well as the context and constraints of the research.

The flexibility, depth, and contextual richness offered by case studies make this approach an excellent research method for various fields of study. They enable researchers to investigate real-world phenomena within their specific contexts, capturing nuances that other research methods might miss. Across numerous fields, case studies provide valuable insights into complex issues.

Critical information systems research

Case studies provide a detailed understanding of the role and impact of information systems in different contexts. They offer a platform to explore how information systems are designed, implemented, and used and how they interact with various social, economic, and political factors. Case studies in this field often focus on examining the intricate relationship between technology, organizational processes, and user behavior, helping to uncover insights that can inform better system design and implementation.

Health research

Health research is another field where case studies are highly valuable. They offer a way to explore patient experiences, healthcare delivery processes, and the impact of various interventions in a real-world context.

Case studies can provide a deep understanding of a patient's journey, giving insights into the intricacies of disease progression, treatment effects, and the psychosocial aspects of health and illness.

Asthma research studies

Specifically within medical research, studies on asthma often employ case studies to explore the individual and environmental factors that influence asthma development, management, and outcomes. A case study can provide rich, detailed data about individual patients' experiences, from the triggers and symptoms they experience to the effectiveness of various management strategies. This can be crucial for developing patient-centered asthma care approaches.

Other fields

Apart from the fields mentioned, case studies are also extensively used in business and management research, education research, and political sciences, among many others. They provide an opportunity to delve into the intricacies of real-world situations, allowing for a comprehensive understanding of various phenomena.

Case studies, with their depth and contextual focus, offer unique insights across these varied fields. They allow researchers to illuminate the complexities of real-life situations, contributing to both theory and practice.

Whatever field you're in, ATLAS.ti puts your data to work for you

Download a free trial of ATLAS.ti to turn your data into insights.

Understanding the key elements of case study design is crucial for conducting rigorous and impactful case study research. A well-structured design guides the researcher through the process, ensuring that the study is methodologically sound and its findings are reliable and valid. The main elements of case study design include the research question , propositions, units of analysis, and the logic linking the data to the propositions.

The research question is the foundation of any research study. A good research question guides the direction of the study and informs the selection of the case, the methods of collecting data, and the analysis techniques. A well-formulated research question in case study research is typically clear, focused, and complex enough to merit further detailed examination of the relevant case(s).

Propositions

Propositions, though not necessary in every case study, provide a direction by stating what we might expect to find in the data collected. They guide how data is collected and analyzed by helping researchers focus on specific aspects of the case. They are particularly important in explanatory case studies, which seek to understand the relationships among concepts within the studied phenomenon.

Units of analysis

The unit of analysis refers to the case, or the main entity or entities that are being analyzed in the study. In case study research, the unit of analysis can be an individual, a group, an organization, a decision, an event, or even a time period. It's crucial to clearly define the unit of analysis, as it shapes the qualitative data analysis process by allowing the researcher to analyze a particular case and synthesize analysis across multiple case studies to draw conclusions.

Argumentation

This refers to the inferential model that allows researchers to draw conclusions from the data. The researcher needs to ensure that there is a clear link between the data, the propositions (if any), and the conclusions drawn. This argumentation is what enables the researcher to make valid and credible inferences about the phenomenon under study.

Understanding and carefully considering these elements in the design phase of a case study can significantly enhance the quality of the research. It can help ensure that the study is methodologically sound and its findings contribute meaningful insights about the case.

Ready to jumpstart your research with ATLAS.ti?

Conceptualize your research project with our intuitive data analysis interface. Download a free trial today.

Conducting a case study involves several steps, from defining the research question and selecting the case to collecting and analyzing data . This section outlines these key stages, providing a practical guide on how to conduct case study research.

Defining the research question

The first step in case study research is defining a clear, focused research question. This question should guide the entire research process, from case selection to analysis. It's crucial to ensure that the research question is suitable for a case study approach. Typically, such questions are exploratory or descriptive in nature and focus on understanding a phenomenon within its real-life context.

Selecting and defining the case

The selection of the case should be based on the research question and the objectives of the study. It involves choosing a unique example or a set of examples that provide rich, in-depth data about the phenomenon under investigation. After selecting the case, it's crucial to define it clearly, setting the boundaries of the case, including the time period and the specific context.

Previous research can help guide the case study design. When considering a case study, an example of a case could be taken from previous case study research and used to define cases in a new research inquiry. Considering recently published examples can help understand how to select and define cases effectively.

Developing a detailed case study protocol

A case study protocol outlines the procedures and general rules to be followed during the case study. This includes the data collection methods to be used, the sources of data, and the procedures for analysis. Having a detailed case study protocol ensures consistency and reliability in the study.

The protocol should also consider how to work with the people involved in the research context to grant the research team access to collecting data. As mentioned in previous sections of this guide, establishing rapport is an essential component of qualitative research as it shapes the overall potential for collecting and analyzing data.

Collecting data

Gathering data in case study research often involves multiple sources of evidence, including documents, archival records, interviews, observations, and physical artifacts. This allows for a comprehensive understanding of the case. The process for gathering data should be systematic and carefully documented to ensure the reliability and validity of the study.

Analyzing and interpreting data

The next step is analyzing the data. This involves organizing the data , categorizing it into themes or patterns , and interpreting these patterns to answer the research question. The analysis might also involve comparing the findings with prior research or theoretical propositions.

Writing the case study report

The final step is writing the case study report . This should provide a detailed description of the case, the data, the analysis process, and the findings. The report should be clear, organized, and carefully written to ensure that the reader can understand the case and the conclusions drawn from it.

Each of these steps is crucial in ensuring that the case study research is rigorous, reliable, and provides valuable insights about the case.

The type, depth, and quality of data in your study can significantly influence the validity and utility of the study. In case study research, data is usually collected from multiple sources to provide a comprehensive and nuanced understanding of the case. This section will outline the various methods of collecting data used in case study research and discuss considerations for ensuring the quality of the data.

Interviews are a common method of gathering data in case study research. They can provide rich, in-depth data about the perspectives, experiences, and interpretations of the individuals involved in the case. Interviews can be structured , semi-structured , or unstructured , depending on the research question and the degree of flexibility needed.

Observations

Observations involve the researcher observing the case in its natural setting, providing first-hand information about the case and its context. Observations can provide data that might not be revealed in interviews or documents, such as non-verbal cues or contextual information.

Documents and artifacts

Documents and archival records provide a valuable source of data in case study research. They can include reports, letters, memos, meeting minutes, email correspondence, and various public and private documents related to the case.

These records can provide historical context, corroborate evidence from other sources, and offer insights into the case that might not be apparent from interviews or observations.

Physical artifacts refer to any physical evidence related to the case, such as tools, products, or physical environments. These artifacts can provide tangible insights into the case, complementing the data gathered from other sources.

Ensuring the quality of data collection

Determining the quality of data in case study research requires careful planning and execution. It's crucial to ensure that the data is reliable, accurate, and relevant to the research question. This involves selecting appropriate methods of collecting data, properly training interviewers or observers, and systematically recording and storing the data. It also includes considering ethical issues related to collecting and handling data, such as obtaining informed consent and ensuring the privacy and confidentiality of the participants.

Data analysis

Analyzing case study research involves making sense of the rich, detailed data to answer the research question. This process can be challenging due to the volume and complexity of case study data. However, a systematic and rigorous approach to analysis can ensure that the findings are credible and meaningful. This section outlines the main steps and considerations in analyzing data in case study research.

Organizing the data

The first step in the analysis is organizing the data. This involves sorting the data into manageable sections, often according to the data source or the theme. This step can also involve transcribing interviews, digitizing physical artifacts, or organizing observational data.

Categorizing and coding the data

Once the data is organized, the next step is to categorize or code the data. This involves identifying common themes, patterns, or concepts in the data and assigning codes to relevant data segments. Coding can be done manually or with the help of software tools, and in either case, qualitative analysis software can greatly facilitate the entire coding process. Coding helps to reduce the data to a set of themes or categories that can be more easily analyzed.

Identifying patterns and themes

After coding the data, the researcher looks for patterns or themes in the coded data. This involves comparing and contrasting the codes and looking for relationships or patterns among them. The identified patterns and themes should help answer the research question.

Interpreting the data

Once patterns and themes have been identified, the next step is to interpret these findings. This involves explaining what the patterns or themes mean in the context of the research question and the case. This interpretation should be grounded in the data, but it can also involve drawing on theoretical concepts or prior research.

Verification of the data

The last step in the analysis is verification. This involves checking the accuracy and consistency of the analysis process and confirming that the findings are supported by the data. This can involve re-checking the original data, checking the consistency of codes, or seeking feedback from research participants or peers.

Like any research method , case study research has its strengths and limitations. Researchers must be aware of these, as they can influence the design, conduct, and interpretation of the study.

Understanding the strengths and limitations of case study research can also guide researchers in deciding whether this approach is suitable for their research question . This section outlines some of the key strengths and limitations of case study research.

Benefits include the following:

• Rich, detailed data: One of the main strengths of case study research is that it can generate rich, detailed data about the case. This can provide a deep understanding of the case and its context, which can be valuable in exploring complex phenomena.
• Flexibility: Case study research is flexible in terms of design , data collection , and analysis . A sufficient degree of flexibility allows the researcher to adapt the study according to the case and the emerging findings.
• Real-world context: Case study research involves studying the case in its real-world context, which can provide valuable insights into the interplay between the case and its context.
• Multiple sources of evidence: Case study research often involves collecting data from multiple sources , which can enhance the robustness and validity of the findings.

On the other hand, researchers should consider the following limitations:

• Generalizability: A common criticism of case study research is that its findings might not be generalizable to other cases due to the specificity and uniqueness of each case.
• Time and resource intensive: Case study research can be time and resource intensive due to the depth of the investigation and the amount of collected data.
• Complexity of analysis: The rich, detailed data generated in case study research can make analyzing the data challenging.
• Subjectivity: Given the nature of case study research, there may be a higher degree of subjectivity in interpreting the data , so researchers need to reflect on this and transparently convey to audiences how the research was conducted.

Being aware of these strengths and limitations can help researchers design and conduct case study research effectively and interpret and report the findings appropriately.

Ready to analyze your data with ATLAS.ti?

See how our intuitive software can draw key insights from your data with a free trial today.

• Privacy Policy

Home » Case Study – Methods, Examples and Guide

Case Study – Methods, Examples and Guide

Table of Contents

A case study is a research method that involves an in-depth examination and analysis of a particular phenomenon or case, such as an individual, organization, community, event, or situation.

It is a qualitative research approach that aims to provide a detailed and comprehensive understanding of the case being studied. Case studies typically involve multiple sources of data, including interviews, observations, documents, and artifacts, which are analyzed using various techniques, such as content analysis, thematic analysis, and grounded theory. The findings of a case study are often used to develop theories, inform policy or practice, or generate new research questions.

Types of Case Study

Types and Methods of Case Study are as follows:

Single-Case Study

A single-case study is an in-depth analysis of a single case. This type of case study is useful when the researcher wants to understand a specific phenomenon in detail.

For Example , A researcher might conduct a single-case study on a particular individual to understand their experiences with a particular health condition or a specific organization to explore their management practices. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of a single-case study are often used to generate new research questions, develop theories, or inform policy or practice.

Multiple-Case Study

A multiple-case study involves the analysis of several cases that are similar in nature. This type of case study is useful when the researcher wants to identify similarities and differences between the cases.

For Example, a researcher might conduct a multiple-case study on several companies to explore the factors that contribute to their success or failure. The researcher collects data from each case, compares and contrasts the findings, and uses various techniques to analyze the data, such as comparative analysis or pattern-matching. The findings of a multiple-case study can be used to develop theories, inform policy or practice, or generate new research questions.

Exploratory Case Study

An exploratory case study is used to explore a new or understudied phenomenon. This type of case study is useful when the researcher wants to generate hypotheses or theories about the phenomenon.

For Example, a researcher might conduct an exploratory case study on a new technology to understand its potential impact on society. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as grounded theory or content analysis. The findings of an exploratory case study can be used to generate new research questions, develop theories, or inform policy or practice.

Descriptive Case Study

A descriptive case study is used to describe a particular phenomenon in detail. This type of case study is useful when the researcher wants to provide a comprehensive account of the phenomenon.

For Example, a researcher might conduct a descriptive case study on a particular community to understand its social and economic characteristics. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of a descriptive case study can be used to inform policy or practice or generate new research questions.

Instrumental Case Study

An instrumental case study is used to understand a particular phenomenon that is instrumental in achieving a particular goal. This type of case study is useful when the researcher wants to understand the role of the phenomenon in achieving the goal.

For Example, a researcher might conduct an instrumental case study on a particular policy to understand its impact on achieving a particular goal, such as reducing poverty. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of an instrumental case study can be used to inform policy or practice or generate new research questions.

Case Study Data Collection Methods

Here are some common data collection methods for case studies:

Interviews involve asking questions to individuals who have knowledge or experience relevant to the case study. Interviews can be structured (where the same questions are asked to all participants) or unstructured (where the interviewer follows up on the responses with further questions). Interviews can be conducted in person, over the phone, or through video conferencing.

Observations

Observations involve watching and recording the behavior and activities of individuals or groups relevant to the case study. Observations can be participant (where the researcher actively participates in the activities) or non-participant (where the researcher observes from a distance). Observations can be recorded using notes, audio or video recordings, or photographs.

Documents can be used as a source of information for case studies. Documents can include reports, memos, emails, letters, and other written materials related to the case study. Documents can be collected from the case study participants or from public sources.

Surveys involve asking a set of questions to a sample of individuals relevant to the case study. Surveys can be administered in person, over the phone, through mail or email, or online. Surveys can be used to gather information on attitudes, opinions, or behaviors related to the case study.

Artifacts are physical objects relevant to the case study. Artifacts can include tools, equipment, products, or other objects that provide insights into the case study phenomenon.

How to conduct Case Study Research

Conducting a case study research involves several steps that need to be followed to ensure the quality and rigor of the study. Here are the steps to conduct case study research:

• Define the research questions: The first step in conducting a case study research is to define the research questions. The research questions should be specific, measurable, and relevant to the case study phenomenon under investigation.
• Select the case: The next step is to select the case or cases to be studied. The case should be relevant to the research questions and should provide rich and diverse data that can be used to answer the research questions.
• Collect data: Data can be collected using various methods, such as interviews, observations, documents, surveys, and artifacts. The data collection method should be selected based on the research questions and the nature of the case study phenomenon.
• Analyze the data: The data collected from the case study should be analyzed using various techniques, such as content analysis, thematic analysis, or grounded theory. The analysis should be guided by the research questions and should aim to provide insights and conclusions relevant to the research questions.
• Draw conclusions: The conclusions drawn from the case study should be based on the data analysis and should be relevant to the research questions. The conclusions should be supported by evidence and should be clearly stated.
• Validate the findings: The findings of the case study should be validated by reviewing the data and the analysis with participants or other experts in the field. This helps to ensure the validity and reliability of the findings.
• Write the report: The final step is to write the report of the case study research. The report should provide a clear description of the case study phenomenon, the research questions, the data collection methods, the data analysis, the findings, and the conclusions. The report should be written in a clear and concise manner and should follow the guidelines for academic writing.

Examples of Case Study

Here are some examples of case study research:

• The Hawthorne Studies : Conducted between 1924 and 1932, the Hawthorne Studies were a series of case studies conducted by Elton Mayo and his colleagues to examine the impact of work environment on employee productivity. The studies were conducted at the Hawthorne Works plant of the Western Electric Company in Chicago and included interviews, observations, and experiments.
• The Stanford Prison Experiment: Conducted in 1971, the Stanford Prison Experiment was a case study conducted by Philip Zimbardo to examine the psychological effects of power and authority. The study involved simulating a prison environment and assigning participants to the role of guards or prisoners. The study was controversial due to the ethical issues it raised.
• The Challenger Disaster: The Challenger Disaster was a case study conducted to examine the causes of the Space Shuttle Challenger explosion in 1986. The study included interviews, observations, and analysis of data to identify the technical, organizational, and cultural factors that contributed to the disaster.
• The Enron Scandal: The Enron Scandal was a case study conducted to examine the causes of the Enron Corporation’s bankruptcy in 2001. The study included interviews, analysis of financial data, and review of documents to identify the accounting practices, corporate culture, and ethical issues that led to the company’s downfall.
• The Fukushima Nuclear Disaster : The Fukushima Nuclear Disaster was a case study conducted to examine the causes of the nuclear accident that occurred at the Fukushima Daiichi Nuclear Power Plant in Japan in 2011. The study included interviews, analysis of data, and review of documents to identify the technical, organizational, and cultural factors that contributed to the disaster.

Application of Case Study

Case studies have a wide range of applications across various fields and industries. Here are some examples:

Business and Management

Case studies are widely used in business and management to examine real-life situations and develop problem-solving skills. Case studies can help students and professionals to develop a deep understanding of business concepts, theories, and best practices.

Case studies are used in healthcare to examine patient care, treatment options, and outcomes. Case studies can help healthcare professionals to develop critical thinking skills, diagnose complex medical conditions, and develop effective treatment plans.

Case studies are used in education to examine teaching and learning practices. Case studies can help educators to develop effective teaching strategies, evaluate student progress, and identify areas for improvement.

Social Sciences

Case studies are widely used in social sciences to examine human behavior, social phenomena, and cultural practices. Case studies can help researchers to develop theories, test hypotheses, and gain insights into complex social issues.

Law and Ethics

Case studies are used in law and ethics to examine legal and ethical dilemmas. Case studies can help lawyers, policymakers, and ethical professionals to develop critical thinking skills, analyze complex cases, and make informed decisions.

Purpose of Case Study

The purpose of a case study is to provide a detailed analysis of a specific phenomenon, issue, or problem in its real-life context. A case study is a qualitative research method that involves the in-depth exploration and analysis of a particular case, which can be an individual, group, organization, event, or community.

The primary purpose of a case study is to generate a comprehensive and nuanced understanding of the case, including its history, context, and dynamics. Case studies can help researchers to identify and examine the underlying factors, processes, and mechanisms that contribute to the case and its outcomes. This can help to develop a more accurate and detailed understanding of the case, which can inform future research, practice, or policy.

Case studies can also serve other purposes, including:

• Illustrating a theory or concept: Case studies can be used to illustrate and explain theoretical concepts and frameworks, providing concrete examples of how they can be applied in real-life situations.
• Developing hypotheses: Case studies can help to generate hypotheses about the causal relationships between different factors and outcomes, which can be tested through further research.
• Providing insight into complex issues: Case studies can provide insights into complex and multifaceted issues, which may be difficult to understand through other research methods.
• Informing practice or policy: Case studies can be used to inform practice or policy by identifying best practices, lessons learned, or areas for improvement.

