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'''Trauma''' can be physical (traumatic injury)<ref name=":2">{{Cite web|url=https://medlineplus.gov/woundsandinjuries.html | title = Wounds and Injuries|website=medlineplus.gov|access-date=2019-02-13}}</ref> resulting in wound or injury<ref name=":2" /><ref name="dict">{{Cite web|url=https://medical-dictionary.thefreedictionary.com/trauma | title = Trauma | last = | first = | author-link =| date = |website=The Free Dictionary|archive-url=|archive-date=|url-status=|access-date=2019-02-14}}</ref><ref>{{Cite web|url=https://medical-dictionary.thefreedictionary.com/injury | title = injury | last = | first = | author-link =| date = |website=The Free Dictionary|archive-url=|archive-date=|url-status=|access-date=2019-02-14}}</ref>or a "psychologically upsetting experience that produces an emotional or [[:Category:Mental disorders|mental disorder]] or otherwise has lasting negative effects on a person's thoughts, feelings, or behavior,"<ref name="dict" /><ref>{{Cite web|url=https://www.thefreedictionary.com/psychologically | title = psychologically | last = | first = | author-link =| date = |website=The Free Dictionary|archive-url=|archive-date=|url-status=|access-date=2019-02-14}}</ref> 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 link between the development of [[chronic fatigue syndrome]] in people with a history of childhood trauma has not been established. A study suggesting a role for childhood trauma in [[ME/CFS]] used the broad [[Fukuda criteria|empirical definition]] of ME/CFS, which resulted in a biased sample with over representation of individuals with [[depression]] and [[post traumatic stress disorder]] (PTSD).<ref name=Heim2009>{{Cite journal | last =Heim | first = Christine | author-link = Christine Heim | last2 = Nater | first2=Urs M. | authorlink2 = Urs Nater | last3=Maloney | first3 = Elizabeth | authorlink3 = Elizabeth M. Maloney | last4 = Boneva | first4=Roumiana | authorlink4 = Roumiana Boneva| last5 = Jones | first5 = James F. | authorlink5 = James Jones | last6 = Reeves | first6 = William C. | authorlink6 = William Reeves | date = 2009-01-01 | title = Childhood Trauma and Risk for Chronic Fatigue Syndrome: Association With Neuroendocrine Dysfunction|url=http://archpsyc.jamanetwork.com/article.aspx?doi=10.1001/archgenpsychiatry.2008.508|journal=Archives of General Psychiatry|language=en|volume=66|issue=1 | pages = 72|doi=10.1001/archgenpsychiatry.2008.508|issn=0003-990X|quote=|via=}}</ref> 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.<ref name="IOM2015">{{Citation | last =Institute of Medicine|location=US|url = http://www.ncbi.nlm.nih.gov/pubmed/25695122 | title = Beyond Myalgic Encephalomyelitis / Chronic Fatigue Syndrome - Redefining an Illness]|publisher=National Academies Press | date = Feb 2015}}</ref><br> 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.<ref name="Clark, 2018" /> {{Quote_frame|The ME that we know has no connection to childhood problems or maternal anxiety but an illness that strikes out of the blue in previously healthy persons.<ref>{{Cite web|url=http://www.investinme.org/IIMER-Newslet-17-07-04.shtml | title = Response to NICE 10 year surveillance (2017) – Chronic fatigue syndrome/myalgic encephalomyelitis | last =Invest in ME Research | first = | authorlink = Invest in ME Research | date = July 2017 | website = [[Invest in ME Research]]|archive-url=|archive-date=|url-status=|access-date=2019-02-07}}</ref> | author = [[Invest in ME Research]]|source=2017}} 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.<ref name="IOM2015" /><ref name=Gjone2009>{{Cite journal | last =Gjone | first = Helene | authorlink = | last2 = Wyller | first2=Vegard Bruun | authorlink2 = Vegard Bruun Wyller | date = 2009 | title = Chronic fatigue in adolescence—autonomic dysregulation and mental health: an exploratory study|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1651-2227.2009.01323.x|journal=Acta Paediatrica|language=en|volume=98|issue=8|pages=1313–1318|doi=10.1111/j.1651-2227.2009.01323.x|issn=1651-2227}}</ref> ==Child abuse and idiopathic chronic fatigue, not CFS == [[Renee Taylor|Taylor]] and [[Leonard Jason|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|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.