Trauma

Trauma can be physical (traumatic injury) resulting in wound or injury or a "psychologically upsetting experience that  produces  an emotional or mental disorder or otherwise has lasting negative effects on a person's thoughts, feelings, or behavior," for example child abuse.

A limited number of studies have investigated a possible link between child abuse, childhood trauma, or lifetime psychological trauma and chronic fatigue syndrome.

Childhood trauma / child abuse and ME/CFS
A study suggesting a role for childhood trauma in ME/CFS used the broad empirical definition of ME/CFS, which resulted in a biased sample with over representation of individuals with depression and post traumatic stress disorder (PTSD) compared to the criteria typically used in clinical practice. The unusually high proportion of subjects with serious psychiatric problems likely explains the study finding of an association between ME/CFS and adverse childhood experiences. More recently, Clark et al. (2018) found that the presence of depression may explain any possible link, and that patients with ME/CFS who did not have depression did not report a higher rate of child abuse or childhood trauma.

No other studies have suggested a higher rate of childhood trauma in those with confirmed ME/CFS as opposed to nonspecific chronic fatigue (CF). In a study of 22 Norwegian adolescents with ME/CFS, no participant reported prior sexual abuse.

Child abuse and idiopathic chronic fatigue, not CFS
Taylor and Jason (2001) investigated possible links between different types of child abuse and chronic fatigue (CF) in general, finding that a history of child sexual abuse was "significantly more likely" in people who had with idiopathic chronic fatigue (chronic fatigue which has no known cause and is not (CFS)), or chronic fatigue linked to a mental health condition, or chronic fatigue resulting from a known medical condition. Taylor and Jason concluded that CFS did not have a significant link with any form of child abuse history.

Adverse Childhood Experiences
Childhood experiences, both positive and negative ones, have been found to have a wide variety of impacts on a person's life and their future, including effects on their health and risk of violence as adults. The CDC refers to the negative experiences of children as Adverse Childhood Experiences (ACEs), a term that includes a range of different negative experiences, e.g. parents divorcing, having a parent imprisoned, emotional neglect, and physical or sexual abuse, ACEs are regarded as a way to measure cumulative childhood stress rather than only trauma or abuse. The CDC and other researchers has carried out extensive research into Adverse Childhood Experiences, finding that they are linked to risky health behaviors (e.g., smoking), the development of many chronic illnesses and long-term health conditions (e.g., diabetes, stroke, and depression), a lower life potential (e.g. academic achievements), and even early death.

ACEs are common
The original ACE study collected data on over 17,000 adults, and found that two-thirds of people had experienced one or more a adverse childhood experience, and 20% of people had experienced 3 or more ACEs. This shows that ACEs are significantly more common than ME/CFS.

ACEs and ME/CFS
The CDC developed both the original Adverse Childhood Experiences research and the Fukuda criteria for chronic fatigue syndrome (CFS), but has not analyzed the influence of Adverse Childhood Experiences on myalgic encephalomyelitis (ME) or chronic fatigue syndrome.

Heins et al. (2011) conducted a study of childhood trauma history, fatigue and overall physical health in 216 patients with chronic fatigue syndrome at a specialist referral center, and reported:

Adult trauma and stress as a trigger for ME/CFS
Physical trauma (for example, accident or injury) and overwhelming emotional stress are known triggers reported in a proportion of people who develop ME/CFS, but these are significantly less common than developing the illness after a virus or bacterial infection. A number of risk factors have also been identified, including a genetic link.

Notable studies

 * 2001, Sexual abuse, physical abuse, chronic fatigue, and chronic fatigue syndrome: a community-based study (Abstract)


 * 2003, Post-Traumatic Stress Disorder and Chronic Fatigue Syndrome-like Illness among Gulf War Veterans: A Population-based Survey of 30,000 Veterans (Full text)
 * This study assessed veterans with both chronic fatigue syndrome and idiopathic chronic fatigue (persistent chronic fatigue not meeting the diagnostic criteria for CFS). Previous studies had found veterans with PTSD had higher rates of CFS than the general population, and the study looked to see if this could be caused by the presence of PTSD or by other factors, for example environmental factors caused by the physical environment the Gulf War veterans experienced. The study reported:

"'The prevalence of PTSD increased with stress intensity, from 3.3 percent to 22.6 percent (test for trend: p < 0.01). In contrast, risk of CFS-like illness did not show a monotonic relation with stressor intensity for the entire stress spectrum. Prevalence increased significantly when nondeployed troops (0.8 percent) were compared with troops deployed outside of the Gulf region (1.7 percent) and when this latter group was compared with troops deployed to the Gulf in noncombat roles (5.4 percent). However, no significant difference in risk of CFS-like illness occurred among four groups of Gulf veterans with different stressor intensities (p > 0.15).'"


 * 2009, Cumulative Childhood Stress and Autoimmune Diseases in Adults (Full text)
 * Shanta et al. found that the likelihood of someone being hospitalized for ANY of 21 different autoimmune diseases, including myasthenia gravis, rheumatic arthritis, Addison's disease, celiac disease, Graves' disease, Hashimoto's thyroiditis, insulin-dependent diabetes mellitus, irritable bowel disease, multiple sclerosis, pernicious anemia, scleroderma, Sjögren's syndrome, and systemic lupus erythematosus, was increased if a person has experienced 2 or more ACEs compared to none. The study found that hospitalizations were specifically more likely for those who had experienced 2 or more ACEs compared to those with none - with the exception of mixed Th1/Th2 autoimmune diseases (e.g., Addison's disease, celiac disease and multiple sclerosis).


 * 2009, Adverse Childhood Experiences and the Risk of Premature Mortality (Full text)
 * Brown et al. found people with 6 or more Adverse Childhood Experiences were 1.7 times more likely to die at or before age 75 years, and 2.4 times more likely to die at or before age 65. ACEs were linked to an increased risk early death, but a graded increase in the risk of early death was not found across the different categories of ACEs.


 * 2011, Childhood maltreatment and the response to cognitive behavior therapy for chronic fatigue syndrome (Abstract)


 * 2018, Rethinking childhood adversity in chronic fatigue syndrome (Full Text)


 * 2019, Socioeconomic Deprivation, Adverse Childhood Experiences and Medical Disorders in Adulthood: Mechanisms and Associations (Full text)

Talks, interviews and blogs

 * 2009, Chronic fatigue syndrome & child abuse: Disordered patients or disordered research? - Pamela Weintraub, Psychology Today

Learn more

 * Adverse Childhood Experiences Study - CDC