Advantages of Case Study Research

There are several advantages of case study research, including:

• In-depth exploration: Case study research allows for a detailed exploration and analysis of a specific phenomenon, issue, or problem in its real-life context. This can provide a comprehensive understanding of the case and its dynamics, which may not be possible through other research methods.
• Rich data: Case study research can generate rich and detailed data, including qualitative data such as interviews, observations, and documents. This can provide a nuanced understanding of the case and its complexity.
• Holistic perspective: Case study research allows for a holistic perspective of the case, taking into account the various factors, processes, and mechanisms that contribute to the case and its outcomes. This can help to develop a more accurate and comprehensive understanding of the case.
• Theory development: Case study research can help to develop and refine theories and concepts by providing empirical evidence and concrete examples of how they can be applied in real-life situations.
• Practical application: Case study research can inform practice or policy by identifying best practices, lessons learned, or areas for improvement.
• Contextualization: Case study research takes into account the specific context in which the case is situated, which can help to understand how the case is influenced by the social, cultural, and historical factors of its environment.

Limitations of Case Study Research

There are several limitations of case study research, including:

• Limited generalizability : Case studies are typically focused on a single case or a small number of cases, which limits the generalizability of the findings. The unique characteristics of the case may not be applicable to other contexts or populations, which may limit the external validity of the research.
• Biased sampling: Case studies may rely on purposive or convenience sampling, which can introduce bias into the sample selection process. This may limit the representativeness of the sample and the generalizability of the findings.
• Subjectivity: Case studies rely on the interpretation of the researcher, which can introduce subjectivity into the analysis. The researcher’s own biases, assumptions, and perspectives may influence the findings, which may limit the objectivity of the research.
• Limited control: Case studies are typically conducted in naturalistic settings, which limits the control that the researcher has over the environment and the variables being studied. This may limit the ability to establish causal relationships between variables.
• Time-consuming: Case studies can be time-consuming to conduct, as they typically involve a detailed exploration and analysis of a specific case. This may limit the feasibility of conducting multiple case studies or conducting case studies in a timely manner.
• Resource-intensive: Case studies may require significant resources, including time, funding, and expertise. This may limit the ability of researchers to conduct case studies in resource-constrained settings.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

You may also like

Qualitative Research Methods

Observational Research – Methods and Guide

Questionnaire – Definition, Types, and Examples

Research Methods – Types, Examples and Guide

Ethnographic Research -Types, Methods and Guide

Correlational Research – Methods, Types and...

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, automatically generate references for free.

• Knowledge Base
• Methodology
• Case Study | Definition, Examples & Methods

Case Study | Definition, Examples & Methods

Published on 5 May 2022 by Shona McCombes . Revised on 30 January 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organisation, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating, and understanding different aspects of a research problem .

Table of contents

When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyse the case.

A case study is an appropriate research design when you want to gain concrete, contextual, in-depth knowledge about a specific real-world subject. It allows you to explore the key characteristics, meanings, and implications of the case.

Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.

You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.

Prevent plagiarism, run a free check.

Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:

• Provide new or unexpected insights into the subject
• Challenge or complicate existing assumptions and theories
• Propose practical courses of action to resolve a problem
• Open up new directions for future research

Unlike quantitative or experimental research, a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.

If you find yourself aiming to simultaneously investigate and solve an issue, consider conducting action research . As its name suggests, action research conducts research and takes action at the same time, and is highly iterative and flexible. 

However, you can also choose a more common or representative case to exemplify a particular category, experience, or phenomenon.

While case studies focus more on concrete details than general theories, they should usually have some connection with theory in the field. This way the case study is not just an isolated description, but is integrated into existing knowledge about the topic. It might aim to:

• Exemplify a theory by showing how it explains the case under investigation
• Expand on a theory by uncovering new concepts and ideas that need to be incorporated
• Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions

To ensure that your analysis of the case has a solid academic grounding, you should conduct a literature review of sources related to the topic and develop a theoretical framework . This means identifying key concepts and theories to guide your analysis and interpretation.

There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews, observations, and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data .

The aim is to gain as thorough an understanding as possible of the case and its context.

In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.

How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis, with separate sections or chapters for the methods , results , and discussion .

Others are written in a more narrative style, aiming to explore the case from various angles and analyse its meanings and implications (for example, by using textual analysis or discourse analysis ).

In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the ‘Cite this Scribbr article’ button to automatically add the citation to our free Reference Generator.

McCombes, S. (2023, January 30). Case Study | Definition, Examples & Methods. Scribbr. Retrieved 27 July 2024, from https://www.scribbr.co.uk/research-methods/case-studies/

Is this article helpful?

Shona McCombes

Other students also liked, correlational research | guide, design & examples, a quick guide to experimental design | 5 steps & examples, descriptive research design | definition, methods & examples.

• History & Society
• Science & Tech
• Biographies
• Animals & Nature
• Geography & Travel
• Arts & Culture
• Games & Quizzes
• On This Day
• One Good Fact
• New Articles
• Lifestyles & Social Issues
• Philosophy & Religion
• Politics, Law & Government
• World History
• Health & Medicine
• Browse Biographies
• Birds, Reptiles & Other Vertebrates
• Bugs, Mollusks & Other Invertebrates
• Environment
• Fossils & Geologic Time
• Entertainment & Pop Culture
• Sports & Recreation
• Visual Arts
• Demystified
• Image Galleries
• Infographics
• Top Questions
• Britannica Kids
• Saving Earth
• Space Next 50
• Student Center
• Introduction

The case study creation process

Types of case studies, benefits and limitations.

• When did science begin?
• Where was science invented?

Our editors will review what you’ve submitted and determine whether to revise the article.

• Academia - Case Study
• Verywell Mind - What is a Case Study?
• Simply Psychology - Case Study Research Method in Psychology
• CORE - Case study as a research method
• National Center for Biotechnology Information - PubMed Central - The case study approach
• BMC Journals - Evidence-Based Nursing - What is a case study?
• Table Of Contents

case study , detailed description and assessment of a specific situation in the real world created for the purpose of deriving generalizations and other insights from it. A case study can be about an individual, a group of people, an organization, or an event, among other subjects.

By focusing on a specific subject in its natural setting, a case study can help improve understanding of the broader features and processes at work. Case studies are a research method used in multiple fields, including business, criminology , education , medicine and other forms of health care, anthropology , political science , psychology , and social work . Data in case studies can be both qualitative and quantitative. Unlike experiments, where researchers control and manipulate situations, case studies are considered to be “naturalistic” because subjects are studied in their natural context . ( See also natural experiment .)

The creation of a case study typically involves the following steps:

• The research question to be studied is defined, informed by existing literature and previous research. Researchers should clearly define the scope of the case, and they should compile a list of evidence to be collected as well as identify the nature of insights that they expect to gain from the case study.
• Once the case is identified, the research team is given access to the individual, organization, or situation being studied. Individuals are informed of risks associated with participation and must provide their consent , which may involve signing confidentiality or anonymity agreements.
• Researchers then collect evidence using multiple methods, which may include qualitative techniques, such as interviews, focus groups , and direct observations, as well as quantitative methods, such as surveys, questionnaires, and data audits. The collection procedures need to be well defined to ensure the relevance and accuracy of the evidence.
• The collected evidence is analyzed to come up with insights. Each data source must be reviewed carefully by itself and in the larger context of the case study so as to ensure continued relevance. At the same time, care must be taken not to force the analysis to fit (potentially preconceived) conclusions. While the eventual case study may serve as the basis for generalizations, these generalizations must be made cautiously to ensure that specific nuances are not lost in the averages.
• Finally, the case study is packaged for larger groups and publication. At this stage some information may be withheld, as in business case studies, to allow readers to draw their own conclusions. In scientific fields, the completed case study needs to be a coherent whole, with all findings and statistical relationships clearly documented.

Case studies have been used as a research method across multiple fields. They are particularly popular in the fields of law, business, and employee training; they typically focus on a problem that an individual or organization is facing. The situation is presented in considerable detail, often with supporting data, to discussion participants, who are asked to make recommendations that will solve the stated problem. The business case study as a method of instruction was made popular in the 1920s by instructors at Harvard Business School who adapted an approach used at Harvard Law School in which real-world cases were used in classroom discussions. Other business and law schools started compiling case studies as teaching aids for students. In a business school case study, students are not provided with the complete list of facts pertaining to the topic and are thus forced to discuss and compare their perspectives with those of their peers to recommend solutions.

In criminology , case studies typically focus on the lives of an individual or a group of individuals. These studies can provide particularly valuable insight into the personalities and motives of individual criminals, but they may suffer from a lack of objectivity on the part of the researchers (typically because of the researchers’ biases when working with people with a criminal history), and their findings may be difficult to generalize.

In sociology , the case-study method was developed by Frédéric Le Play in France during the 19th century. This approach involves a field worker staying with a family for a period of time, gathering data on the family members’ attitudes and interactions and on their income, expenditures, and physical possessions. Similar approaches have been used in anthropology . Such studies can sometimes continue for many years.

Case studies provide insight into situations that involve a specific entity or set of circumstances. They can be beneficial in helping to explain the causal relationships between quantitative indicators in a field of study, such as what drives a company’s market share. By introducing real-world examples, they also plunge the reader into an actual, concrete situation and make the concepts real rather than theoretical. They also help people study rare situations that they might not otherwise experience.

Because case studies are in a “naturalistic” environment , they are limited in terms of research design: researchers lack control over what they are studying, which means that the results often cannot be reproduced. Also, care must be taken to stay within the bounds of the research question on which the case study is focusing. Other limitations to case studies revolve around the data collected. It may be difficult, for instance, for researchers to organize the large volume of data that can emerge from the study, and their analysis of the data must be carefully thought through to produce scientifically valid insights. The research methodology used to generate these insights is as important as the insights themselves, for the latter need to be seen in the proper context. Taken out of context, they may lead to erroneous conclusions. Like all scientific studies, case studies need to be approached objectively; personal bias or opinion may skew the research methods as well as the results. ( See also confirmation bias .)

Business case studies in particular have been criticized for approaching a problem or situation from a narrow perspective. Students are expected to come up with solutions for a problem based on the data provided. However, in real life, the situation is typically reversed: business managers face a problem and must then look for data to help them solve it.

Modular construction: From projects to products

For decades, construction has lagged behind other sectors in productivity. Modular construction offers the industry an opportunity to make a step change : shifting many aspects of building activity away from traditional construction sites and into factories with off-site, manufacturing-style production.

Modular (or prefabricated) construction is not a new concept, but technological improvements, economic demands, and changing mind-sets mean it is attracting an unprecedented wave of interest and investment. If it takes hold, it could give the industry a huge productivity boost , help solve housing crises in many markets, and significantly reshape the way we build today. Our new report, Modular construction: From projects to products , dives deeper into the issues.

What is modular construction, and how has it evolved?

In broad terms, modular construction involves producing standardized components of a structure in an off-site factory, then assembling them on-site. Terms such as “off-site construction,” “prefabrication,” and “modular construction” are used interchangeably. These terms cover a range of different approaches and systems, from single elements that are clipped together using standard connections and interfaces to 3-D volumetric units with full fixtures.

Modular construction has been a cost-efficient option at certain historical points, but its popularity has been short lived. It enjoyed postwar booms in the United Kingdom and the United States, when there was a need for speedy reconstruction and social housing, when wartime factories lay empty, and when there were shortages of steel and labor. But its popularity waned as supply and demand began to even out in the United States; a 1968 UK apartment-tower collapse also sparked concerns about the safety of prefabricated buildings.

Today, modular construction is experiencing a new wave of attention and investment, and several factors suggest it may have renewed staying power. The maturing of digital tools has radically changed the modular-construction proposition—for instance, by facilitating the design of modules and optimizing delivery logistics. Consumer perceptions of prefab housing are beginning to change, particularly as new, more varied material choices improve the visual appeal of prefab buildings.

Perhaps most important, we see a change in mind-set among construction-sector CEOs, as many leaders see technology-based disruptors entering the scene—and realizing it may be time to reposition themselves.

Potential for profound impact

Construction is one of the world’s largest sectors, so a profound shift in the sector can have a major impact on global economic productivity—and recent modular projects have already established a solid track record of accelerating project timelines by 20 to 50 percent (Exhibit 1).

The modular approach also has the potential to yield significant cost savings, although that is still more the exception than the norm today. As supply-chain players advance along the learning curve, we believe that leading real-estate players that are prepared to make the shift and optimize for scale can realize more than 20 percent in construction-cost savings, with additional potential gains in full-life costs (for instance, through reducing running costs via energy and maintenance savings) (Exhibit 2). Under moderate assumptions of penetration, the market value for modular construction in new real-estate construction alone could reach $130 billion in Europe and the United States by 2030.

Pockets of promise—especially where unmet demand coincides with labor shortages

To date, prefabricated housing has achieved a sustainable foothold in only a few places, including Japan and Scandinavia. In markets such as the United Kingdom and the United States, it has been in and out of favor since the postwar era. However, modular construction in European and US markets has the potential to deliver annual savings of up to $22 billion, and there is reason to believe the current revival could be different. The industry is adopting new, lighter-weight materials as well as digital technologies  that enhance design capabilities and variability, improve precision and productivity in manufacturing, and facilitate logistics. Countering the old reputation of prefabricated housing as an unattractive, cheap, poor-quality option, some builders are focused on sustainability, aesthetics, and the higher end of the market. New entrants and first movers that are unwilling to tolerate the industry’s fragmentation and lagging productivity are starting to disrupt the market and change the mind-sets of incumbents.

In many countries, modular construction is still very much an outlier. But there are strong signs of what could be a genuine broad-scale disruption in the making.

Many factors determine whether a given market is likely to embrace modular construction, but the two biggest determinants are real-estate demand and the availability (and relative costs) of skilled construction labor. In places such as Australia’s East Coast, Germany’s major cities, the southern part of the United Kingdom, and the US West Coast, labor shortages and large-scale unmet demand for housing intersect, making this model particularly relevant (Exhibit 3).

A real-estate disruption in the making

Capturing the full cost and productivity benefits of modular construction is not a straightforward proposition. It requires carefully optimizing the choice of materials; finding the right mix of 2-D panels, 3-D modules, and hybrid designs; and mastering challenges in design, manufacturing, technology, logistics, and assembly. It also depends on whether builders operate in a market where they can achieve scale and repeatability.

In many countries, modular construction is still very much an outlier. But there are strong signs of what could be a genuine broad-scale disruption in the making. It is already drawing in new competitors—and it will most likely create new winners and losers across the entire construction ecosystem. Different stakeholders face a series of choices.

Realizing the benefits of modular construction will require different stakeholders to make a series of choices. Developers, for example, need to identify segments of the portfolio that can serve as their “product core”; investors, on the other hand, must focus more on markets likely to be disrupted and trends defining winners and losers.

For example, a good starting point for developers is to identify the segments of a portfolio where volume and repeatability come into play. These can be designed as a “product core” that remains consistent across developments. Developers should assume that successful modularization will require more than merely asking suppliers for tender offers on existing designs; rather, they will need to work with the supply chain to optimize for manufacturability and make the right trade-offs among quality, cost savings, and time savings.

Meanwhile, for investors, the anticipated disruption will create a very different-looking landscape. This makes it a particularly interesting sector for smart investors seeking alpha at this time. They should look to understand the markets that will most likely be disrupted and the detailed trends, strategies, and capabilities that will set the winners and losers apart.

Would you like to learn more about our Capital Projects & Infrastructure Practice ?

Building-materials suppliers will face a shift in the choice of materials available to customers and prefabricators. For instance, cement companies will be affected if cross-laminated timber and steel-frame-based modules gain market share. Materials suppliers may also face an entirely different go-to-market landscape. Their customers may no longer be fragmented installers or traditional distributors but rather larger manufacturers that are optimizing for different objectives. However, these suppliers may be well positioned to enter the prefabrication space, given their knowledge both of traditional construction and of efficient manufacturing and supply-chain environments.

Modular construction in European and US markets has the potential to deliver annual savings of up to $22 billion.

Public-sector entities, like private-sector developers, will be able to capture cost savings and productivity benefits by taking a modular approach  with any large-scale publicly funded projects that have repeatable elements, such as schools and affordable housing. At the same time, the public sector has an additional role to play in facilitating modular adoption by modernizing building codes—which dovetails with the goal of removing barriers to more housing. Approval processes can be faster and more efficient if product designs and production processes can be approved in factories rather than on each individual project site, thus reducing the on-site inspection burden solely to assembly verification.

Finally, engineering and construction companies should consider preempting the trend that will see on-site construction becoming a smaller and more commoditized part of the value chain. Today, general contractors manage complex on-site projects with many subcontracted trades involved, but they may risk being cut out of a value chain focused on simple module assembly that brings with it a high degree of cost and schedule certainty.

After decades of relatively slow change, an at-scale shift to modularization—alongside digitization—looks likely to disrupt the construction industry and broader ecosystem. All players should evaluate the trend and impact, and assess their strategic choices, to ensure they can benefit rather than risk being left behind.

Download Modular construction: From projects to products , the full report on which this article is based (PDF–1MB).

Stay current on your favorite topics

Nick Bertram is an associate partner in McKinsey’s London office, Steffen Fuchs is a senior partner in the Dallas office, Jan Mischke is a partner in the Zurich office, Rob Palter is a senior partner in the Toronto office, Gernot Strube is a senior partner in the Munich office, and Lola Woetzel is a senior partner in the Shanghai office.

Explore a career with us

Related articles.

Reinventing construction through a productivity revolution

Seizing opportunity in today’s construction technology ecosystem

How analytics can drive smarter engineering and construction decisions

Understanding Causes and Resolutions of Construction Disputes: A Case Study

• Conference paper
• First Online: 05 August 2023
• Cite this conference paper

• Haijun Gu 23 ,
• Shang Zhang 23 &
• Qianqian Wang 23  

Part of the book series: Lecture Notes in Operations Research ((LNOR))

Included in the following conference series:

• International Symposium on Advancement of Construction Management and Real Estate

Although there are a few empirical research into the dispute problem in the Chinese construction industry, the causes and effective resolution methods are unknown in the context of COVID-19 pandemic. To investigate the causes and resolutions of construction disputes in China, this research employs the methods of literature review, questionnaire survey and interview. 93 professionals’ viewpoints were used for empirical analysis. The results indicate that the COVID-19 (4.20) has a significant impact on construction disputes, and contractual causes (4.00) are the most common disputes. Diverse stakeholders’ perceptions of the causes of construction disputes varied significantly. Furthermore, most disputes are resolved by negotiation (35.5%) and mediation (49.5%). This research provides professionals with invaluable insights into construction dispute’s types and dispute resolution systems. Moreover, it allows the various construction stakeholders to understand and take into consideration the perceptions of other participants when applying risk and dispute prevention techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save.