<ref name="Taylor2001">{{Cite journal | last = Taylor | first = R.R. | authorlink = Renee Taylor | last2=Jason | first2 = L.A. | authorlink2 = Leonard Jason | date = Oct 2001 | title = Sexual abuse, physical abuse, chronic fatigue, and chronic fatigue syndrome: a community-based study|url=https://www.ncbi.nlm.nih.gov/m/pubmed/11708672/|journal=The Journal of Nervous and Mental Disease|volume=189|issue=10 | pages = 709–715|issn=0022-3018|pmid=11708672|quote=Compared with healthy controls, childhood sexual abuse was significantly more likely to be associated with outcomes of idiopathic chronic fatigue, chronic fatigue explained by a psychiatric condition, and chronic fatigue explained by a medical condition. None of the abuse history types were significant predictors of chronic fatigue syndrome.|via=}}</ref> == 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.<ref name="aces-about">{{Cite web|url=https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/aboutace.html | title = About Adverse Childhood Experiences {{!}} Violence Prevention {{!}} Injury Center | last=CDC | first = | authorlink = Centers for Disease Control and Prevention | date = 2019-02-05 | website = [[Centers for Disease Control and Prevention]]|language=en-us|archive-url=|archive-date=|url-status=|access-date=2019-02-24}}</ref> The [[Centers for Disease Control and Prevention|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,<ref name="aces">{{Cite web|url=https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy | title = Adverse Childhood Experiences {{!}} Violence Prevention {{!}} Injury Center | last=CDC | first = | authorlink = Centers for Disease Control and Prevention | date = 2019-02-07 | website = [[Centers for Disease Control and Prevention]]|language=en-us|archive-url=|archive-date=|url-status=|access-date=2019-02-24}}</ref> ACEs are regarded as a way to measure '''cumulative childhood stress''' rather than only trauma or abuse.<ref name="aces-about" /> 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 illness|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.<ref name="aces-about" /> === 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 three or more ACEs.<ref>{{Cite web|url=https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html | title = About the CDC-Kaiser ACE Study | last =CDC | first = | authorlink = Centers for Disease Control and Prevention | date = 2019-02-05 | website = [[Centers for Disease Control and Prevention]]|language=en-us|archive-url=|archive-date=|url-status=|access-date=2019-02-24}}</ref> This shows that ACEs are significantly more common than [[ME/CFS]]. ===ACEs and ME/CFS === The [[Centers for Disease Control and Prevention|CDC]] developed both the original Adverse Childhood Experiences research and the [[Fukuda criteria]] for [[Chronic fatigue syndrome|chronic fatigue syndrome]] (CFS), but has not analyzed the influence of Adverse Childhood Experiences on [[Myalgic encephalomyelitis|myalgic encephalomyelitis]] (ME) or chronic fatigue syndrome. Heins et al. (2011)<ref name="Heins2011" /> 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: {{Quote frame|text=At baseline, patients with a history of childhood maltreatment had significantly more limitations and a higher level of psychological distress, but were not more severely fatigued. Change scores on the outcome measures after cognitive behavior therapy did not differ significantly between patients with or without a history of childhood maltreatment, or between the different types of childhood maltreatment. | author = Heins et al. (2011) | title = |source=|align=}} ==Adult trauma and stress as a trigger for ME/CFS == Physical trauma (for example, accident or injury)<ref name=":2" /> and overwhelming emotional stress are known triggers reported in a proportion of people who develop ME/CFS,<ref name="ICP2011primer" /> but these are significantly less common than developing the illness after a [[virus]] or [[bacterial infection]].<ref>{{Cite web|url=https://www.cdc.gov/grand-rounds/pp/2016/20160216-presentation-chronic-fatigue-H.pdf | title = CDC Public Health Grand Rounds - Chronic Fatigue Syndrome - Advancing Research and Clinical Education | last = | first = | author-link =| date = |website=cdc.gov | page = 6|archive-url=|archive-date=|url-status=|access-date=}}</ref> A number of [[Causes|risk factors]] have also been identified, including a [[gene|genetic]] link.