Post-traumatic stress disorder

Post-traumatic stress disorder or 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.

A 2012 study by Dansie, et al, investigated the co-occurrence of CFS, PTSD, and trauma symptoms and concluded "that a lifetime diagnosis of CFS is strongly associated with both lifetime PTSD and current traumatic symptoms."

Notable studies

• 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)."

• 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.

• 2012, The Comorbidity of Self-Reported Chronic Fatigue Syndrome, Posttraumatic Stress Disorder, and Traumatic Symptoms (Full Text)

See also

• Trauma
• Mental health
• Medical Abuse In ME Sufferers (MAIMES)

Learn more

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