• Get 10 units per month
• Download Article/Chapter or eBook
• 1 Unit = 1 Article or 1 Chapter
• Cancel anytime
• Available as PDF
• Read on any device
• Instant download
• Own it forever
• Available as EPUB and PDF
• Compact, lightweight edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Awwad, R., Barakat, B., Menassa, C.: Understanding dispute resolution in the Middle East region from perspectives of different stakeholders. J. Manag. Eng. 32 (06), 05016019 (2016)

Article   Google Scholar  

Chen, Q.W.: Research on dispute resolution of international construction projects. South China University of Technology (in Chinese) (2019)

Google Scholar  

Ding, J.: Research on conflict management mechanism of construction project. Constr. Econ. 1 , 57–59 (2012). (in Chinese)

Gaum, T., Laubscher, J.: The implementation of alternative dispute resolution methods by architectural practitioners in South Africa. Acta Structilia 26 (01), 97–119 (2019)

Guo, D.D., She, L.Z.: Analysis on issues related to the construction of domestic DAB dispute resolution mechanism. J. Eng. Manage. 27 (06), 11–15 (2013). (in Chinese)

Jia, H.J., Sun, L.Z., Guo, X.L.: Research on the risk and dispute of construction project provisional valuation. Constr. Econ. 40 (04), 69–72 (2019). (in Chinese)

Li, K., Cheung, S.O.: Bias measurement scale for repeated dispute evaluations. J. Manag. Eng. 34 (04), 04018016 (2018)

Li, X.J., Ji, Z.K.: Study on the causes and countermeasures of construction contract disputes. Constr. Econ. 8 , 62–65 (2013). (in Chinese)

Marques, R.C.: Is arbitration the right way to settle conflicts in PPP arrangements? J. Manag. Eng. 34 (01), 05017007 (2018)

Mi, Q.: Research on dispute resolution mode of construction engineering. Zhejiang University (2012). (in Chinese)

Osei-Kyei, R., Chan, A.P.C., Yu, Y., Chen, C., Dansoh, A.: Root causes of conflict and conflict resolution mechanisms in public-private partnerships: comparative study between Ghana. Cities 87 , 185–195 (2019)

Tang, Y., Jing, Y.F.: Analysis and solution of the dispute on the completion settlement and price evaluation of the general contracting project. Constr. Econ. 41 (S1), 119–122 (2020). (in Chinese)

Wang, X.J. (2021). Study on the control of influencing factors of construction contract price disputes. Yangzhou University (2012). (in Chinese)

Wen, J.A.: Research on the dispute of payment terms in construction contract. Constr. Econ. 35 (08), 83–86 (2014). (in Chinese)

Wu, M.L.: Questionnaire Statistical Analysis Practice: SPSS Operation and Application. Chongqing University Press, Chongqing (2019). (in Chinese)

Xu, J.X.: Research on influencing factors and solutions of construction contract price disputes. Nanjing Forestry University (2018). (in Chinese)

Xu, K.B.: Influence of epidemic situation on the trial of construction contract dispute cases and countermeasures. J. Law Appl. 7 , 29–38 (2020). (in Chinese)

Yang, Y., Zhang, J.: Comparative analysis of DAB and domestic legal construction contract dispute resolution. Constr. Econ. 6 , 51–54 (2012). (in Chinese)

Ye, G., Jin, Z., Xia, B., Skitmore, M.: Analyzing causes for reworks in construction projects in China. J. Manag. Eng. 31 (06), 04014097 (2015)

Zhang, J.D.: Research on risk sharing of general contracting project of construction engineering. Harbin Institute of Technology (2020). (in Chinese)

Zhang, L.Z., Xu, W., Chen, H.: A model for the causes of disputes in engineering construction contracts. J. Civ. Eng. Manag. 33 (04), 76–82 (2016). (in Chinese)

Zhang, S., Loosemore, M., Sunindijo, R.Y., Galvin, S., Wu, J., Zhang, S.Y.: Assessing safety risk management performance in Chinese subway construction projects: a multistakeholder perspective. J. Manag. Eng. 38 (4), 05022009 (2022)

Download references

Author information

Authors and affiliations.

Department of Construction Management, Suzhou University of Science and Technology, Suzhou, China

Haijun Gu, Shang Zhang & Qianqian Wang

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Haijun Gu .

Editor information

Editors and affiliations.

Department of Geography and Resource Management, The Chinese University of Hong Kong, Hong Kong, China

Department of Real Estate and Construction, University of Hong Kong, Hong Kong, Hong Kong

Weisheng Lu

Department of Emergency Management, Nanjing University, Nanjing, China

School of Management, Guangzhou University, Guangzhou, Guangdong, China

Hongping Yuan

Daikun Wang

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this paper

Cite this paper.

Gu, H., Zhang, S., Wang, Q. (2023). Understanding Causes and Resolutions of Construction Disputes: A Case Study. In: Li, J., Lu, W., Peng, Y., Yuan, H., Wang, D. (eds) Proceedings of the 27th International Symposium on Advancement of Construction Management and Real Estate. CRIOCM 2022. Lecture Notes in Operations Research. Springer, Singapore. https://doi.org/10.1007/978-981-99-3626-7_56

Download citation

DOI : https://doi.org/10.1007/978-981-99-3626-7_56

Published : 05 August 2023

Publisher Name : Springer, Singapore

Print ISBN : 978-981-99-3625-0

Online ISBN : 978-981-99-3626-7

eBook Packages : Business and Management Business and Management (R0)

Share this paper

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

The Power of Continuous Improvement in Construction

The company.

The origins of the company date back to the end of the XIX century, with the construction of chimneys for factories in the Textile Industry. In the 90s, the company invested in the design area and started to develop projects from “A to Z”, taking on large projects for national and multinational companies. It specializes in the Design & Build of industrial, logistic, commercial, and residential buildings. It offers an integrated service that, depending on the needs, can go from the choice of a location to the construction, including the design, ensuring a result on spec, time, and budget. 

The challenge

This company faced a decrease in net income and the consequent awareness of the decrease in the organization’s efficiency. It was necessary to rethink the entire strategy, from people to processes, and define a growth strategy with solid foundations to leverage operational results. 

In an external context of increased investment and possible attraction of new customers and projects, it was necessary to increase efficiency and identify everything considered waste, directing the focus to optimize processes. In parallel, external difficulties emerged due to labor shortages and the demands posed by customers for increasingly shorter deadlines in an increasingly competitive market. 

The project’s primary goals were to ensure the agility and quality of the execution of processes in the support areas, minimizing rework; improve the quality of execution and management on site; adopt visual management processes and increase productivity on site; review the procurement process; improve productivity in project execution (Multi-Projects) release resources for value-added activities (more projects) and design and implementation of a strategic planning process to increase profitability to continue to invest and sustain growth based on operational indicators – Increase in business volume in non-core areas, on-time delivery of projects, margin per project. 

The approach

The implementation process entailed two cycles. 

During the 1st cycle, the focus was to build base teams and identify core areas that needed improvement. Then, the 2nd cycle, after the operational improvements, was about defining a strategic improvement process to grow and consolidate the 1st cycle improvements, together with identifying new opportunities. 

Mission Control Room

The implementation of the Mission Control Room marked the beginning of the project. The Mission Control Room is a visual control room for project management , which presents the project’s main indicators, a summary A3 for the follow-up of ongoing initiatives, and includes a routine of meetings for presentation and follow-up of the project.

Project Management

Another aspect addressed was project management with the definition of the meeting cascade, implementation of a sales funnel, definition and analysis of load-capacity per project and creation of the project manager role, and creation of structured meetings to pass information between the commercial and the multi-projects team.

Daily KAIZEN™

Simultaneously, a Daily KAIZEN management and development model provided visibility to each team’s work plan, definition and analysis of each team’s process indicators, and timely reaction to deviations.

This team alignment and development model allows for greater involvement and participation of all team members in the processes and their improvement.

Improving the teams’ work involves mapping and identifying the main processes to simplify and eliminate associated waste. The mapping of the critical processes of each team generated a series of points to standardize: the creation of an indicator of execution hours and the standardization of models.

Visual management

The construction site was also the focus of improvement implementation. All construction sites worked on visual management. Each construction site included a control room with visual management, allowing for monitoring of the main elements for project management. Some of these elements were the construction planning, the map of needs, and tools such as the last planner and pull planning for managing the entire project.

The project also implemented some actions to physically organize the construction sites, resulting in gains in productivity and safety.

Such actions counted on coaching and a lot of behavior reinforcement to succeed. The process has been rolled out across all teams and works in progress. Frequent audits accompanied all this.

Purchasing process

The second implementation cycle focused on improving the purchasing process, with its standardization and request for supplier consultation and evaluation and defining a supply chain control process.

Man-hours on site

Another area of work in this second cycle was the reduction of man-hours on site with the development of solutions to increase work performance and reduce waste hours.

Strategic Plan

Finally, we worked on the strategic plan defining disruptive objectives in Growth, Quality, Cost, and Service. We defined the key processes to improve by assigning metrics and resources needed for implementation.

This transformation journey has profoundly impacted the growth and success of the business, setting a benchmark for excellence in the marketplace. The company achieved solid and sustainable financial results with increased net income and turnover through a focused approach to resource management and identifying savings opportunities. 

One of the standouts was the 42% improvement in on-time delivery. This achievement reflects the company’s commitment to meeting strict deadlines and ensuring customer satisfaction. It directly results from teamwork, adopting best practices, and optimizing planning and execution processes. 

In addition, the company achieved a 25% reduction in purchasing time, optimizing and streamlining the materials acquisition process. This reduction in purchasing time allowed the company to respond quickly to market requests, ensuring the availability of essential resources. 

The success of this project was mainly due to the involvement of more than 800 employees, internal and external. Commitment, dedication, and collaborative efforts were vital to implementing the changes and fostering a culture of continuous improvement throughout the organization . 

The outstanding results and positive impact generated in the construction industry are a reason for celebration. This case exemplifies how a continuous improvement project can empower operations, ensure efficiency, and reinforce the company’s commitment to outstanding service.  

# construction # teammanagement

See more on agile construction.

Find out more about transformation in this sector

See more on Team Management

Find out more about improving this business area

Get the latest news about Kaizen Institute

Join TheConstructor to ask questions, answer questions, write articles, and connect with other people. When you join you get additional benefits.

Confirm Password *

First Name *

Last Name *

Country Select a country… Åland Islands Afghanistan Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belau Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba CuraÇao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Republic of Ireland Reunion Romania Russia Rwanda São Tomé and Príncipe Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (Dutch part) Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines San Marino Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia/Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom (UK) United States (US) Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Western Samoa Yemen Zambia Zimbabwe

By registering, you agree to the Terms of Service and Privacy Policy . *

Log in to TheConstructor to ask questions, answer people’s questions, write articles & connect with other people. When you join you get additional benefits.

Join for free or log in to continue reading...

Username or email *

Forgot Password

Lost your password? Please enter your email address. You will receive a link and will create a new password via email.

Sorry, you do not have permission to ask a question, You must log in to ask a question. Join now!

The Constructor

3 important cases of building collapse due to poor construction management.

Do you need to remove the ads? Join now!

🕑 Reading time: 1 minute

Construction is perhaps the most critical stage in the life cycle of structures, mainly because of the danger of failure and the high chances of underestimating construction loads.

A report developed by the American Society of Civil Engineers, based on their study of around 600 failed structures, found that around 40% of the structures failed during the construction stage, 36% of the structures failed during the pre-construction stage due to flawed designs, and 24% failed during their operational stage.

The failure of a structure is described as the propagation of local collapse from one segment to another segment, eventually resulting in the failure of an entire building or its lopsided part. It could be a product of natural disasters, for example, seismic tremors, floods, or coincidental acts such as an explosion in the service system or terrorist bombings.

Analyzing the reasons for explicit structural failures and proposing measures to relieve their effects is a successful measure to lessen risks and improve the safety of structures. Therefore, this article discusses the failure of some major structures, their root causes, and the lessons learned. 

1. The Skyline Plaza Apartment Building, Virginia, US

The design plan of the Skyline Plaza complex included six office buildings, eight apartment buildings, shops, and one hotel. The project was a $200 million residential-commercial complex and was situated in Fairfax County, Virginia. During the construction of the skyline plaza complex, one of the apartment buildings under construction collapsed. A total of 15 labors were killed, and 40 were injured.

Design drawings of the collapsed building included the construction of 26 stories, a penthouse, and a four-story storm basement for parking. The building design was of a reinforced concrete flat plate with a 200 mm thick concrete slab. The height between each story was 2.7 m. 

1.1 Investigation Findings 

On 2 nd March 1973, some portion of the apartment building collapsed during construction. The collapse began on the 23 rd floor when the slab of the 24 th floor was being cast. On the 23 rd floor, the slab started showing cracks and the failure of the building occurred vertically along the full height of the building, including the basement levels. Also, the adjacent post-tensioned reinforced concrete car parking structure collapsed. 

Specialists concurred that the concrete had not acquired sufficient strength to carry the construction loads applied during the construction process. Investigators confirmed that the original design plan had no deficiencies. The most probable reason for the collapse of the building was the punching shear failure on the 23 rd floor of the building.  

After the collapse, a team from the Occupational Safety and Health Administration (OSHA) came to the site and started an investigation. Further, a detailed investigation was conducted by the National Bureau of Standards (NBS). 

NBS and OSHA mentioned in their reports that the collapse of the building was directly related to poorly managed construction processes. The court found that the contractor and the site engineer were guilty of negligence as the contractor didn't follow the building code requirement and the site engineer didn't inspect the work properly. 

1.2 Lessons Learned

After the collapse of the Skyline Plaza apartment building, a series of changes were made in the building code related to the progressive collapse failure. Special inspection procedures were added in the inspection section of the building codes. Design criteria were also changed for effective planning to reduce the possibility of failure due to progressive collapse. The following points describe the violations of specified construction requirements and standard practices: 

• Violation of prerequisites to completely shore the two stories underneath the floor being cast. 
• Failure to permit legitimate curing time before removing shoring. 
• Failure to conduct curing test on the concrete specimen in the field. 
• Use of out-of-plumb shoring. 
• Improper inspection during casting and formwork removal to check the strength of concrete.  
• Improper installation of the climbing crane. 

2. Ronan Point Tower, Canning Town ,   London

The need to give substitution lodging to homes destroyed in World War-II encouraged European engineers to develop innovative pre-assembled construction strategies. One such plan included the construction of high-rise buildings using pre-stressed concrete components made in factories.

The structural framework included the construction of load-bearing walls and each floor was directly stacked onto the walls. Grouted bearing surfaces were used to construct the joint between the wall and the floor. This process of construction was termed as system building. A skyscraper at Ronan Point, Canning Town, UK, was built using this system building technique. 

On 16 th May 1968, a blast occurred due to gas leakage in the kitchen of a house on the 18 th floor. Just after the blast, the kitchen walls collapsed, and in-turn, the walls above the 18 th floor caved in. This impacted the floors beneath and obliterated the entire corner of the structure. A total of 14 people were injured and three were killed. 

2.1 Investigation Findings 

The investigation team revealed that the building collapsed due to the non-availability of an alternative load path when one portion of the external wall collapsed. After the demolition of the building, it was also revealed that the quality of the grouted bearing surface for the joints between floors and the walls was poor.

Because of the unprecedented collapse, the government examined the safety of other buildings constructed using the same concept as the Ronan Point Tower. Many buildings were demolished well ahead of their life span. 

The concept of progressive collapse of structures was not much known to the engineers before the failure of the Ronan Point Tower. In such collapses, a local failure is followed by widespread collapse through a chain reaction. What was irregular on account of the failure of the Ronan Point Tower was that a minor gas blast set off the collapse of a huge portion of a finished structure.

2.2 Lessons Learned

The experience due to the failure of Ronan Point Tower re-emphasized the following points: 

• Progressive failure can also occur in fully constructed structures.
• A structure should have redundancies to reduce the possibility of progressive failure. 
• Quality control should strictly be followed in the construction processes. 

3. 2000 Commonwealth Avenue, Boston, US

On 25 th January 1971, a two-third portion of a 16-story residential building known as 2000-Commonwealth Avenue in Boston collapsed during construction, leading to the death of four workers. The building was under construction for more than six years. The collapse of the building generated approximately 8000 tons of debris. Luckily, the failure of the building was gradual, giving the workers some time to escape from the building site. 

The building was designed as a reinforced concrete structure and flat slabs were used for the roofing system with an elevator shaft provided in the center. This type of structural design is mainly famous for multi-story construction as it reduces the thickness of the slab and overall height between the floors. The thickness of flat slabs was between 160-190 mm for all the building areas except near the elevator core where it was 230 mm thick. The arrangement of the structural component constituted a height of 2.7 m for all the floors.    

The building, situated at 2000 Commonwealth Avenue, was intended to be 16 stories high with a mechanical room of height 1.5 m for the working of the lift at the rooftop. The plan area of the structure was 56 x 21 m 2 . The building additionally had underground parking of two levels. A pool, auxiliary spaces, and one flat were situated on the first floor, and a total of 132 flats were on the second through sixteen floors. At first, these flats were to be leased. However, the proprietors later chose to advertise them as apartment suites. 

At the hour of the collapse of the building, construction work was almost completed. The brickwork was finished up to the sixteenth floor, and the structure was generally encased from the second to the fifteenth floor. Heating, plumbing, and ventilation frameworks were introduced all through different floors of the structure. The interior work had also started on the lower floors. A temporary lift was constructed to help in moving equipment to various floors. It was assessed that 100 individuals were working in or around the structure at the hour of the collapse. 

The collapse of the building occurred in three stages. These stages were, failure due to punching shear in the rooftop at section E5, the failure of the slab, and in the end, the progressive failure of the structure. 

3.1 Investigation Findings 

The civic chairman of Boston appointed a commission to inquire about the collapse of the building. The commission discovered the following critical observations: 

• There was no signature of an architect or engineer found on a single drawing of the building. 
• The design engineer didn't give the computations supporting his structural drawings to the commission. No head or representative of the team of contractors held a building construction license of Boston city. 
• Ownership of the venture changed a few times, with changes in planners and architects. This scenario added to the general disarray and contributed to the abnormalities referred above. 
• The general contractual worker just had a solitary representative on location. Most subcontracts were given directly by the owner to the subcontractors and bypassed the general contractor. A total of seven subcontractors were involved in the construction. 
• The subcontractor, who was assigned to conduct the cold weather protection work on the structural concrete didn't carry out the assigned work. However, the structural engineer had indicated these measures. 
• There was no proof of any inspection of the work by a specialist despite the fact that the project particulars needed this. 
• The quality of construction material and quality inspections were poor. 
• The collapse of the building occurred due to the development of punching shear mechanism around column E5. Punching shear developed the flexural cracks around the roof slab located near the elevator core. Thus, the slab collapsed due to flexural yielding. 
• The design manual indicated a 28-day strength of 25 MPa. However, at the failure time, 47 days after casting work, the concrete couldn't seem to attain the necessary 28-day strength. 
• The most critical inadequacies were an absence of shoring under the slab at the roof and the quality of the concrete.

3.2 Lessons Learned

The following key factors describe the collapse of the multi-story building situated at 2000 Commonwealth Avenue: 

• Authorized design engineers should be chosen for the development of working drawings for construction. 
• Engineers and architects should be responsible for all the design-related calculations and their design work must be examined by the experts in that field from a government organization. 
• Ownership of a project should not change multiple times to reduce the confusion between the previous engineer and the newly appointed engineer. 
• Inspection at the construction site should be conducted regularly by government organizations, especially for cold weather work.  
• The quality of concrete work should be monitored throughout the project. 
• The construction work should conform to design documents and construction procedures.