<ref name="ICP2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 = L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 = N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | authorlink14 = John Chia | last15 = Darragh | first15 = A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 = D | authorlink17 = Daehyun Jo | last18 = Lewis | first18 = DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012 | isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf }}</ref> ==Trauma and PTSD as a result of ME/CFS== Some [[ME/CFS]] patients have reported being abused by others as a result of having [[ME/CFS]], for example forced, painful exercise treatments, and psychological abuse by medical professionals or carers, particularly by those with [[Severe and very severe ME|severe or very severe ME]]. British doctor [[Sarah Myhill]] created the [[MAIMES petition|MAIMES campaign and petition]] for the investigation of medical abuse in ME patients. Dr [[Nigel Speight]] has spoken about the neglect and mistreatment of children with ME by medical professionals, including forced [[Graded exercise therapy|exercise therapy]] and [[cognitive behavioral therapy|psychotherapy]] carried out on children with ME who were incorrectly forced into locked psychiatric hospitals, based on the mistaken belief that their physical symptoms had a psychiatric basis.{{citation needed | date = Sep 2020}}. The [[25 Percent ME Group|25% ME Group]] for severe ME and [[The Grace Charity for M.E.]] jointly published a document describing how patients or carers may be able to avoid inappropriate psychiatric hospitalization. There is a lack of research regarding the traumatization of patients as a result of [[ME/CFS]], but research has shown that both ME/CFS patients often experience significant [[stigma and discrimination]]. {{See also|Ethical issues|Ethical issues|MAIMES petition|MAIMES petition|Stigma and discrimination|Stigma and discrimination}} ==Notable studies== *2001, Sexual abuse, physical abuse, chronic fatigue, and chronic fatigue syndrome: a community-based study<ref name="Taylor2001" /> [https://www.ncbi.nlm.nih.gov/m/pubmed/11708672/ (Abstract)] *2003, Post-Traumatic Stress Disorder and Chronic Fatigue Syndrome-like Illness among Gulf War Veterans: A Population-based Survey of 30,000 Veterans<ref name="veterans2003">{{Cite journal | last =Murphy | first = Frances M. | author-link = Frances Murphy | last2 = Lee | first2 = Kyung Y. | authorlink2 = Kyung Lee | last3 = Mahan | first3=Clare M. | author-link3 = Clare Mahan | last4 = Natelson | first4=Benjamin H. | authorlink4 = Benjamin Natelson| last5 = Kang | first5 = Han K. | authorlink5 = Han Kang | date = 2003-01-15 | title = Post-Traumatic Stress Disorder and Chronic Fatigue Syndrome-like Illness among Gulf War Veterans: A Population-based Survey of 30,000 Veterans|url=https://academic.oup.com/aje/article/157/2/141/90101|journal=American Journal of Epidemiology|language=en|volume=157|issue=2|pages=141–148|doi=10.1093/aje/kwf187|issn=0002-9262|quote=|via=}}</ref> [https://doi.org/10.1093/aje/kwf187 (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: <blockquote>"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)."</blockquote> * 2009, Cumulative Childhood Stress and Autoimmune Diseases in Adults<ref name="Dube2009">{{Cite journal | last =Dube | first = Shanta R. | author-link = Shanta Dube | last2 = Fairweather | first2=DeLisa | authorlink2 = DeLisa Fairweather | last3=Pearson | first3=William S. | author-link3 = William Pearson | last4 = Felitti | first4 = Vincent J. | authorlink4 = Vincent Felitti| last5 = Anda | first5 = Robert F. | authorlink5 = Robert Anda | last6 = Croft | first6 = Janet B. | authorlink6 = Janet Croft | date = Feb 2009 | title = Cumulative Childhood Stress and Autoimmune Diseases in Adults|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3318917/|journal=Psychosomatic Medicine|volume=71|issue=2|pages=243–250|doi=10.1097/PSY.0b013e3181907888|issn=0033-3174|pmc=3318917|pmid=19188532|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3318917/ (Full text)] ::Shanta et al. found that the likelihood of someone being hospitalized for ANY of 21 different [[autoimmune disease]]s, including [[myasthenia gravis]], [[rheumatoid arthritis |rheumatic arthritis]], [[Addison's disease]], [[celiac disease]], [[Graves' disease]], [[Hashimoto's thyroiditis]], insulin-dependent [[diabetes |diabetes mellitus]], [[irritable bowel syndrome|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<ref name="Brown2009">{{Cite journal | last7 = Giles | first7 = Wayne H. | authorlink7 = Wayne Giles | last4 = Croft | first4=Janet B. | authorlink4 = Janet Croft | last5 = Edwards | first5 = Valerie J. | authorlink5 = Valerie Edwards | last6 = Felitti | first6 = Vincent