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Stress
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==Notable studies== Several studies found it is not uncommon to experience major psychological chronic stress (from events such as divorce, bereavement or serious financial worries) in the year prior to developing ME/CFS.<ref>{{Cite journal | last = Hatcher | first = Simon | last2 = House | first2 = Allan | date = Oct 2003 | title = Life events, difficulties and dilemmas in the onset of chronic fatigue syndrome: a case-control study|url=https://www.ncbi.nlm.nih.gov/pubmed/14580073|journal=Psychological Medicine|volume=33|issue=7|pages=1185β1192|doi=10.1017/s0033291703008274|issn=0033-2917|pmid=14580073|pmc=|quote=|access-date=|via=}}</ref><ref>{{Cite journal | last = Theorell | first = T. | last2 = Blomkvist | first2 = V. | last3 = Lindh | first3 = G. | last4 = EvengΓ₯rd | first4 = B. | date = May 1999 | title = Critical life events, infections, and symptoms during the year preceding chronic fatigue syndrome (CFS): an examination of CFS patients and subjects with a nonspecific life crisis|url=https://www.ncbi.nlm.nih.gov/pubmed/10367610|journal=Psychosomatic Medicine|volume=61|issue=3|pages=304β310|issn=0033-3174|pmid=10367610|doi=|pmc=|quote=|access-date=|via=}}</ref><ref>{{Cite journal | last = Salit | first=Irving E. | date = 1997-01-01 | title = Precipitating factors for the chronic fatigue syndrome|url=http://www.sciencedirect.com/science/article/pii/S0022395696000507|journal=Journal of Psychiatric Research|volume=31|issue=1|pages=59β65|doi=10.1016/S0022-3956(96)00050-7|issn=0022-3956}}</ref> Chronic psychological stress elevates cortisol which suppresses the Th1 antiviral/intracellular immune response and the T-cell response.<ref>{{Cite journal | last = Dhabhar | first=Firdaus S | date = 2008-03-15 | title = Enhancing versus Suppressive Effects of Stress on Immune Function: Implications for Immunoprotection versus Immunopathology|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2869337/|journal=Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology|volume=4|issue=1|pages=2β11|doi=10.1186/1710-1492-4-1-2|issn=1710-1484|pmc=2869337|pmid=20525121}}</ref> Chronic stress has also been shown to greatly increase susceptibility to viral infection.<ref>{{Cite journal | last = Murphy | first = Michael L. M. | last2 = Cohen | first2 = Sheldon | last3 = Janicki-Deverts | first3=Denise | last4 = Doyle | first4 = William J. | date = 2017-06-20 | title = Offspring of parents who were separated and not speaking to one another have reduced resistance to the common cold as adults|url=https://www.ncbi.nlm.nih.gov/pubmed/28584098|journal=Proceedings of the National Academy of Sciences of the United States of America|volume=114|issue=25 | pages = 6515β6520|doi=10.1073/pnas.1700610114|issn=1091-6490|pmc=5488935|pmid=28584098|quote=|access-date=|via=}}</ref> This increased susceptibility is not observed after short-term acute stress (periods of stress of less than 1 month duration).<ref>{{Cite journal | last = Cohen | first = S. | last2 = Frank | first2 = E. | last3 = Doyle | first3 = W.J. | last4 = Skoner | first4 = D.P. | last5 = Rabin | first5 = B.S. | last6 = Gwaltney | first6 = J.M. | date=May 1998 | title = Types of stressors that increase susceptibility to the common cold in healthy adults|url=https://www.ncbi.nlm.nih.gov/pubmed/9619470|journal=Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association|volume=17|issue=3|pages=214β223|doi=10.1037//0278-6133.17.3.214|issn=0278-6133|pmid=9619470|pmc=|quote=|access-date=|via=}}</ref> As ME/CFS normally appears after acute viral infection, the presence of chronic stress may weaken immunity and allow a normally mild virus to trigger the serious disease of ME/CFS.
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