The collapse of a building is characterized as the propagation of an initial local collapse from component to component, ultimately resulting in the collapse of a whole structure or a disproportionately large portion of it.

Construction is one of the most critical phases in the life cycle of buildings due to the risk of failure and the possibility of underestimating construction loads.

The structural framework included the construction of load-bearing walls and each floor was directly stacked on the walls. Grouted bearing surfaces were used to construct the joint between the wall and the floor. This process of construction was termed system building.

Top 5 Biggest Dam Failures in the World

5 Disastrous Foundation Failures in New York City

Top 6 Energy-Efficient High-Rise Buildings in the World

Ravi Panwar

Related posts.

16 Types of Pipelines and their Construction Method

Factors Influencing Earthquake Resistant Design of Structures

Construction Parts in Building Projects: Definition and Case Study

• Journal of Management in Engineering 34(4)
• This person is not on ResearchGate, or hasn't claimed this research yet.

Discover the world's research

• 25+ million members
• 160+ million publication pages
• 2.3+ billion citations

No full-text available

To read the full-text of this research, you can request a copy directly from the authors.

• BUILD RES INF

• Mohammed Izrai Abd Razak

• Wan Hamidon Wan Badaruzzaman

• Jianzhuang Xiao
• Robert Tiong
• AUTOMAT CONSTR

• Matthew Ball

• Antonio José Araujo Lima
• Ronaldo Silva Júnior
• Amanda Alves Feitosa
• Ubiraélcio Malheiros

• Nawari O. Nawari
• Heap Yih Chong

• U. Natarajan

• Moonseo Park

• Zsolt Kemény

• Keith W. Hipel

• Steven Ashley

• ADV ENG INFORM

• Alba Fuertes

• COMPUT IND ENG
• Herman R. Leep

• A. P. Nyaluke
• Incorporated Merriam-Webster
• K Grigorova
• Recruit researchers
• Join for free
• Login Email Tip: Most researchers use their institutional email address as their ResearchGate login Password Forgot password? Keep me logged in Log in or Continue with Google Welcome back! Please log in. Email · Hint Tip: Most researchers use their institutional email address as their ResearchGate login Password Forgot password? Keep me logged in Log in or Continue with Google No account? Sign up

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• Open access
• Published: 28 July 2024

The construction of stance in English and Arabic newspaper editorials: a case study

• Sharif Alghazo 1 , 2 ,
• Khulood Al-Anbar 2 ,
• Ghaleb Rabab’ah   ORCID: orcid.org/0000-0003-1804-5859 1 , 2 ,
• Nimer Abusalim 2 &
• Mohammad Rayyan 2  

Humanities and Social Sciences Communications volume  11 , Article number:  971 ( 2024 ) Cite this article

Metrics details

• Cultural and media studies
• Language and linguistics

This study explores the construction of authorial stance in English and Arabic newspaper editorials. To achieve this objective, the study examines a corpus of 80 newspaper editorials retrieved from two newspapers: The first publishes in English ( The Guardian , the UK), and the second publishes in Arabic ( Addustour , Jordan). The study adopts Hyland’s taxonomy of stance, which includes features of hedges, boosters, attitude markers and self-mentions. To analyse the data, the study follows a mixed-methods approach to identify differences, if any, in the construction of authorial stance in the two languages in the editorial genre. A functional analysis is carried out to capture these markers within contexts. The results reveal that the most frequently used stance devices in Arabic editorials are the attitude markers, followed by boosters, hedges and self-mentions. Contrariwise, the findings showcase that the most frequently used stance device is hedging, followed by attitude markers, boosters, and self-mention. The study concludes that the two languages differ in the way they construct stance in editorials, a conclusion that provides implications for second-language professional writing teachers and students. The findings provide insights that might enhance the skills of argumentative writing in English for media courses.

Similar content being viewed by others

Engagement strategies in English and Arabic newspaper editorials

A corpus-based comparison of linguistic markers of stance and genre in the academic writing of novice and advanced engineering learners

Representations of 5G in the Chinese and British press: a corpus-assisted critical discourse analysis

Introduction.

In research on intercultural rhetoric, the use of linguistic conventions to structure a text is of paramount importance. Equally important is the way authorial stance is constructed to achieve the objectives of writing (Pho, 2013 ; Peng, 2019 ). Intercultural rhetoric is concerned with the influence of the writer’s first language on the production of a text in the second language. Such an influence is explored by comparing writings in two languages. Of the most under-researched types of writing is the writing of newspaper editorials, which is used to express opinions and argue for certain positions. It is no accident that editors and members of the editorial board opt for certain stance markers in their editorials to unveil the mystery behind their own judgements and evaluations. That decision to pick a certain stance feature in a language is not a random one but rather a deliberate and thoughtful one based on the setting in which it exists. Such acts of evaluation or expression of opinion merely draw on a variety of different factors, including the newspaper’s ideology and the editorialist’s stance.

Editorials are the institutionally constructed voice of the newspaper. Therefore, a balanced, fair, and factual manner of reporting events is seen as something that most journalists and editors aspire to do in journalism. However, it could be argued that editorial writers do not have the option of excluding their views and their organisational cultures in the writing of their editorials. In fact, editorials can be less restricted with the absence of biases and prejudices as long as they completely concur with the stipulations of the institution. Therefore, editorials may influence one’s eyesight or sentiments of an issue over time. Richardson and Lancendorfer ( 2004 ), in their discussion of the framing theory and affirmative action in newspaper editorials, stated that ‘the opinion page is just that- a place where editors can bluntly state exactly what they think’ (p. 75). In broad terms, editorials have been proved to be a stance-rich environment where the ideology of the newspaper can be represented in journalism circles and to the public. For Hyland ( 2008 , p. 5), stance means “the writer’s textual voice or community recognised personality”.

A straightforward reflection of opinion in an editorial targeted at the newspaper readership is not as simple as it seems. The editorial stance is generally seen to have a strong power in the process of agenda-building and political agenda-setting in their respective countries. Jaffe ( 2009 , p. 8) pointed out that ‘stance attributions are tools of control and ideological domination’. Thus, editorial stance is believed to have a considerable influence on the ideologies, social attitudes and values of the community. Resulting of this, many studies have suggested a number of functions that stance performs in a written text (e.g. Biber and Finegan, 1988 ; Hunston and Thompson, 2000 ; Hyland, 2005 ; Dafouz-Milne, 2008 ). For instance, Biber and Finegan ( 1988 , p. 2) stated that ‘a broad range of functions falls under the umbrella of ‘stance’ including expression of certainty, generalisation, and actuality’. It is worth noting in this respect that stance as a linguistic term was referred to in the literature using different labels, such as evaluation, appraisal, voice, and writer’s commitment. Hunston and Thompson ( 2000 , p. 6), in their discussion of why evaluation has attracted broad interest, also identified three functions that evaluation is used to perform: expressing opinion, maintaining relations, and organising the discourse.

In this study, we compare the use of stance features in English and Arabic editorials to identify differences (if any) in how editorialists construct their stance in the two languages. The aim is to highlight the similarities and/or differences between both languages in the use of stance features, with a view to determining the factors affecting the use of stance in editorials. To achieve this objective, the study analyses editorials published in two well-known newspapers: The first in English ( The Guardian , the UK), and the second in Arabic ( Addustour , Jordan). These newspapers were selected based on their popularity and wide readership in their respective contexts. This study seeks to answer the following search questions:

How do newspaper editorialists construct their stance in English and Arabic newspaper editorials?

What are the similarities and/or differences (if any) in the use of stance markers in English and Arabic newspaper editorials?

Literature review

The literature on metadiscourse use abounds with studies that analysed different text types and genres (e.g. Abusalim et al., 2022 ; Alghazo et al., 2023a ; Alghazo et al., 2021a ; Rabab’ah et al., 2022 ; Rabab’ah et al., 2024 ). However, little research has been found on the use of metadiscourse in media discourse genres. For example, Chen and Li ( 2023 ) examine how two newspaper agencies, namely China Daily (CD) and The New York Times (NYT), use interactional metadiscourse to engage the readers and the similarities and differences in their usage. Specifically, the research focuses on identifying the rhetorical tools used by each agency and how/why they are used. The researchers used corpus analysis where the data was collected from 60 commentaries, 30 from each newspaper agency, which were published over the course of 6 months and the analytical framework used to analyse the data was derived from Hyland’s works on metadiscourse. The results show that both newspaper agencies used interactional metadiscourse, but their usage differed in terms of total frequency; the NYT used interactional discourse more. Secondly, in terms of the macro level, the NYT uses of stance and engagement were balanced, whereas the CD heavily focused on stance. Thirdly, in terms of the subcategories, the NYT used ‘hedges, self-mention, and engagement markers’ more frequently compared to the CD. As for ‘boosters and attitude markers,’ the differences were insignificant.

McCambridge ( 2022 ) examined how commenters on YouTube use stance to construe their voice while reacting to a video by compiling a list of 2000 comments on a viral video of Greta Thunberg made by 1949 users and analysing them using ATLAS.ti. The study states that from the data collected, the voice that seems to be construed is that of bullying. In terms of the frequency of the codified categories, attitude markers came first, followed by boosters, reader addresses, self-mentions, and hedging, respectively. The overall stance of the comments was negative and can easily be ‘[characterised] as bullying.’ The comments as a whole nurtured hate towards Thunberg through the use of sarcasm and insults, amongst other methods which fall under the above-mentioned categories. Finally, McCambridge ( 2022 ) extrapolates these results to the ‘wider social scale’ where group commentaries such as the one covered in this paper can be used to create an intimidating force against a given entity or figure.

Hyland and Zou ( 2021 ) studied the usage and function of stance in the genre of ‘Three Minute Thesis presentation (3MT)’. More specifically, the research focuses on analysing the usage of stance by the presenters, the differences that exist in said stances between the different fields, and the reasoning behind the differences using a corpus analysis of 140 presentations, which were transcribed from the video format. The presentation material covered multiple fields, including education, applied linguistics, history, and sociology. The corpus was categorised under hard sciences and soft sciences. Hyland’s model was used as the analytical framework, and AntConc was used to analyse the data. The results showed that in total, there were 4616 stance markers, where 2086 belonged to the social sciences, and 2529 belonged to the hard sciences. This difference was proven to be statistically significant. Moreover, when it comes to the subcategories, the hard sciences had more uses of boosters and hedges, whereas ‘attitude markers and self-mention were only slightly more frequent in the social [sciences]’. Finally, the hard science presenters used ‘more epistemic devices’ to support their claims, whereas soft science presenters used ‘a more affective and visible stance’.

Droz-dit-Busset ( 2022 ) explored the representation of Social Media Influencers (SMIs) by English news agencies by analysing the usage of the celebration and derision stances through the usage of ‘legitimation and delegitimation’ approaches. Droz-dit-Busset ( 2022 ) used a corpus analysis of 143 pieces, which included editorials, features, and opinion pieces extracted from a number of international English news agencies through LexisNexis, as well as pieces from the Guardian and the New York Times. The results show that for ‘celebration,’ techniques used included discussing positive metrics (view count, reach, etc.) as well as ‘narratives of [societal] upward mobility,’ where the SMIs are celebrated as individuals who went from zero to hero. As for the ‘derision’ stance, approaches to delegitimise SMIs include ‘negative moral evaluations’ regarding ‘their work [ethics]’ and referencing their ‘lack of institutional legitimation’.

Yazdani et al. ( 2014 ) investigated how articles from Persian and English news agencies utilise interactional metadiscourse, using a corpus analysis tool to analyse 30 articles (15 from Persian and 15 from English) and adopting Hyland’s ( 2005 ) system of metadiscourse. The results show that, in total, the English articles had a much higher frequency of interactional metadiscourse compared to the Persian articles, with a value of 70% compared to 29% respectively. In terms of the subcategories, English articles’ most frequently found markers were hedges (38%), followed by attitude markers (26%), boosters (18%), self-mentions (12%), and engagement markers (6%), respectively. As for the Persian articles, the most frequently used markers were the attitude markers (48%), followed by hedges (32%) and boosters (20%), respectively. Interestingly, the engagement markers and self-mentions were not present in the Persian articles, which led the researchers to conclude that these differences are attributed to the different writing styles of English and Persian writers, the writer-reader relationship dynamics, and the cultural differences between the two languages.

Fu ( 2012 ) examined how interactional metadiscourse is utilised in job postings, adopting a corpus analysis method to analyse a corpus consisting of 220 different job postings obtained from five sub-corpora of job postings, including that of ‘The Daily Telegraph’ and ‘The Guardian.’ These postings were further divided into postings made for college students and another for non-college students. Hyland’s ( 2005 ) model was used as the analytical framework, and the instances of interactional metadiscourse were categorised. Moreover, a questionnaire was given to 30 randomly selected students. The results show that, in total, the number of engagement features and stance features are similar, 1757 to 1804, respectively. Among these features, self-mentions (1145) and reader-inclusive pronouns (1497) are the most frequent. On the other hand, micro-level features (hedges/boosters) are not frequent. Personalisation is also a distinct feature, as displayed in the use of ‘we’ and ‘you’ when referring to the writer and the reader, respectively. As for the difference between postings made by college students and non-college students, interactional metadiscourse was more frequent in the postings by college students.

Al-Subhi ( 2023 ) investigated the use of interactional metadiscourse in the USA and UAE-based leading newspaper editorials, using a corpus analysis on a corpus consisting of 24 editorials with 12 from UAE-based news agencies ‘namely, Khaleej Times, Gulf Today, and The National Gulf,’ and 12 from USA-based news agencies namely, ‘The New York Times, Los Angeles Times, and Washington Times’. The analytical framework used was Hyland’s ( 2005 ) model of interactional meta-discourse. The results showed that both corpora had similar frequencies when using interactional metadiscourse. Moreover, both corpora used stance markers more frequently compared to engagement markers. As for the subcategories of stance, both corpora used hedges most frequently, followed by attitude markers, boosters, and self-mentions, respectively. Engagement markers were few, with only ‘5%–8%’ present in the corpora. Al-Subhi ( 2023 ) concludes by addressing how editorials ‘constitute a persuasive genre par excellence’ given their usage of ‘rhetorical and argumentative structures’ which ‘[aims] to influence public opinion and [express] the institutional voice of a newspaper’.

Shen and Tao ( 2021 ) examined the usage of stance markers in scientific medical research articles and newspaper opinion columns, using a corpus analysis on two corpora: 52 articles and 175 opinion articles from ‘The New York Times’. Hyland’s ( 2005 ) framework of stance was used as the analytical framework of the study. The results showed that stance markers were frequently used in both corpora; however, the number of markers in the opinion columns was nearly twice as many compared to the medical corpus, which in turn ‘[reflects] a high level of interaction between writers and readers’ in that genre. As for the frequency of the categories, hedges were the most frequent, followed by boosters and attitude markers; all these categories were more frequent in opinion columns compared to medical articles. Self-mentions were also used in both genres; however, their usage differed, with opinion columns using ‘first person singular forms’ and medical articles using ‘the first person plural forms’. The results also showed that there was some overlapping in the usage of markers and that even though stance markers were more frequent in opinion articles, there were some subcategories under the difference between the two genres.

In a recent study on the use of stance features in the editorial section of newspapers, Al-Anbar et al. ( 2023 ) compared the use of interactional features of metadiscourse in two groups of editorials: the first was written by native English authors, and the second by nonnative English authors, using Hyland’s ( 2019 ) framework. The findings showed that non-native editorialists used fewer hedges and more boosters than native editorialists, who were found to also use more engagement markers in writing. In a related investigation, Alghazo et al. ( 2023b ) explored the interactive features of metadiscourse in 80 newspaper editorials written in first language (L1) English and second language (L2) English. The analysis showed that, in the main, there was no significant difference in the use of interactive features. However, a slight variation in the use of frame markers and evidentials was observed in the data analysed.

Methodology

The data were gathered from two broadsheet daily newspapers in Jordan and the UK, namely Addustour newspaper and the Guardian newspaper. This study is focused primarily on editorials which were published on the websites of the two newspapers between 2020 and 2021. Simply put, the present study gives an account of how stance is expressed in Arabic and English editorials. Therefore, it was decided that the best method to adopt for this investigation was to analyse the data both quantitively and qualitatively. A mixed-methods approach, combining both the quantitative and qualitative analysis of the data, was used to allow for a deeper insight into the use of stance markers by editors of both languages. Eighty editorials were divided into two sets; each set consisted of 40 editorials in each language. The data was collected from the two newspapers’ websites (Addustour and the Guardian) and then transferred to a Microsoft Word document. This study utilises Hyland’s ( 2005 , 2019 ) model of interaction, which includes stance and features of writer positioning. As for Hyland’s ( 2019 ) typology of stance, features of writer positioning are of four kinds: hedges, boosters, attitude markers and self-mentions .

In order to identify stance markers in the two sets of editorials, a functional analysis was carried out to capture these markers within contexts. Studies of stance have traditionally relied upon the contextual analysis of texts in stance detection (e.g. Dobbs, 2014 ; Aull and Lancaster, 2014 ; Wu and Paltridge, 2021 ). We prepared a list of potential stance markers in English and Arabic after reviewing many relevant studies in the literature (e.g. Biber and Finegan, 1988 , 1989 ; Fitzmaurice, 2004 ; Jaffe, 2009 ; Johnstone, 2009 ; Kiesling, 2009 ; Grey and Biber, 2012 ; Alghazo et al., 2021b ). After that, each potential stance marker was double-checked within context to verify its analysis. Each stance marker was then highlighted to lay down the ground for the calculation of the number of stance markers in each set of editorials. It should be noted here that Arabic stance examples were translated carefully after ensuring that they are considered stance features. In the quantitative part, a statistical analysis was performed using SPSS and the Mann–Whitney U test to compare the differences between the two independent groups. And for the purpose of qualitative analysis, numerous examples have been discussed with reference to earlier studies of stance. An explication of these instances has been made to uncover the interpretations and justifications of stance-taking options in both languages.

The findings of the study show that the most frequently used stance markers in the Arabic set of data were the attitude markers, followed by boosters, hedges, and self-mentions, respectively. Attitude markers, interestingly enough, were far more frequent than any other kind of stance features in the Arabic group of editorials. While boosters were the second most employed feature of stance across the Arabic editorials (23.4%), hedges were used less and less frequently (7.3%). There was only one instance of self-mentions in the Arabic collection of editorials (see Table 1 ). Self-mentions are considered to be the least recurring feature of stance in the Arabic editorials (0.1%), which was exactly the same as that of the English ones (0.1%).