J. | authorlink6 = Vincent Felitti | last3 = Tiemeier | first3=Henning | author-link3 = Henning Tiemeier | last2=Anda | first2 = Robert F. | authorlink2 = Robert Anda | last =Brown | first = David W. | author-link = David Brown | date = 2009-11-01 | title = Adverse Childhood Experiences and the Risk of Premature Mortality|url=https://www.ajpmonline.org/article/S0749-3797(09)00506-6/abstract|journal=American Journal of Preventive Medicine|language=English|volume=37|issue=5|pages=389–396|doi=10.1016/j.amepre.2009.06.021|issn=0749-3797|quote=|via=}}</ref> [https://www.researchgate.net/profile/David_Brown37/publication/38021750_Adverse_Childhood_Experiences_and_the_Risk_of_Premature_Mortality/links/5ad49e95aca272fdaf7bf377/Adverse-Childhood-Experiences-and-the-Risk-of-Premature-Mortality.pdf (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 behavioral therapy|cognitive behavior therapy]] for chronic fatigue syndrome<ref name="Heins2011">{{Cite journal | last =Heins | first = Marianne J. | author-link = Marianne Heins | last2 = Knoop | first2 = Hans | authorlink2 = Hans Knoop | last3 = Lobbestael | first3 = Jill | author-link3 = Jill Lobbestael | last4 = Bleijenberg | first4 = Gijs | authorlink4 = Gijs Bleijenberg | authorlink5 = | date = Dec 2011 | title = Childhood maltreatment and the response to cognitive behavior therapy for chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/m/pubmed/22118383/|journal=Journal of Psychosomatic Research|volume=71|issue=6|pages=404–410|doi=10.1016/j.jpsychores.2011.05.005|issn=1879-1360|pmid=22118383|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/m/pubmed/22118383/ (Abstract)] *2018, Rethinking childhood adversity in chronic fatigue syndrome<ref name="Clark, 2018">{{Citation | last1 = Clark | first1 = James E. | authorlink1 = James Clark | last2 = Davidson | first2 = Sean L. | authorlink2 = Sean Davidson | last3 = Maclachlan | first3 = Laura | authorlink3 = Laura Maclachlan | last4 = Newton | first4 = Julia | authorlink4 = Julia Newton | last5 = Watson | first5 = Stuart | authorlink5 = Stuart Watson | title = Rethinking childhood adversity in chronic fatigue syndrome | journal = Fatigue: Biomedicine, Health & Behavior | volume = | issue = | page = | date = 2017 | pmid = | doi = 10.1080/21641846.2018.1384095 }}</ref> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774185/ (Full Text)] * 2019, Socioeconomic Deprivation, Adverse Childhood Experiences and Medical Disorders in Adulthood: Mechanisms and Associations<ref name=Morris2019>{{Cite journal | last =Morris | first = Gerwyn | author-link = Gerwyn Morris | last2 = Berk | first2 = Michael | authorlink2 = Michael Berk | last3 = Maes | first3=Michael | author-link3 = Michael Maes | last4 = Carvalho | first4 = André F. | authorlink4 = André Carvalho| last5 = Puri | first5 = Basant K. | authorlink5 = Basant Puri | date = 2019-01-26 | title = Socioeconomic Deprivation, Adverse Childhood Experiences and Medical Disorders in Adulthood: Mechanisms and Associations|url=https://doi.org/10.1007/s12035-019-1498-1|journal=Molecular Neurobiology|language=en|volume=|issue=|pages=1-25|doi=10.1007/s12035-019-1498-1|issn=1559-1182|quote=|via=}}</ref> [https://doi.org/10.1007/s12035-019-1498-1 (Full text)] == Talks, interviews and blogs == * 2009, [http://www.psychologytoday.com/blog/emerging-diseases/200901/chronic-fatigue-syndrome-child-abuse-disordered-patients-or-disordered Chronic fatigue syndrome & child abuse: Disordered patients or disordered research?]<ref name=Weintraub2019>{{Cite web|url=http://www.psychologytoday.com/blog/emerging-diseases/200901/chronic-fatigue-syndrome-child-abuse-disordered-patients-or-disordered | title = Chronic fatigue syndrome & child abuse: Disordered patients or disordered research? | last =Weintraub | first = Pamela | authorlink= | date = Jan 13, 2019 | website = Psychology Today|language=en-US|archive-url=|archive-date=|url-status=|access-date=2019-02-10}}</ref> - Pamela Weintraub, Psychology Today ==Media coverage== ==See also== *[[Psychologization]] *[[Biopsychosocial model]] *[[Epidemiology]] *[[Etiology|Risk factors]] *[[Onset of ME/CFS]] *[[Post-traumatic stress disorder|PTSD]] *[[Sarah Myhill#maimes|Medical Abuse In ME Sufferers petition]] ==Learn more== * [https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/index.html Adverse Childhood Experiences Study] - CDC ==References== {{Reflist}} [[Category:Triggers and risk factors]] [[Category:Abuse]]
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