Post-traumatic stress disorder

Post-traumatic stress disorder of PTSD is a condition of persistent mental and emotional stress occurring as a result of injury or severe psychological shock. It most often develops after experiencing or witnessing a life-threatening event, such as combat, a natural disaster, a car accident, or violent or sexual assault. Traumatic events of a criminal nature are more likely to induce PTSD than are random “acts of God.”

DSM-IV Stressor Criterion
The person has been exposed to a traumatic event in which both of the following have been present:
 * 1) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others;
 * 2)  The person’s response involved intense fear, helplessness, or horror.

PTSD and ME/CFS
Dr. Nancy Klimas and Dr. Mary Ann Fletcher surveyed patients of chronic illness on the experience of living through Hurricane Andrew, a Category-5 hurricane that hit Florida in 1992. During the survey they found that post-traumatic stress disorder is more common in ME/CFS patients than in other patients with chronic illness, even for those who did not live through the hurricane. Upon further examination, Dr. Klimas found that the increased incidence of PTSD was attributed to the poor treatment of ME/CFS patients by the medical community, as well as the stigma surrounding the illness and the general lack of support patients receive. Patients reported in the study that the trauma that had happened in physicians' offices was related to "being disregarded, being patronized, being dismissed, and told you're crazy, or go get your hair changed, or you need a new boyfriend, divorce your husband" repeatedly by different physicians instead of being given medical care for their symptoms.

In an interview in the Miami Herald in 2009, Klimas said: "I've had patients who met posttraumatic stress disorder criteria, where their trauma was their interaction with their physician around this illness. They came to a doctor with Chronic Fatigue Syndrome; they left the doctor with PTSD."

Both PTSD and chronic illness increase the risk of suicide, which is higher in ME/CFS patients then the general population.

Notable studies

 * 2012, The Comorbidity of Self-Reported Chronic Fatigue Syndrome, Posttraumatic Stress Disorder]], and Traumatic Symptoms (FULL TEXT)"'Abstract - Background: Data from primary care and community samples suggest higher rates of posttraumatic stress disorder (PTSD) among individuals with chronic fatigue syndrome (CFS). Objective: This study investigated the co-occurrence of CFS, PTSD, and trauma symptoms and assessed the contribution of familial factors to the association of CFS with lifetime PTSD and current traumatic symptoms. Method: Data on lifetime CFS and PTSD, as measured by self report of a doctor’s diagnosis of the disorder, and standardized questionnaire data on traumatic symptoms, using the Impact of Events Scale (IES), were obtained from 8,544 female and male twins from the community-based University of Washington Twin Registry. Results: Lifetime prevalence of CFS was 2% and lifetime prevalence of PTSD was 4%. Participants who reported a history of PTSD were over 8 times more likely to report a history of CFS. Participants with scores ≥ 26 on the IES were over 4 times more likely to report CFS than those who had scores ≤ 25. These associations were attenuated but remained significant after adjusting for familial factors through within-twin pair analyses. Conclusion: These results support similar findings that a lifetime diagnosis of CFS is strongly associated with both lifetime PTSD and current traumatic symptoms, although familial factors such as shared genetic and environmental contributions played a limited role in the relationship between CFS, PTSD, and traumatic symptoms. These findings suggest that future research should investigate both the familial and the unique environmental factors that may give rise to both CFS and PTSD.'"
 * 2004, Post-traumatic stress disorder among patients with chronic pain and chronic fatigue."'Abstract - BACKGROUND: Fibromyalgia (FM), a chronic pain condition of unknown aetiology often develops following a traumatic event. FM has been associated with post-traumatic stress disorder (PTSD) and major depression disorder (MDD). METHOD: Patients seen in a referral clinic (N=571) were evaluated for FM and chronic fatigue syndrome (CFS) criteria. Patients completed questionnaires, and underwent a physical examination and a structured psychiatric evaluation. Critical components of the diagnostic criteria of FM (tender points and diffuse pain) and CFS (persistent debilitating fatigue and four of eight associated symptoms) were examined for their relationship with PTSD. RESULTS: The prevalence of lifetime PTSD was 20% and lifetime MDD was 42%. Patients who had both tender points and diffuse pain had a higher prevalence of PTSD (OR=3.4, 95% CI 2.0-5.8) compared with those who had neither of these FM criteria. Stratification by MDD and adjustment for sociodemographic factors and chronic fatigue revealed that the association of PTSD with FM criteria was confined to those with MDD. Patients with MDD who met both components of the FM criteria had a three-fold increase in the prevalence of PTSD (95% CI 1.5-7.1); conversely, FM patients without MDD showed no increase in PTSD (OR=1.3, 95% CI 0.5-3.2). The components of the CFS criteria were not significantly associated with PTSD. CONCLUSION: Optimal clinical care for patients with FM should include an assessment of trauma in general, and PTSD in particular. This study highlights the importance of considering co-morbid MDD as an effect modifier in analyses that explore PTSD in patients with FM."

Learn more

 * Livets bilder - The most extreme consequence - trauma and premature death
 * DSM-IV Diagnostic Criteria for PTSD