Table 2 below shows the frequencies, percentages, and frequencies per 1000 words of stance features in the Guardian collection of editorials. By far, the most frequent stance feature in the English set of editorials was hedges (37.7%), followed by attitude markers (37%) (see Table 2 ). It is also worth noting that the gap between the usage of hedges and attitude markers in English editorials was relatively small (only 0.7%). Boosters ranked third among the most frequent stance features in the Guardian English editorials (25.2%). At the very least, self-mentions were used only once in the English editorials (0.1%), as can be seen in the table below.

The Mann–Whitney U Test, also known as the Wilcoxon Rank Sum Test, was adopted to capture further in-depth information on the similarities and/or differences between both languages in the practices of stance. This non-parametric statistical test was selected for its reliability and validity when comparing two independent groups. The results of the correlational analysis are summarised in Table 3 , and all types of stance markers were evidently present in the editorials of both languages. There is also evidence of a statistically significant difference between both sets of editorials in the total usage of stance markers, where the Z value reached (−7.713). Most strikingly, the test revealed a significant difference between the two groups of editorials in the usage of each type of stance markers. The two sets of editorials differed in the use of every category of stance markers (namely hedges, boosters, attitude markers, and self-mentions). This means that the expression of stance in editorials has significantly diverged from the Jordanian versus the British setting.

We turn now to consider the different types of stance with some examples from both sets of editorials. Stance, with its roots in metadiscourse and Hyland’s interpersonal model, is generally broken down into four elements. Hyland ( 2005 ) categorised stance elements as being hedges, boosters, attitude markers, and self-mentions. Hyland’s ( 2005 ) typology of stance features is very widely used in the studies of interaction and stance in written discourse.

Hedges have basically been used to refer to the linguistic items used by writers to distance themselves from their content. Hedging can be loosely described as ‘the softening’ of the writer’s statements or comments (Housen et al., 2012 ). Kaltenböck et al. ( 2012 , p. 1) defined hedging as ‘a discourse strategy that reduces the force or truth of an utterance and thus reduces the risk a speaker runs when uttering a strong or firm assertion or other speech act’. Van Dijk ( 1995 , p. 16) has also emphasised that ‘opinions may not only be expressed implicitly but also be implied indirectly’. Examples of hedges from the editorials of both languages are presented below. Hedges are used in the below-mentioned examples to moderate and tone down the rhetoric in these utterances.

1 In defense of a nation that is almost overwhelmed by despair.

This would also promote our national economy.

Perhaps we could cultivate such attachments (The Guardian view on second-hand clothes, The Guardian, 2021).

But Prince Philip was also, perhaps paradoxically , the trailblazer for the idea of royalty as a profession. (The Guardian view on Prince Phillip, The Guardian, 2021).

Although Arabic editorials contained a relatively small amount of hedges (7.3%), they performed a variety of vital functions in these editorials. Editors may comment on a topic of interest using an adverb of degree, which is placed before the verb it modifies (see Example (1)). Badawi et al. ( 2013 ) also mentioned that words such as kada كاد ‘almost’ or ‘nearly’ are regarded among the most commonly used words in Arabic discourse. A possible explanation of this use of the stance adverbial ‘almost’ in Example (1) as a hedge may be related to the employment of hedges as face-saving strategies (Hübler, 1983 ). In this example, the writer has the ability to say غلبها or ‘that is overwhelmed’, but the writer preferred using كاد ‘almost’ to avoid any face-threatening act (FTA). Crompton ( 1997 , p. 278), in a discussion about hedging, argued that “the writer is not displaying a lack of confidence in his own proposition but politeness towards the discourse community”.

In the second example, an expression of stance was delivered through the use of the modal verb ‘would’. Almeida and Vazquez ( 2009 , p. 1171) mentioned that ‘modal verbs grammaticalize speaker’s subjectivity’. The category of modals or modal verbs can be considered a grammatical category or a pragmatic one (Kreutz and Harres, 1997 ). The epistemic modals or modals of probability, like ‘would’ in Example (2) and could in Example (3), are used to soothe the firmness and intensity of these narratives. Since hedges were the most commonly employed stance feature in the English corpus, the editors often utilised the hedging word to express a sense of ambiguity. Thus, it is obvious that the adverbial hedging word was an interpretation devised and presented by the writer, as shown in Examples (3) to (4). Biber et al. ( 2021 , p. 861) claimed that ‘news and academic prose also use probably and perhaps, with predictions, suppositions, explanations, and interpretations that have not been clearly proven’. As for Biber et al. ( 2021 ), ‘perhaps’ is one of the most common stance adverbials across all registers for marking doubt about what you are saying. Hyland ( 2019 , p.143), in a discussion about Milne’s ( 2003 ) comparison between Spanish and English editorials, highlighted that ‘similarities in the use of hedges and attitude markers, for instance, reflect the combination of mitigation and opinion needed to persuade newspaper readers’.

In the literature, the term ‘boosters’ tends to be used to refer to the amount of affirmation or emphasis a writer is putting on a certain claim. Multiple terms were used to describe the notion of placing a level of ‘assertion’ on a proposition, such as certainty markers, emphatics, and modality markers. Hyland ( 1998 ) reminds us that boosters ‘allow writers to negotiate information, helping to establish its perceived truth by strategically presenting it as consensually given’. In fact, the degree of certainty voiced by boosters in editorials is not equal in all cases. Therefore, previous research has established a scale of certainty to describe the level of assertion that a writer asserts (e.g. Holmes, 1982 ; and Rubin, 2007 ). To illustrate, the continuum of certainty in these scales ranges from absolute certainty to low certainty with varying degrees in between. A point to note is that we observed the use of boosters with high levels of certainty or with what is called ‘absolute certainty’ in the editorials of both languages, as shown in Examples (5) to (8). A possible explanation for this result is that editors are trying to build authority and trust between themselves and their readership. Perhaps stance-taking from a strong foundation exerts a hidden power on the public. For example, Hyland ( 2008 ) suggested that boosters might help bring readers to the text or involve them in building some kind of solidarity. Since editorials are meant to be the newspapers’ voice, the journalistic stance of the newspaper about issues of the day is assumed to be firmly present by means of pragmatic boosters.

In Examples (5) and (6), writers of the editorials used boosters in their discussion of political issues in the Jordanian context. Namely, the writers handled the partnership between the public and private sectors in Jordan and the prime minister’s visits to the cities of the country. The same applies to their English counterparts from the Guardian newspaper, where boosters were utilised to discuss some politically oriented topics in the British context (see Examples (7) and (8)). In particular, the writers addressed topics such as Biden’s 100 days after the presidency and the view on the BBC.

The relationship between the sectors and its sustainability will necessarily improve the citizens’ standards of living.

The approach of communication and fieldwork, that aims to serve Jordanians, has been consistently the focus of the leader’s attention and care.

No one doubts the sincerity of the Biden team. (The Guardian view on Biden’s 100 days, The Guardian, 2021).

It is often said that the BBC has never faced such towering challenges. In this occasion, that is certainly true . (The Guardian view on the BBC, 2021).

Attitude markers

The use of ‘emotive markers’ or ‘frames of mind’ in speech, originating from Aristotle’s attitude to Austin’s illocutionary force, is one of the deeply entrenched topics in linguistics and has its deep roots within the field of sociolinguistics. In Searle’s ( 1975 ) taxonomy of illocutionary acts, he defined what is meant by an illocutionary force and argues that ‘the illocutionary force indicating device in the sentence operates on the propositional content to indicate, among other things, the direction to fit between the propositional content and reality’ (p. 359). In speech, the illocutionary force of a sentence might be used for asserting, demanding, promising, exclaiming, or questioning. The idea of attitude markers in writing is similar to that of emotive markers or illocutionary acts in speech. Attitude markers are set forth by the writers to describe their own faith and feelings about the given content. Hyland ( 2019 , p. 36) points out that ‘almost any linguistic choice conveys an attitude of some kind, expressing our likes and dislikes, our approval and disapproval’. Since editorials are packed with opinions and attitudes, it is essential to analyse the linguistic aspects used to express these sentiments. Below are some examples of attitude markers in their context of use.

The Hashemites were wise and capable of being with their people

These meetings, where citizens and officials present both their vision and their hopes for their officials, are responsible for achieving the desired development, which is the most useful and beneficial .

It is disappointing but not surprising that the PM appears uninterested in plans to make people healthier. (The Guardian view on the way we eat, The Guardian, 2021)

The situation is extraordinarily difficult , with cases at about 40 universities so far and further outbreaks expected. (The Guardian view on universities, The Guardian, 2020).

Examples (9) to (12) illustrate the use of attitude markers in the editorials of the two languages. In every instance of these attitude markers, the writers used an adjective to describe their own stance. This is exactly what Dafouz-Milne ( 2008 ), in her discussion of attitude markers, referred to as the use of ‘attitudinal adjectives’. An example of an attitudinal adjective would be the usage of the word ‘disappointing’ in Example (11).

Self-mentions

Drawing on features of interactional metadiscourse, self-mention markers can be considered as the link between authors of the texts and their communities. Hyland ( 2001 , p. 208) demonstrated that self-mention is ‘a strategy that maximises the credibility of the writer to elicit credence from the reader’. Self-mention markers in the editorials of both languages were indicated using first-person plural pronouns rather than using self-reference words such as the author(s) or the name of the institution. In only one instance was the existence of self-mention markers in English and Arabic editorials. Numerous studies attributed the low frequency of self-mentions in certain texts to the writer’s absence of awareness about their metadiscoursal and pragmatic role. However, we find it unreasonable that the editorial authors are unaware of the self-mentions’ pragmatic role but are rather constrained by the genre style and conventions.

As far as we are concerned, there are two likely causes for this result, as it seems possible that the paucity of self-mentions in the editorial genre will be made for a good reason. Firstly, the number one reason for this might be the idea that editorials are responsible for representing the institution’s voice rather than the individuals’ viewpoints. Secondly, this result can also be attributed to the intricacies of authorial identity construction in the genre of newspaper editorials. It might be the case that editorial writers struggle with separating their own sense of identity or personal beliefs from their institutional identity (personal voice versus institutional voice). Wu and Zhu ( 2014 , p. 137) argued that ‘everyone has a ‘core identity’ connected to internal states, but all people have multiple identities connected to their performances in society’.

Wu and Zhu ( 2014 ) also mentioned three aspects of the authorial identity: the detached self, the individual self and the collective self. Though this classification has been proposed in the context of academic discourse, it seems that it also applies to the editorial genre of texts. In this sense, it can be noticed that ‘the collective self’, where the writer is showing a strong affiliation with the discourse community, is the dominating aspect of identity within newspaper editorials (Wu and Zhu, 2014 ). A prominent explanation about self-mentions’ scarcity in certain genres was proposed by Hyland ( 2002 ), who argued that the little existence of self-mentions may be due to ‘the culturally specific views of authority’. The use of self-mentions in newspaper editorials of both languages is shown in Examples (13) and (14).

As a result, we are facing a promising new phase full of vital projects.

The pandemic has opened our eyes to the predicament of the poor. (The Guardian view on food banks, The Guardian, 2020).

In Example (13), the usage of the first-person plural pronoun ‘we’ may partly be explained by the intention of involving a broader audience in the discourse. An alternative explanation is that the writers tend to capitalise on the collective identity of their target audience (mainly Arabs and Jordanians in this context). Furthermore, Arabs lean toward a shared sense of belonging to a group or a collective identity, which is formulated by the sociopolitical environment (Smooha, 1992 , as cited in Amara, 2016 ). Direct self-mention using a first-person pronoun can be regarded as a method to invite readers to collective bargaining. The use of the first-person pronoun ‘our’ in a discussion of a current issue (i.e. the pandemic in this respect) was the only instance of self-mentions in the Guardian (see Example (14)). The authors’ use of the self-mention marker ‘our’ is likely to be related to the assumption and promotion of a level of societal responsibility. In this regard, ‘our’ is more than a sign of visibility or author presence. Finally, here are a few more instances of stance features from the editorials of both languages Table 4 .

The aim of the present study was to examine the stance-taking strategies that editors employ when defending the newspapers’ standpoint. It has then investigated how the use of stance markers varied across two different newspapers using two separate languages with two totally different cultures. Editorials, however, are a remarkably distinct genre with respect to persuasion, evaluation, and appraisal. The discrepancy between editorials and the other text genres in the articulation of stance arises from the power of editorials on the political decisions in their respective geographic areas. For instance, Van Dijk ( 1995 ) observed that editorials might have an impact on the presidential elections or the “formulating” of people’s ideologies. Van Dijk, in this sense, defined the term ‘ideologies’ as ‘the basic ‘axioms’ of socially shared representation of groups about themselves and their relations to other groups, including such categories as membership criteria, activities, goals, values, and crucial group resources’ (1995, p. 30). This brings us to the conclusion that there is a consensus among researchers about the idea that public ideologies and beliefs are being framed or at least influenced by the stance of newspapers offered in editorials.

The present study contributes to our understanding of intercultural rhetoric and the use of rhetorical devices such as stance markers across two languages (i.e. Arabic and English). It also lays the groundwork for future research into stance markers in the editorials of other languages. The results of this study add to the rapidly expanding field of rhetoric in editorial journalism. In this regard, the findings of this study can be utilised to train editors, editors-in-chief, and members of the editorial board about stance and positioning in their early or mid-career phases. Introductory webinars for editors can take advantage of the findings of this research to help editors pursue a professional usage of stance devices in editorials. This paper is of interest to the society of editorial freelancers to assist them in understanding the tactics through which editors-in-chief optimise their strategies in showing stance.

Stance-taking and writer positioning in media discourse, plus the idea of finding the appropriate policy to present your perspective and the counterargument, would indeed be a daunting task. Kärkkäinen ( 2006 , p. 699) argued that ‘stance in discourse is not the transparent linguistic packaging of ‘internal states’ of knowledge, but rather emerges from dialogic interaction between interlocutors’. Therefore, argumentative writing in editorials is quite complex and sometimes misleading and requires a great amount of observation to be fully understood by the average reader. A contrastive analysis of the rhetorical strategies, such as stance devices and how they are utilised in editorials from diverse cultures, is needed for better comprehension of them. For that being the case, this study compared the use of stance devices in English and Arabic editorials from two national broadsheets in Jordan and the UK. This study has found that generally, Arabic editorials in Addustour newspaper employed stance markers in a different way than English editorials in the Guardian newspaper.

Some statistically significant differences were detected between the two languages in the total usage of stance markers. Significant differences were also identified between the two languages in the use of each category of stance features (i.e. hedges, boosters, attitude markers, and self-mentions). Although all stance types were present in the English and Arabic editorials, self-mentions were the least-employed stance features with the same value in both languages (0.1%). Perhaps this resemblance in the little use of self-mentions is due to the genre conventions and style of the editorials. To illustrate, it seems that the authorial presence via self-mentioning is a privilege in editorials’ argumentative writing rather than a necessity. By and large, the editorial section of the newspaper is designed to display the newspaper’s voice and not the author’s voice.

A thorough understanding of stance features in editorials, which are concerned with the most pressing current political issues, would foster the public audience’s comprehension of these columns. Liu and Hood ( 2019 , p. 589) pitched the idea that ‘the non-neutral construal of people and events in the media is an issue of considerable significance’. Editorials are now considered as the organisation’s or media institution’s portrayal of the issues of the day, and wherefore this genre has come to be referred to as ‘leading articles’ or ‘leaders’. Vigilance in observing stance features within the scope of metadiscourse in editorials is not only fruitful for an avid reader of politics but also for foreign language learners. Hashemi and Golparvar ( 2011 , p. 122) claimed that ‘metadiscourse can play a more influencing role on reading comprehension if the consciousness of the EFL learners’ is raised by their teachers, especially at the intermediate level’. In consequence, students who are learning English or Arabic as a foreign language can take advantage of the findings of this study in their comprehension of such kinds of opinion articles.

Additionally, a persona in editorials is generally affected by the dominating culture in that language. To elaborate, the term ‘persona’ here refers to ‘the mask served to express the speaker’s own opinion, only by a tactful indirection’ (Mayer, 2003 , p. 60). Broadly speaking, editorials are designed by the editor-in-chief and writers from the editorial board about socially or politically sensitive topics with careful attention paid to the culture and community convenience. This idea is positively related to what Strauss ( 2004 ) has reported about ‘cultural standing’ in the expression of opinion. She demonstrated that opinion display, argumentation, hedges, and modality are heavily impacted by the ‘cultural standing’. According to a definition by Strauss ( 2004 , p. 161), cultural standing is ‘the location of a view on a continuum that ranges from highly controversial to completely taken for granted in the relevant opinion community’. Taken together, this suggests that the examination of how stance features are used in two different languages will have significant implications for the understanding of language within a cultural and institutional frame of community.

Conclusion and implications

The findings of this study have implications for the teaching of argumentative writing in both languages (i.e. English and Arabic). These findings reveal something about the nature of discourse markers used in opinion articles. This research may provide insights to editorial training and editorial training fellowships because it might enhance the skills of argumentative writing. In these training and fellowship programmes, trainees can emulate some of the examples of stance given in this study. This simulation would further help them fine-tune their strategies for displaying stance.

Further research might explore the use of stance features in editorials in other languages to gain a greater understanding of stance in the editorial genre. That is to say, the use of stance markers as a compelling force in editorials is known to be affected by a range of factors. To start with, the differences in the use of stance markers between the two sets of editorials can be linked to the language and register that these editorials belong to. Matthiessen ( 2019 , p. 207) initially stated that ‘registers are functional varieties of language that have evolved as adaptations to different institutional settings’. Then, he argued in his discussion of language as an aggregate of registers that ‘a key aspect of the adaptive nature of language is that it adapts to its contexts of use’ (Matthiessen, 2019 , p. 212). Subsequently, it is possible to assume that register and language are the reasons behind some of the significant differences in stance markers between the two groups of editorials.

Secondly, the sociocultural dimensions can play a significant role in the choice of stance markers in editorials. Du Bois ( 2007 , p. 139) claimed that ‘stance can be approached as a linguistically articulated form of social action whose meaning is to be construed within the broader scope of language, interaction, and sociocultural value’. Thirdly, routines can be regarded among the factors affecting the use of stance markers in editorials. Reese ( 2016 , ‘levels of analysis’) said that ‘if journalism is primarily a social practice, routines are the ways of working that constitute that practice’. Along these lines, routines and institutional policies of the newspaper can determine the approach and means of displaying stance. To conclude, factors affecting the use of stance markers in English and Arabic editorials can be discussed under four headings: language, register, routines and institutional policies, and sociocultural systems and values.

As a matter of fact, there is no alternative to adopting a position and taking a stance in editorial journalism. Even when the editorial holds no position on the issue of discussion, this is believed to be a stance on its own, as Jaffe ( 2009 , p. 3) suggested that ‘neutrality is itself a stance’. Hyland ( 2019 , p. 63) also reported that ‘writers cannot avoid projecting an impression of themselves and how they stand in relation to their arguments, their community and their readers’. The grasp of this idea makes it extremely significant to pinpoint these positionings in editorials and to understand them (i.e. stance markers). As far as objectivity is meritorious in news coverage, it is thought of as blameworthy in editorials. Firmstone ( 2019 , p. 6) observed that ‘in direct contrast to most other forms of journalism, subjectivity and opinion is not only permitted in editorials- it is expected’. And there is no better way to express opinion in editorials than using stance markers. The evidence from this study suggests that the analysis and use of stance features should be carefully observed by both lay readers and editorial specialists.

Data availability

Data sharing is not applicable to this research as no data were generated or analysed.

Abusalim N, Zidouni S, Alghazo SM, Rabab’ah G, Rayyan M (2022) Textual and interpersonal metadiscourse markers in political discourse: a case study. Cogent Arts Humanities 9(1):2124683. https://doi.org/10.1080/23311983.2022.2124683

Article   Google Scholar  

Al-Anbar K, Alghazo SM, Jarrah M, Altakhaineh A (2023) First language and second language English editorialists’ use of interactional metadiscourse. Discourse Interact 16(2):5–28. https://doi.org/10.5817/DI2023-2-5

Alghazo SM, Al-Anbar K, Altakhaineh A, Jarrah M (2023a) Interactive metadiscourse in L1 and L2 English: evidence from editorials. Top Linguist 24(1):55–66. https://doi.org/10.2478/topling-2023-0004

Alghazo SM, Al-Anbar K, Jarrah M, Rabab’ah G, Al-Deaibes M (2023b) Engagement strategies in English and Arabic newspaper editorials. Human Soc Sci Commun 22:1–10. https://doi.org/10.1057/s41599-023-01519-y

Alghazo S, Al Salem MN, Alrashdan I (2021a) Stance and engagement in English and Arabic research article abstracts. System 103:102681. https://doi.org/10.1016/j.system.2021.102681

Alghazo SM, Al Salem MN, Alrashdan I, Rabab’ah G (2021b) Grammatical devices of stance in written academic English. Heliyon 7(11):e08463. https://doi.org/10.1016/j.heliyon.2021.e08463

Article   PubMed   PubMed Central   Google Scholar  

Al-Subhi AS (2023) Interactional meta-discourse and phraseology in newspaper editorials during the Russia-Ukraine War. Online J Commun Media Technol 13(3):e202331. https://doi.org/10.30935/ojcmt/13259

Almeida FA, Vazquez N (2009) Modality and stance in the modern English part of the” Corpus of early English recipes”. In A survey of corpus-based research Murcia: Asociación Española de Lingüística del Corpus[Recurso electrónico] pp 1171–1179

Amara M (2016) Language, identity and conflict: examining collective identity through the labels of the Palestinians in Israel. J Holy Land Palest Stud 15(2):203–223

Aull LL, Lancaster Z (2014) Linguistic markers of stance in early and advanced academic writing: a corpus-based comparison. Writ Commun 31(2):151–183. https://doi.org/10.1177/0741088314527055

Badawi ES, Carter M, Gully A (2013) Modern written Arabic: A comprehensive grammar. Routledge

Biber D, Finegan E (1988) Adverbial stance types in English. Discourse Process 11(1):1–34. https://doi.org/10.1080/01638538809544689

Biber D, Finegan E (1989) Styles of stance in English: Lexical and grammatical marking of evidentiality and affect. Text Interdiscip J Study Discourse 9(1):93–124. https://doi.org/10.1515/text.1.1989.9.1.93

Biber D, Johansson S, Leech GN, Conrad S, Finegan E (2021) Grammar of spoken and written English. John Benjamins

Chen L, Li C (2023) Interactional metadiscourse in news commentaries: a corpus-based study of China daily and The New York Times. J Pragmat 212:29–40. https://doi.org/10.1016/j.pragma.2023.04.018

Crompton P (1997) Hedging in academic writing: some theoretical problems. Engl Specif Purp 16(4):271–287. https://doi.org/10.1016/S0889-4906(97)00007-0

Dafouz-Milne E (2008) The pragmatic role of textual and interpersonal metadiscourse markers in the construction and attainment of persuasion: a cross-linguistic study of newspaper discourse. J Pragmat 40(1):95–113. https://doi.org/10.1016/j.pragma.2007.10.003

Dobbs CL (2014) Signaling organization and stance: academic language use in middle grade persuasive writing. Read Writ 27:1327–1352. https://doi.org/10.1007/s11145-013-9489-5

Droz-dit-Busset O (2022) So-called influencers”: Stancetaking and (de) legitimation in mediatized discourse about social media influencers. Discourse Context Media 49:100629. https://doi.org/10.1016/j.dcm.2022.100629

Du Bois JW (2007) The stance triangle. Stancetaking Discourse Subjectivity Eval Interact 164(3):139–182

Firmstone J (2019) Editorial journalism and newspapers’ editorial opinions. In Oxford research encyclopedia of communication, Oxford University Press

Fitzmaurice S (2004) Subjectivity, intersubjectivity and the historical construction of interlocutor stance: from stance markers to discourse markers. Discourse Stud. 6(4):427–448. https://doi.org/10.1177/1461445604046585

Fu X (2012) The use of interactional metadiscourse in job postings. Discourse Stud 14(4):399–417. https://doi.org/10.1177/1461445612450373

Gray B, Biber D (2012) Current conceptions of stance. Stance and voice in written academic genres, pp15–33. https://doi.org/10.1057/9781137030825_2

Hashemi MR, Golparvar (2011) Exploring metadiscourse markers in Persian news reports. Int J Soc Sci Tomorrow 1(2):1–6

Google Scholar  

Holmes J (1982) Expressing doubt and certainty in English. RELC J 13(2):9–28. https://doi.org/10.1177/003368828201300202

Housen A, Vedder I, Kuiken F (2012) Dimensions of L2 performance and proficiency, John Benjamins Publishing

Hübler A (1983) Understatements and hedges in English. John Benjamins Publishing

Hunston S, Thompson G (eds) (2000) Evaluation in text: Authorial stance and the construction of discourse: Authorial stance and the construction of discourse. Oxford University Press, UK

Hyland K (1998) Boosting, hedging and the negotiation of academic knowledge. Text Talk 18(3):349–382. https://doi.org/10.1515/text.1.1998.18.3.349

Hyland K (2001) Humble servants of the discipline? Self-mention in research articles. Engl Specif Purp 20(3):207–226. https://doi.org/10.1016/S0889-4906(00)00012-0

Hyland K (2002) Authority and invisibility: authorial identity in academic writing. J Pragmat 34(8):1091–1112. https://doi.org/10.1016/S0378-2166(02)00035-8

Hyland K (2005) Stance and engagement: a model of interaction in academic discourse. Discourse Stud 7(2):173–192. https://doi.org/10.1177/1461445605050365

Hyland K (2008) Persuasion, interaction and the construction of knowledge: representing self and others in research writing. Int J Engl Stud 8(2):1–23

Hyland K (2019) Metadiscourse: Exploring interaction in writing. Bloomsbury Publishing

Hyland K, Zou HJ (2021) “I believe the findings are fascinating”: stance in three-minute theses. J Engl Acad Purp 50:100973. https://doi.org/10.1016/j.jeap.2021.100973

Jaffe A (ed) (2009) Stance: sociolinguistic perspectives. Oxford University Press; USA

Johnstone B (2009) Stance, style, and the linguistic individual. In A. Jaffe (ed) Stance: Sociolinguistic Perspectives. Oxford: Oxford University Press. pp 29–52

Kaltenböck G, Mihatsch W, Schneider S (2010) New approaches to hedging. Bingley, UK: Emerald Group Publishing

Kärkkäinen E (2006) Stance taking in conversation: from subjectivity to intersubjectivity Text & Talk 26(6):699–731. https://doi.org/10.1515/TEXT.2006.029.2006

Kiesling SF (2009) Style as stance. Stance Sociolinguistic Perspective 171

Kreutz H, Harres A (1997) Some observations on the distribution and function of hedging in German and English academic writing. Cult Styles Acad Discourse 104:181–201

Liu F, Hood S (2019) Rhetorical strategies of political persuasion: the play of irrealis and realis meaning in re/aligning readers in newspaper editorials. Text Talk 39(5):589–611. https://doi.org/10.1515/text-2019-2041

Matthiessen CM (2019) Register in systemic functional linguistics. Register Stud 1(1):10–41. https://doi.org/10.1075/rs.18010.mat

Mayer RG (2003) Persona< l> problems. The literary persona in antiquity revisited. Materiali e discussioni per l’analisi dei testi classici, 50:55–80

McCambridge L (2022) Describing the voice of online bullying: an analysis of stance and voice type in YouTube comments. Discourse Context Media 45:100552. https://doi.org/10.1016/j.dcm.2021.100552

Milne ED (2003) Metadiscourse revisited: a contrastive study of persuasive writing in professional discourse. Regreso al metadiscurso: estudio contrastivo de la persuasión en el discurso profesional. Estudios Ingl de la Univ Complut 11:29–52

Peng JE (2019) Authorial voice constructed in citation in literature reviews of doctoral theses: variations across training contexts. J Engl Acad Purp 37:11–21. https://doi.org/10.1016/j.jeap.2018.11.001

Pho P (2013) Authorial stance in research articles: Examples from applied linguistics and educational technology. Springer

Rabab’ah G, M’atouq A, Alghazo SM (2022) Discourse markers in narrative essays: a case study of Jordanian high school EFL learners. Jordan J Mod Lang Lit 14(1):203–217. https://doi.org/10.47012/jjmll.14.1.11

Rabab’ah G, Yagi S, Alghazo SM (2024) Using metadiscourse to create effective and engaging EFL virtual classrooms during the Covid-19 pandemic. Iran J Lang Teach Res 12(1):107–129. https://doi.org/10.30466/ijltr.2024.121421

Reese SD (2016) Theories of journalism. In Oxford research encyclopedia of communication. https://doi.org/10.1093/acrefore/9780190228613.013.83

Richardson JD, Lancendorfer KM (2004) Framing affirmative action: the influence of race on newspaper editorial responses to the University of Michigan cases. Harv Int J Press/Politics 9(4):74–94. https://doi.org/10.1177/1081180X04271863

Rubin VL (2007) Stating with certainty or stating with doubt: Intercoder reliability results for manual annotation of epistemically modalized statements. In Proceedings of the Human Language Technologies Conference

Searle JR (1975) A taxonomy of illocutionary acts. In Language, Mind and Knowledge. University of Minnesota, Minneapolis, Minn, pp 344–369

Shen Q, Tao Y (2021) Stance markers in English medical research articles and newspaper opinion columns: a comparative corpus-based study. Plos one 16(3):e0247981. https://doi.org/10.1371/journal.pone.0247981

Smooha S (1992) Arabs and Jews in Israel: Change and continuity in mutual intolerance. Boulder, CO: Boulder University Press

Strauss C (2004) Cultural standing in expression of opinion. Lang Soc 33(2):161–194. https://doi.org/10.1017/S004740450433201X

Van Dijk TA (1995) Opinions and ideologies in editorials. Paper for the 4th International Symposium of Critical Discourse Analysis, Language, Social Life and Critical Thought. Athens, Greece, December 14–16

Wu B, Paltridge B (2021) Stance expressions in academic writing: a corpus-based comparison of Chinese students’ MA dissertations and PhD theses. Lingua 253:103071. https://doi.org/10.1016/j.lingua.2021.103071

Wu G, Zhu Y (2014) Self-mention and authorial identity construction in English and Chinese research articles: a contrastive study. Linguistics Human Sci 10(2). https://doi.org/10.1558/lhs.v10.2.28557

Yazdani S, Sharifi S, Elyassi M (2014) Interactional metadiscourse in English and Persian news articles about 9/11. Theory Pract Lang Stud 4(2):428. https://doi.org/10.4304/tpls.4.2.428-434

Download references

Author information

Authors and affiliations.

University of Sharjah, Sharjah, UAE

Sharif Alghazo & Ghaleb Rabab’ah

The University of Jordan, Amman, Jordan

Sharif Alghazo, Khulood Al-Anbar, Ghaleb Rabab’ah, Nimer Abusalim & Mohammad Rayyan

You can also search for this author in PubMed   Google Scholar

Contributions

Sharif Alghazo analysed the data and wrote the first draft. Khuloud Al-Anbar collected the data and wrote parts of the literature review. Ghaleb Rabab’ah wrote the discussion. Nimer Abusalim wrote the conclusion and references. Mohammad Rayyan wrote parts of literature review and conclusion and conducted the final editing and proofreading.

Corresponding author

Correspondence to Mohammad Rayyan .

Ethics declarations

Competing interests.

The authors declare no competing interests.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

No informed consent was needed for this article.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Cite this article.

Alghazo, S., Al-Anbar, K., Rabab’ah, G. et al. The construction of stance in English and Arabic newspaper editorials: a case study. Humanit Soc Sci Commun 11 , 971 (2024). https://doi.org/10.1057/s41599-024-03418-2

Download citation

Received : 15 April 2024

Accepted : 27 June 2024

Published : 28 July 2024

DOI : https://doi.org/10.1057/s41599-024-03418-2

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

Information

• Author Services

Initiatives

You are accessing a machine-readable page. In order to be human-readable, please install an RSS reader.

All articles published by MDPI are made immediately available worldwide under an open access license. No special permission is required to reuse all or part of the article published by MDPI, including figures and tables. For articles published under an open access Creative Common CC BY license, any part of the article may be reused without permission provided that the original article is clearly cited. For more information, please refer to https://www.mdpi.com/openaccess .

Feature papers represent the most advanced research with significant potential for high impact in the field. A Feature Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for future research directions and describes possible research applications.

Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive positive feedback from the reviewers.

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

Original Submission Date Received: .

• Active Journals
• Find a Journal
• Proceedings Series
• For Authors
• For Reviewers
• For Editors
• For Librarians
• For Publishers
• For Societies
• For Conference Organizers
• Open Access Policy
• Institutional Open Access Program
• Special Issues Guidelines
• Editorial Process
• Research and Publication Ethics
• Article Processing Charges
• Testimonials
• Preprints.org
• SciProfiles
• Encyclopedia

Article Menu

• Subscribe SciFeed
• Recommended Articles
• Google Scholar
• on Google Scholar
• Table of Contents

Find support for a specific problem in the support section of our website.

Please let us know what you think of our products and services.

Visit our dedicated information section to learn more about MDPI.

JSmol Viewer

Long covid is not a functional neurologic disorder.

1. Introduction

2. pathobiological disease characterization: from neurasthenia to myalgic encephalomyelitis/chronic fatigue syndrome, 3. psychosomatic/sociogenic illness construction: from neurasthenia to functional neurologic disorder.

• One or more symptoms of altered voluntary motor behavior or sensory function
• Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions
• The symptom or deficit is not better explained by another medical or mental disorder
• The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, or warrants medical evaluation

4. Evidence Refutes That Long COVID Should Be Considered a Functional Neurologic Disorder

• Autonomic conditions , such as neurocardiogenic syncope, postural orthostatic tachycardia syndrome, orthostatic intolerance, and autonomic and small fiber neuropathy
• Chronic pain conditions , such as fibromyalgia, myofascial pain syndrome, and complex regional pain syndrome
• Systemic immune conditions , such as mast cell activation syndrome and mastocytosis
• Autoimmune conditions , such as Sjögren’s syndrome, systemic lupus erythematosus, and anti-phospholipid syndrome
• Genetic conditions , such as hypermobile Ehlers-Danlos syndrome and other hypermobility spectrum disorders, Fabry’s disease and others
• Mitochondrial and metabolic conditions
• Infection-associated chronic conditions , such as myalgic encephalomyelitis, Long COVID/Post-COVID condition, and post-treatment Lyme disease

4.1. Refutative Evidence from Pathophysiology

4.2. refutative evidence from clinical presentation, 4.2.1. motor examination.

4.2.2. Sensory Examination

4.2.3. tremor, 4.2.4. spells and seizures, 4.2.5. gait examination, 4.2.6. urinary functioning, 4.2.7. cognition, 4.2.8. summary, 4.3. refutative evidence from neuroimaging, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

• Beard, G. Neurasthenia, or nervous exhaustion. Boston Med. Surg. J. 1869 , 3 , 217–221. [ Google Scholar ] [ CrossRef ]
• Goetz, C.G. Poor Beard!! Charcot’s internationalization of neurasthenia, the “American disease”. Neurology 2001 , 57 , 510–514. [ Google Scholar ] [ CrossRef ]
• Hickie, I.; Davenport, T.; Wakefield, D.; Vollmer-Conna, U.; Cameron, B.; Vernon, S.D.; Reeves, W.C.; Lloyd, A.; Dubbo Infection Outcomes Study Group. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: Prospective cohort study. BMJ 2006 , 333 , 575. [ Google Scholar ] [ CrossRef ]
• Holmes, G.P.; Kaplan, J.E.; Gantz, N.M.; Komaroff, A.L.; Schonberger, L.B.; Straus, S.E.; Jones, J.F.; Dubois, R.E.; Cunningham-Rundles, C.; Pahwa, S.; et al. Chronic fatigue syndrome: A working case definition. Ann. Intern. Med. 1988 , 108 , 387–389. [ Google Scholar ] [ CrossRef ]
• Ikuta, K.; Yamada, T.; Shimomura, T.; Kuratsune, H.; Kawahara, R.; Ikawa, S.; Ohnishi, E.; Sokawa, Y.; Fukushi, H.; Hirai, K.; et al. Diagnostic evaluation of 2′, 5′-oligoadenylate synthetase activities and antibodies against Epstein-Barr virus and Coxiella burnetii in patients with chronic fatigue syndrome in Japan. Microbes Infect. 2003 , 5 , 1096–1102. [ Google Scholar ] [ CrossRef ]
• Klimas, N.G.; Salvato, F.R.; Morgan, R.; Fletcher, M.A. Immunologic abnormalities in chronic fatigue syndrome. J. Clin. Microbiol. 1990 , 28 , 1403–1410. [ Google Scholar ] [ CrossRef ]
• Kogelnik, A.M.; Loomis, K.; Hoegh-Petersen, M.; Rosso, F.; Hischier, C.; Montoya, J.G. Use of valganciclovir in patients with elevated antibody titers against Human Herpesvirus-6 (HHV-6) and Epstein-Barr Virus (EBV) who were experiencing central nervous system dysfunction including long-standing fatigue. J. Clin. Virol. 2006 , 37 (Suppl. S1), S33–S38. [ Google Scholar ] [ CrossRef ]
• Lerner, A.M.; Beqaj, S.H.; Deeter, R.G.; Fitzgerald, J.T. IgM serum antibodies to Epstein-Barr virus are uniquely present in a subset of patients with the chronic fatigue syndrome. In Vivo 2004 , 18 , 101–106. [ Google Scholar ]
• Shikova, E.; Reshkova, V.; Kumanova, A.; Raleva, S.; Alexandrova, D.; Capo, N.; Murovska, M.; On Behalf of the European Network on Me/Cfs Euromene. Cytomegalovirus, Epstein-Barr virus, and human herpesvirus-6 infections in patients with myalgic encephalomyelitis/chronic fatigue syndrome. J. Med. Virol. 2020 , 92 , 3682–3688. [ Google Scholar ] [ CrossRef ]
• Kasimir, F.; Toomey, D.; Liu, Z.; Kaiping, A.C.; Ariza, M.E.; Prusty, B.K. Tissue specific signature of HHV-6 infection in ME/CFS. Front. Mol. Biosci. 2022 , 9 , 1044964. [ Google Scholar ] [ CrossRef ]
• Sejvar, J.J.; Curns, A.T.; Welburg, L.; Jones, J.F.; Lundgren, L.M.; Capuron, L.; Pape, J.; Reeves, W.C.; Campbel, G.L. Neurocognitive and functional outcomes in persons recovering from West Nile virus illness. J. Neuropsychol. 2008 , 2 , 477–499. [ Google Scholar ] [ CrossRef ]
• Prevail III Study Group; Sneller, M.C.; Reilly, C.; Badio, M.; Bishop, R.J.; Eghrari, A.O.; Moses, S.J.; Johnson, K.L.; Gayedyu-Dennis, D.; Hensley, L.E.; et al. A longitudinal study of Ebola sequelae in Liberia. N. Engl. J. Med. 2019 , 380 , 924–934. [ Google Scholar ] [ CrossRef ]
• Kelly, J.D.; Van Ryn, C.; Badio, M.; Fayiah, T.; Johnson, K.; Gayedyu-Dennis, D.; Weiser, S.D.; Porco, T.C.; Martin, J.N.; Sneller, M.C.; et al. Clinical sequelae among individuals with pauci-symptomatic or asymptomatic Ebola virus infection and unrecognised Ebola virus disease in Liberia: A longitudinal cohort study. Lancet Infect. Dis. 2022 , 22 , 1163–1171. [ Google Scholar ] [ CrossRef ]
• Chia, J.K. The role of enterovirus in chronic fatigue syndrome. J. Clin. Pathol. 2005 , 58 , 1126–1132. [ Google Scholar ] [ CrossRef ]
• Chia, J.K.; Chia, A.Y. Chronic fatigue syndrome is associated with chronic enterovirus infection of the stomach. J. Clin. Pathol. 2008 , 61 , 43–48. [ Google Scholar ] [ CrossRef ]
• Ledina, D.; Bradaric, N.; Milas, I.; Ivic, I.; Brncic, N.; Kuzmicic, N. Chronic fatigue syndrome after Q fever. Med. Sci. Monit. 2007 , 13 , CS88–CS92. [ Google Scholar ]
• Treib, J.; Grauer, M.T.; Haass, A.; Langenbach, J.; Holzer, G.; Woessner, R. Chronic fatigue syndrome in patients with Lyme borreliosis. Eur. Neurol. 2000 , 43 , 107–109. [ Google Scholar ] [ CrossRef ]
• Fares-Medina, S.; Diaz-Caro, I.; Garcia-Montes, R.; Corral-Liria, I.; Garcia-Gomez-Heras, S. Multiple Chemical Sensitivity Syndrome: First symptoms and evolution of the clinical picture: Case-control study/epidemiological case-control study. Int. J. Environ. Res. Public Health 2022 , 19 , 15891. [ Google Scholar ] [ CrossRef ]
• Katerndahl, D.A.; Bell, I.R.; Palmer, R.F.; Miller, C.S. Chemical intolerance in primary care settings: Prevalence, comorbidity, and outcomes. Ann. Fam. Med. 2012 , 10 , 357–365. [ Google Scholar ] [ CrossRef ]
• National Academies of Sciences, Engineering, and Medicine. A Long COVID Definition: A Chronic, Systemic Disease State with Profound Consequences ; The National Academies Press: Washington, DC, USA, 2024. [ Google Scholar ]
• Chen, C.; Haupert, S.R.; Zimmermann, L.; Shi, X.; Fritsche, L.G.; Mukherjee, B. Global Prevalence of Post COVID-19 Condition or long COVID: A meta-analysis and systematic review. J. Infect. Dis. 2022 , 226 , 1593–1607. [ Google Scholar ] [ CrossRef ]
• Xie, Y.; Xu, E.; Bowe, B.; Al-Aly, Z. Long-term cardiovascular outcomes of COVID-19. Nat. Med. 2022 , 28 , 583–590. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Bowe, B.; Xie, Y.; Al-Aly, Z. Postacute sequelae of COVID-19 at 2 years. Nat. Med. 2023 , 29 , 2347–2357. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Cai, M.; Xie, Y.; Topol, E.J.; Al-Aly, Z. Three-year outcomes of post-acute sequelae of COVID-19. Nat. Med. 2024 , 30 , 1564–1573. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Davis, H.E.; Assaf, G.S.; McCorkell, L.; Wei, H.; Low, R.J.; Re’em, Y.; Redfield, S.; Austin, J.P.; Akrami, A. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. eClinicalMedicine 2021 , 38 , 101019. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Bai, N.A.; Richardson, C.S. Posttreatment Lyme disease syndrome and myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and comparison of pathogenesis. Chronic Dis. Transl. Med. 2023 , 9 , 183–190. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ruiz-Pablos, M.; Paiva, B.; Montero-Mateo, R.; Garcia, N.; Zabaleta, A. Epstein-Barr Virus and the origin of myalgic encephalomyelitis or chronic fatigue syndrome. Front. Immunol. 2021 , 12 , 656797. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Jason, L.A.; Katz, B.Z.; Shiraishi, Y.; Mears, C.J.; Im, Y.; Taylor, R. Predictors of post-infectious chronic fatigue syndrome in adolescents. Health Psychol. Behav. Med. 2014 , 2 , 41–51. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Jason, L.A.; Dorri, J.A. ME/CFS and post-exertional malaise among patients with long COVID. Neurol. Int. 2022 , 15 , 1–11. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Twomey, R.; DeMars, J.; Franklin, K.; Culos-Reed, S.N.; Weatherald, J.; Wrightson, J.G. Chronic fatigue and postexertional malaise in people living with long COVID: An observational study. Phys. Ther. 2022 , 102 , pzac005. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Vernon, S.D.; Hartle, M.; Sullivan, K.; Bell, J.; Abbaszadeh, S.; Unutmaz, D.; Bateman, L. Post-exertional malaise among people with long COVID compared to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Work 2023 , 74 , 1179–1186. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Jason, L.A.; Islam, M.; Conroy, K.; Cotler, J.; Torres, C.; Johnson, M.; Mabie, B. COVID-19 symptoms over time: Comparing long-haulers to ME/CFS. Fatigue 2021 , 9 , 59–68. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Tokumasu, K.; Honda, H.; Sunada, N.; Sakurada, Y.; Matsuda, Y.; Yamamoto, K.; Nakano, Y.; Hasegawa, T.; Yamamoto, Y.; Otsuka, Y.; et al. Clinical characteristics of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) diagnosed in patients with long COVID. Medicina 2022 , 58 , 850. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Little, J.; Higgins, M.; Palepu, R. Long COVID—Can we deny a diagnosis without denying a person’s reality? Australas. Psychiatry 2024 , 32 , 44–46. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Leitch, A.G. Neurasthenia, myalgic encephalitis or cryptogenic chronic fatigue syndrome? QJM 1995 , 88 , 447–450. [ Google Scholar ]
• Gilliam, A.G. Epidemiological Study on an Epidemic, Diagnosed as Poliomyelitis, Occurring among the Personnel of Los Angeles County General Hospital during the Summer of 1934 ; United States Government Printing Office: Washington, DC, USA, 1934. [ Google Scholar ]
• Sigurdsson, B.; Sigurjonsson, J.; Sigurdsson, J.H.; Thorkelsson, J.; Gudmundsson, K.R. A disease epidemic in Iceland simulating poliomyelitis. Am. J. Hyg. 1950 , 52 , 222–238. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ramsay, A.M. Myalgic encephalomyelitis: A baffling syndrome with a tragic aftermath. ME Assoc. J. 1981 , 153 , 40–41. [ Google Scholar ]
• Ramsay, A.M. Myalgic Encephalomyelitis and Postviral Fatigue States: The Saga of Royal Free Disease ; Gower Medical Publishing: London, UK, 1986. [ Google Scholar ]
• Epidemic myalgic encephalomyelitis. Br. Med. J. 1978 , 1 , 1436–1437. [ CrossRef ]
• Evengard, B.; Schacterle, R.S.; Komaroff, A.L. Chronic fatigue syndrome: New insights and old ignorance. J. Intern. Med. 1999 , 246 , 455–469. [ Google Scholar ] [ CrossRef ]
• Jason, L.A.; Eisele, H.; Taylor, R.R. Assessing attitudes toward new names for chronic fatigue syndrome. Eval. Health Prof. 2001 , 24 , 424–435. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Carruthers, B.M.; Jain, A.K.; DeMeirleir, K.L.; Peterson, D.L.; Klimas, N.G.; Lerner, A.M.; Flor-Henry, P.; Joshi, P.; Powles, A.C.; Sherkey, J.A.; et al. Myalgic encephalomyelitis/chronic fatigue syndrome: Clinical working case definition, diagnostic and treatment protocols. J. Chronic Fatigue Syndr. 2003 , 1 , 7–115. [ Google Scholar ] [ CrossRef ]
• Carruthers, B.M.; van de Sande, M.I.; De Meirleir, K.L.; Klimas, N.G.; Broderick, G.; Mitchell, T.; Staines, D.; Powles, A.C.; Speight, N.; Vallings, R.; et al. Myalgic encephalomyelitis: International Consensus Criteria. J. Intern. Med. 2011 , 270 , 327–338. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Chu, L.; Valencia, I.J.; Garvert, D.W.; Montoya, J.G. Deconstructing post-exertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome: A patient-centered, cross-sectional survey. PLoS ONE 2018 , 13 , e0197811. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Chu, L.; Valencia, I.J.; Garvert, D.W.; Montoya, J.G. Onset patterns and course of myalgic encephalomyelitis/chronic fatigue syndrome. Front. Pediatr. 2019 , 7 , 12. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Fukuda, K.; Straus, S.E.; Hickie, I.; Sharpe, M.C.; Dobbins, J.G.; Komaroff, A. The chronic fatigue syndrome: A comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann. Intern. Med. 1994 , 121 , 953–959. [ Google Scholar ] [ CrossRef ]
• Jason, L.A.; Torres-Harding, S.R.; Carrico, A.W.; Taylor, R.R. Symptom occurrence in persons with chronic fatigue syndrome. Biol. Psychol. 2002 , 59 , 15–27. [ Google Scholar ] [ CrossRef ]
• Stussman, B.; Williams, A.; Snow, J.; Gavin, A.; Scott, R.; Nath, A.; Walitt, B. Characterization of post-exertional malaise in patients with myalgic encephalomyelitis/chronic fatigue syndrome. Front. Neurol. 2020 , 11 , 1025. [ Google Scholar ] [ CrossRef ]
• Van Ness, J.M.; Stevens, S.R.; Bateman, L.; Stiles, T.L.; Snell, C.R. Postexertional malaise in women with chronic fatigue syndrome. J. Womens Health 2010 , 19 , 239–244. [ Google Scholar ] [ CrossRef ]
• O’Brien, K.K.; Brown, D.A.; Bergin, C.; Erlandson, K.M.; Vera, J.H.; Avery, L.; Carusone, S.C.; Cheung, A.M.; Goulding, S.; Harding, R.; et al. Long COVID and episodic disability: Advancing the conceptualisation, measurement and knowledge of episodic disability among people living with Long COVID—Protocol for a mixed-methods study. BMJ Open 2022 , 12 , e060826. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• O’Brien, K.K.; Brown, D.A.; McDuff, K.; St Clair-Sullivan, N.; Solomon, P.; Chan Carusone, S.; McCorkell, L.; Wei, H.; Goulding, S.; O’Hara, M.; et al. Conceptualising the episodic nature of disability among adults living with Long COVID: A qualitative study. BMJ Glob. Health 2023 , 8 , e011276. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Sharpe, M.C.; Archard, L.C.; Banatvala, J.E.; Borysiewicz, L.K.; Clare, A.W.; David, A.; Edwards, R.H.; Hawton, K.E.; Lambert, H.P.; Lane, R.J.; et al. A report–chronic fatigue syndrome: Guidelines for research. J. R. Soc. Med. 1991 , 84 , 118–121. [ Google Scholar ] [ CrossRef ]
• Reeves, W.C.; Wagner, D.; Nisenbaum, R.; Jones, J.F.; Gurbaxani, B.; Solomon, L.; Papanicolaou, D.A.; Unger, E.R.; Vernon, S.D.; Heim, C. Chronic fatigue syndrome—A clinically empirical approach to its definition and study. BMC Med. 2005 , 3 , 19. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• United States National Academy of Medicine. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. The National Academies Collection: Reports Funded by National Institutes of Health ; NAM: Washington, DC, USA, 2015. [ Google Scholar ]
• National Institute for Health and Care Excellence. Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome: Diagnosis and Management—NICE Guideline, No. 206 ; National Institute for Health and Care Excellence: Guidelines; National Institute for Health and Care Excellence: London, UK, 2021. [ Google Scholar ]
• A new clinical entity? Lancet 1956 , 270 , 789–790.
• World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death Based on the Recommendations of the Eighth Revision Conference , 8th ed.; World Health Organization: Geneva, Switzerland, 1969. [ Google Scholar ]
• World Health Organization. ICD-11: International Classification of Diseases, 11th revision ; World Health Organization: Geneva, Switzerland, 2022. [ Google Scholar ]
• American Psychiatric Association. Committee on Nomenclature and Statistics. In Mental Disorders ; Diagnostic and Statistical Manual; American Psychiatric Association: Washington, DC, USA, 1952. [ Google Scholar ]
• American Psychiatric Association. Committee on Nomenclature and Statistics. In Diagnostic and Statistical Manual of Mental Disorders , 2nd ed.; American Psychiatric Association: Washington, DC, USA, 1968. [ Google Scholar ]
• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders , 3rd ed.; American Psychiatric Association: Washington, DC, USA, 1980. [ Google Scholar ]
• Owens, C.; Dein, S. Conversion disorder: The modern hysteria. Adv. Psychiatr. Treat. 2006 , 12 , 152–157. [ Google Scholar ] [ CrossRef ]
• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders , 5th ed.; American Psychiatric Association: Arlington, VA, USA, 2013. [ Google Scholar ]
• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR , 5th ed., text revision ed.; American Psychiatric Association Publishing: Washington, DC, USA, 2022. [ Google Scholar ]
• Mayo Clinic. Dissociative Disorders. Available online: https://www.mayoclinic.org/diseases-conditions/dissociative-disorders/symptoms-causes/syc-20355215 (accessed on 12 October 2023).
• Diez, I.; Williams, B.; Kubicki, M.R.; Makris, N.; Perez, D.L. Reduced limbic microstructural integrity in functional neurological disorder. Psychol. Med. 2021 , 51 , 485–493. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Hassa, T.; Spiteri, S.; Schmidt, R.; Merkel, C.; Schoenfeld, M.A. Increased amygdala activity associated with cognitive reappraisal strategy in functional neurologic disorder. Front. Psychiatry 2021 , 12 , 613156. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ospina, J.P.; Jalilianhasanpour, R.; Perez, D.L. The role of the anterior and midcingulate cortex in the neurobiology of functional neurologic disorder. Handb. Clin. Neurol. 2019 , 166 , 267–279. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Perez, D.L.; Matin, N.; Williams, B.; Tanev, K.; Makris, N.; LaFrance, W.C., Jr.; Dickerson, B.C. Cortical thickness alterations linked to somatoform and psychological dissociation in functional neurological disorders. Hum. Brain Mapp. 2018 , 39 , 428–439. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Perez, D.L.; Williams, B.; Matin, N.; LaFrance, W.C., Jr.; Costumero-Ramos, V.; Fricchione, G.L.; Sepulcre, J.; Keshavan, M.S.; Dickerson, B.C. Corticolimbic structural alterations linked to health status and trait anxiety in functional neurological disorder. J. Neurol. Neurosurg. Psychiatry 2017 , 88 , 1052–1059. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Williams, B.; Jalilianhasanpour, R.; Matin, N.; Fricchione, G.L.; Sepulcre, J.; Keshavan, M.S.; LaFrance, W.C., Jr.; Dickerson, B.C.; Perez, D.L. Individual differences in corticolimbic structural profiles linked to insecure attachment and coping styles in motor functional neurological disorders. J. Psychiatr. Res. 2018 , 102 , 230–237. [ Google Scholar ] [ CrossRef ]
• Gutkin, M.; McLean, L.; Brown, R.; Kanaan, R.A. Systematic review of psychotherapy for adults with functional neurological disorder. J. Neurol. Neurosurg. Psychiatry 2020 . Online ahead of print . [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Stone, J.; LaFrance, W.C., Jr.; Levenson, J.L.; Sharpe, M. Issues for DSM-5: Conversion disorder. Am. J. Psychiatry 2010 , 167 , 626–627. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Stone, J.; Hoeritzauer, I.; McWhirter, L.; Carson, A. Functional neurological disorder: Defying dualism. World Psychiatry 2024 , 23 , 53–54. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• McLoughlin, C.; Hoeritzauer, I.; Cabreira, V.; Aybek, S.; Adams, C.; Alty, J.; Ball, H.A.; Baker, J.; Bullock, K.; Burness, C.; et al. Functional neurological disorder is a feminist issue. J. Neurol. Neurosurg. Psychiatry 2023 , 94 , 855–862. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Stone, J.; Carson, A.; Sharpe, M. Functional symptoms and signs in neurology: Assessment and diagnosis. J. Neurol. Neurosurg. Psychiatry 2005 , 76 (Suppl. S1), i2–i12. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• National Institute for Health and Care Excellence. Suspected Neurological Conditions: Recognition and Referral|NICE Guideline [NG127]. Available online: https://www.nice.org.uk/guidance/ng127 (accessed on 12 October 2023).
• ME Association. ME Association Petition: M.E. is Not a Functional Disorder. 27 September 2017. Available online: https://meassociation.org.uk/2017/09/me-association-petition-m-e-is-not-a-functional-disorder-27-september-2017/ (accessed on 12 October 2023).
• Anonymous. The On-Call Doctor Rejected Line’s Desperate Call Just Days before Her Husband’s Death: ‘He Was Let Down by the System’. Available online: https://www-bt-dk.translate.goog/samfund/vagtlaegen-afviste-lines-desperate-opkald-faa-dage-foer-sin-mands-doed-han-blev?_x_tr_sl=da&_x_tr_tl=en&_x_tr_hl=en-US&_x_tr_pto=wapp (accessed on 12 October 2023).
• ME Action. Advocacy Update from Finland. Available online: https://www.meaction.net/2020/12/07/advocacy-update-from-finland/ (accessed on 12 October 2023).
• American Psychiatric Association. Desk Reference to the Diagnostic Criteria from DSM-5-TR ; American Psychiatric Association: Washington, DC, USA, 2022. [ Google Scholar ]
• Mishra, A.; Pandey, S. Functional neurological disorders: Clinical spectrum, diagnosis, and treatment. Neurologist 2022 , 27 , 276–289. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Hira, R.; Karalasingham, K.; Baker, J.R.; Raj, S.R. Autonomic manifestations of long-COVID syndrome. Curr. Neurol. Neurosci. Rep. 2023 , 23 , 881–892. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Turner, S.; Khan, M.A.; Putrino, D.; Woodcock, A.; Kell, D.B.; Pretorius, E. Long COVID: Pathophysiological factors and abnormalities of coagulation. Trends Endocrinol. Metab. 2023 , 34 , 321–344. [ Google Scholar ] [ CrossRef ]
• Boccatonda, A.; Campello, E.; Simion, C.; Simioni, P. Long-term hypercoagulability, endotheliopathy and inflammation following acute SARS-CoV-2 infection. Expert Rev. Hematol. 2023 , 16 , 1035–1048. [ Google Scholar ] [ CrossRef ]
• Smadja, D.M.; Mentzer, S.J.; Fontenay, M.; Laffan, M.A.; Ackermann, M.; Helms, J.; Jonigk, D.; Chocron, R.; Pier, G.B.; Gendron, N.; et al. COVID-19 is a systemic vascular hemopathy: Insight for mechanistic and clinical aspects. Angiogenesis 2021 , 24 , 755–788. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Proal, A.D.; VanElzakker, M.B.; Aleman, S.; Bach, K.; Boribong, B.P.; Buggert, M.; Cherry, S.; Chertow, D.S.; Davies, H.E.; Dupont, C.L.; et al. SARS-CoV-2 reservoir in post-acute sequelae of COVID-19 (PASC). Nat. Immunol. 2023 , 24 , 1616–1627. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Yin, K.; Peluso, M.J.; Luo, X.; Thomas, R.; Shin, M.G.; Neidleman, J.; Andrew, A.; Young, K.C.; Ma, T.; Hoh, R.; et al. Long COVID manifests with T cell dysregulation, inflammation and an uncoordinated adaptive immune response to SARS-CoV-2. Nat. Immunol. 2024 , 25 , 218–225. [ Google Scholar ] [ CrossRef ]
• Roe, K. A role for T-cell exhaustion in Long COVID-19 and severe outcomes for several categories of COVID-19 patients. J. Neurosci. Res. 2021 , 99 , 2367–2376. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Durstenfeld, M.S.; Peluso, M.J.; Kaveti, P.; Hill, C.; Li, D.; Sander, E.; Swaminathan, S.; Arechiga, V.M.; Lu, S.; Goldberg, S.A.; et al. Reduced exercise capacity, chronotropic incompetence, and early systemic inflammation in cardiopulmonary phenotype long coronavirus disease 2019. J. Infect. Dis. 2023 , 228 , 542–554. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Durstenfeld, M.S.; Sun, K.; Tahir, P.; Peluso, M.J.; Deeks, S.G.; Aras, M.A.; Grandis, D.J.; Long, C.S.; Beatty, A.; Hsue, P.Y. Use of cardiopulmonary exercise testing to evaluate long COVID-19 symptoms in adults: A systematic review and meta-analysis. JAMA Netw. Open 2022 , 5 , e2236057. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ortona, E.; Buonsenso, D.; Carfi, A.; Malorni, W.; Long COVID Kids study group. Long COVID: An estrogen-associated autoimmune disease? Cell Death Discov. 2021 , 7 , 77. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Amiral, J.; Seghatchian, J. Autoimmune complications of COVID-19 and potential consequences for long-lasting disease syndromes. Transfus. Apher. Sci. 2023 , 62 , 103625. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Vojdani, A.; Vojdani, E.; Saidara, E.; Maes, M. Persistent SARS-CoV-2 Infection, EBV, HHV-6 and other factors may contribute to inflammation and autoimmunity in long COVID. Viruses 2023 , 15 , 400. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Kahn, P.A.; Joseph, P.; Heerdt, P.M.; Singh, I. Differential cardiopulmonary haemodynamic phenotypes in PASC-related exercise intolerance. ERJ Open Res. 2024 , 10 , 00714-2023. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Singh, I.; Joseph, P.; Heerdt, P.M.; Cullinan, M.; Lutchmansingh, D.D.; Gulati, M.; Possick, J.D.; Systrom, D.M.; Waxman, A.B. Persistent exertional intolerance after COVID-19: Insights from invasive cardiopulmonary exercise testing. Chest 2022 , 161 , 54–63. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Appelman, B.; Charlton, B.T.; Goulding, R.P.; Kerkhoff, T.J.; Breedveld, E.A.; Noort, W.; Offringa, C.; Bloemers, F.W.; van Weeghel, M.; Schomakers, B.V.; et al. Muscle abnormalities worsen after post-exertional malaise in long COVID. Nat. Commun. 2024 , 15 , 17. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• McAlpine, L.; Zubair, A.S.; Joseph, P.; Spudich, S. Case-control study of individuals with small fiber neuropathy after COVID-19. Neurol. Neuroimmunol. Neuroinflamm. 2024 , 11 , e200244. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Nagata, N.; Takeuchi, T.; Masuoka, H.; Aoki, R.; Ishikane, M.; Iwamoto, N.; Sugiyama, M.; Suda, W.; Nakanishi, Y.; Terada-Hirashima, J.; et al. Human gut microbiota and its metabolites impact immune responses in COVID-19 and its complications. Gastroenterology 2023 , 164 , 272–288. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• United States Centers for Disease Control and Prevention. New ICD-10-CM Code for Post-COVID Conditions, Following the 2019 Novel Coronavirus (COVID-19). Available online: https://www.cdc.gov/nchs/data/icd/announcement-new-icd-code-for-post-covid-condition-april-2022-final.pdf (accessed on 10 July 2023).
• Novakova, L.; Anyz, J.; Forejtova, Z.; Rosikova, T.; Vechetova, G.; Sojka, P.; Ruzicka, E.; Serranova, T. Increased frequency of self-reported obsessive-compulsive symptoms in patients with functional movement disorders. Mov. Disord. Clin. Pract. 2023 , 10 , 1341–1348. [ Google Scholar ] [ CrossRef ]
• Roivainen, E.; Peura, M.; Patsi, J. Cognitive profile in functional disorders. Cogn. Neuropsychiatry 2023 , 28 , 424–436. [ Google Scholar ] [ CrossRef ]
• Hamilton, J.; Campos, R.; Creed, F. Anxiety, depression and management of medically unexplained symptoms in medical clinics. J. R. Coll. Physicians Lond. 1996 , 30 , 18–20. [ Google Scholar ] [ PubMed ]
• Afari, N.; Ahumada, S.M.; Wright, L.J.; Mostoufi, S.; Golnari, G.; Reis, V.; Cuneo, J.G. Psychological trauma and functional somatic syndromes: A systematic review and meta-analysis. Psychosom. Med. 2014 , 76 , 2–11. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Teodoro, T.; Chen, J.; Gelauff, J.; Edwards, M.J. Functional neurological disorder in people with long COVID: A systematic review. Eur. J. Neurol. 2023 , 30 , 1505–1514. [ Google Scholar ] [ CrossRef ]
• Bennett, K.; Diamond, C.; Hoeritzauer, I.; Gardiner, P.; McWhirter, L.; Carson, A.; Stone, J. A practical review of functional neurological disorder (FND) for the general physician. Clin. Med. 2021 , 21 , 28–36. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Oaklander, A.L.; Mills, A.J.; Kelley, M.; Toran, L.S.; Smith, B.; Dalakas, M.C.; Nath, A. Peripheral neuropathy evaluations of patients with prolonged long COVID. Neurol. Neuroimmunol. Neuroinflamm. 2022 , 9 , e1146. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Gemignani, F.; Bellanova, M.F.; Saccani, E.; Pavesi, G. Non-length-dependent small fiber neuropathy: Not a matter of stockings and gloves. Muscle Nerve 2022 , 65 , 10–28. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Larsen, N.W.; Stiles, L.E.; Shaik, R.; Schneider, L.; Muppidi, S.; Tsui, C.T.; Geng, L.N.; Bonilla, H.; Miglis, M.G. Characterization of autonomic symptom burden in long COVID: A global survey of 2314 adults. Front. Neurol. 2022 , 13 , 1012668. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Thijs, R.D.; Brignole, M.; Falup-Pecurariu, C.; Fanciulli, A.; Freeman, R.; Guaraldi, P.; Jordan, J.; Habek, M.; Hilz, M.; Traon, A.P.; et al. Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness: Consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN). Clin. Auton. Res. 2021 , 31 , 369–384. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Panicker, J.N.; Selai, C.; Herve, F.; Rademakers, K.; Dmochowski, R.; Tarcan, T.; von Gontard, A.; Vrijens, D. Psychological comorbidities and functional neurological disorders in women with idiopathic urinary retention: International Consultation on Incontinence Research Society (ICI-RS) 2019. Neurourol. Urodyn. 2020 , 39 (Suppl. S3), S60–S69. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Shouman, K.; Vanichkachorn, G.; Cheshire, W.P.; Suarez, M.D.; Shelly, S.; Lamotte, G.J.; Sandroni, P.; Benarroch, E.E.; Berini, S.E.; Cutsforth-Gregory, J.K.; et al. Autonomic dysfunction following COVID-19 infection: An early experience. Clin. Auton. Res. 2021 , 31 , 385–394. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• McWhirter, L.; Ritchie, C.; Stone, J.; Carson, A. Functional cognitive disorders: A systematic review. Lancet Psychiatry 2020 , 7 , 191–207. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Monje, M.; Iwasaki, A. The neurobiology of long COVID. Neuron 2022 , 110 , 3484–3496. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Soung, A.L.; Vanderheiden, A.; Nordvig, A.S.; Sissoko, C.A.; Canoll, P.; Mariani, M.B.; Jiang, X.; Bricker, T.; Rosoklija, G.B.; Arango, V.; et al. COVID-19 induces CNS cytokine expression and loss of hippocampal neurogenesis. Brain 2022 , 145 , 4193–4201. [ Google Scholar ] [ CrossRef ]
• Voruz, P.; Allali, G.; Benzakour, L.; Nuber-Champier, A.; Thomasson, M.; Jacot de Alcântara, I.; Pierce, J.; Lalive, P.H.; Lövblad, K.-O.; Braillard, O.; et al. Long COVID neuropsychological deficits after severe, moderate, or mild infection. Clin. Transl. Neurosci. 2022 , 6 , 9. [ Google Scholar ] [ CrossRef ]
• Blackmon, K.; Day, G.S.; Powers, H.R.; Bosch, W.; Prabhakaran, D.; Woolston, D.; Pedraza, O. Neurocognitive screening in patients following SARS-CoV-2 infection: Tools for triage. BMC Neurol. 2022 , 22 , 285. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Lynch, S.; Ferrando, S.J.; Dornbush, R.; Shahar, S.; Smiley, A.; Klepacz, L. Screening for brain fog: Is the montreal cognitive assessment an effective screening tool for neurocognitive complaints post-COVID-19? Gen. Hosp. Psychiatry 2022 , 78 , 80–86. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Klein, J.; Wood, J.; Jaycox, J.R.; Dhodapkar, R.M.; Lu, P.; Gehlhausen, J.R.; Tabachnikova, A.; Greene, K.; Tabacof, L.; Malik, A.A.; et al. Distinguishing features of long COVID identified through immune profiling. Nature 2023 , 623 , 139–148. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Altmann, D.M.; Whettlock, E.M.; Liu, S.; Arachchillage, D.J.; Boyton, R.J. The immunology of long COVID. Nat. Rev. Immunol. 2023 , 23 , 618–634. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ruffieux, H.; Hanson, A.L.; Lodge, S.; Lawler, N.G.; Whiley, L.; Gray, N.; Nolan, T.H.; Bergamaschi, L.; Mescia, F.; Turner, L.; et al. A patient-centric modeling framework captures recovery from SARS-CoV-2 infection. Nat. Immunol. 2023 , 24 , 349–358. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Mina, Y.; Enose-Akahata, Y.; Hammoud, D.A.; Videckis, A.J.; Narpala, S.R.; O’Connell, S.E.; Carroll, R.; Lin, B.C.; McMahan, C.C.; Nair, G.; et al. Deep phenotyping of neurologic postacute sequelae of SARS-CoV-2 infection. Neurol. Neuroimmunol. Neuroinflamm. 2023 , 10 , e200097. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Douaud, G.; Lee, S.; Alfaro-Almagro, F.; Arthofer, C.; Wang, C.; McCarthy, P.; Lange, F.; Andersson, J.L.R.; Griffanti, L.; Duff, E.; et al. SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Nature 2022 , 604 , 697–707. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Hosp, J.A.; Reisert, M.; Dressing, A.; Gotz, V.; Kellner, E.; Mast, H.; Arndt, S.; Waller, C.F.; Wagner, D.; Rieg, S.; et al. Cerebral microstructural alterations in Post-COVID-condition are related to cognitive impairment, olfactory dysfunction and fatigue. Nat. Commun. 2024 , 15 , 4256. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Wu, L.; Zhang, Z.; Liang, X.; Wang, Y.; Cao, Y.; Li, M.; Zhou, F. Glymphatic system dysfunction in recovered patients with mild COVID-19: A DTI-ALPS study. iScience 2024 , 27 , 108647. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Greene, C.; Connolly, R.; Brennan, D.; Laffan, A.; O’Keeffe, E.; Zaporojan, L.; O’Callaghan, J.; Thomson, B.; Connolly, E.; Argue, R.; et al. Blood-brain barrier disruption and sustained systemic inflammation in individuals with long COVID-associated cognitive impairment. Nat. Neurosci. 2024 , 27 , 421–432. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Chaganti, J.; Poudel, G.; Cysique, L.A.; Dore, G.J.; Kelleher, A.; Matthews, G.; Darley, D.; Byrne, A.; Jakabek, D.; Zhang, X.; et al. Blood brain barrier disruption and glutamatergic excitotoxicity in post-acute sequelae of SARS COV-2 infection cognitive impairment: Potential biomarkers and a window into pathogenesis. Front. Neurol. 2024 , 15 , 1350848. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• VanElzakker, M.B.; Bues, H.F.; Brusaferri, L.; Kim, M.; Saadi, D.; Ratai, E.M.; Dougherty, D.D.; Loggia, M.L. Neuroinflammation in post-acute sequelae of COVID-19 (PASC) as assessed by [(11)C]PBR28 PET correlates with vascular disease measures. Brain Behav. Immun. 2024 , 119 , 713–723. [ Google Scholar ] [ CrossRef ]
• Peluso, M.J.; Ryder, D.; Flavell, R.R.; Wang, Y.; Levi, J.; LaFranchi, B.H.; Deveau, T.M.; Buck, A.M.; Munter, S.E.; Asare, K.A.; et al. Tissue-based T cell activation and viral RNA persist for up to 2 years after SARS-CoV-2 infection. Sci. Transl. Med. 2024 , 16 , eadk3295. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Perez, D.L.; Nicholson, T.R.; Asadi-Pooya, A.A.; Begue, I.; Butler, M.; Carson, A.J.; David, A.S.; Deeley, Q.; Diez, I.; Edwards, M.J.; et al. Neuroimaging in functional neurological disorder: State of the field and research agenda. Neuroimage Clin. 2021 , 30 , 102623. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Mavroudis, I.; Kazis, D.; Kamal, F.Z.; Gurzu, I.L.; Ciobica, A.; Padurariu, M.; Novac, B.; Iordache, A. Understanding Functional Neurological Disorder: Recent insights and diagnostic challenges. Int. J. Mol. Sci. 2024 , 25 , 4470. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Schneider, A.; Weber, S.; Wyss, A.; Loukas, S.; Aybek, S. BOLD signal variability as potential new biomarker of functional neurological disorders. Neuroimage Clin. 2024 , 43 , 103625. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Maurer, C.W.; LaFaver, K.; Limachia, G.S.; Capitan, G.; Ameli, R.; Sinclair, S.; Epstein, S.A.; Hallett, M.; Horovitz, S.G. Gray matter differences in patients with functional movement disorders. Neurology 2018 , 91 , e1870–e1879. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Begue, I.; Adams, C.; Stone, J.; Perez, D.L. Structural alterations in functional neurological disorder and related conditions: A software and hardware problem? Neuroimage Clin. 2019 , 22 , 101798. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• van Campen, C.; Rowe, P.C.; Verheugt, F.W.A.; Visser, F.C. Cognitive function declines following orthostatic stress in adults with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Front. Neurosci. 2020 , 14 , 688. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• van Campen, C.; Rowe, P.C.; Verheugt, F.W.A.; Visser, F.C. Numeric rating scales show prolonged post-exertional symptoms after orthostatic testing of adults with myalgic encephalomyelitis/chronic fatigue syndrome. Front. Med. 2020 , 7 , 602894. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• van Campen, C.; Rowe, P.C.; Visser, F.C. Cerebral blood flow is reduced in severe myalgic encephalomyelitis/chronic fatigue syndrome patients during mild orthostatic stress testing: An exploratory study at 20 degrees of head-up tilt testing. Healthcare 2020 , 8 , 169. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• van Campen, C.; Rowe, P.C.; Visser, F.C. Cerebral blood flow remains reduced after tilt testing in myalgic encephalomyelitis/chronic fatigue syndrome patients. Clin. Neurophysiol. Pract. 2021 , 6 , 245–255. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• van Campen, C.M.C.; Rowe, P.C.; Visser, F.C. Worsening symptoms is associated with larger cerebral blood flow abnormalities during tilt-testing in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Medicina 2023 , 59 , 2153. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Blitshteyn, S.; Verduzco-Gutierrez, M. Long COVID: A major public health issue. Am. J. Phys. Med. Rehabil. 2024 . Online ahead of print . [ Google Scholar ] [ CrossRef ] [ PubMed ]

Click here to enlarge figure

Share and Cite

Davenport, T.E.; Blitshteyn, S.; Clague-Baker, N.; Davies-Payne, D.; Treisman, G.J.; Tyson, S.F. Long COVID Is Not a Functional Neurologic Disorder. J. Pers. Med. 2024 , 14 , 799. https://doi.org/10.3390/jpm14080799

Davenport TE, Blitshteyn S, Clague-Baker N, Davies-Payne D, Treisman GJ, Tyson SF. Long COVID Is Not a Functional Neurologic Disorder. Journal of Personalized Medicine . 2024; 14(8):799. https://doi.org/10.3390/jpm14080799

Davenport, Todd E., Svetlana Blitshteyn, Nicola Clague-Baker, David Davies-Payne, Glenn J. Treisman, and Sarah F. Tyson. 2024. "Long COVID Is Not a Functional Neurologic Disorder" Journal of Personalized Medicine 14, no. 8: 799. https://doi.org/10.3390/jpm14080799

Article Metrics

Further information, mdpi initiatives, follow mdpi.

Subscribe to receive issue release notifications and newsletters from MDPI journals