Trauma

Trauma can be physical (traumatic injury) resulting in wound or injuryor 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 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 empirical definition of ME/CFS, which resulted in a biased sample with over representation of individuals with depression and post traumatic stress disorder (PTSD). 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.

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. — Invest in ME Research, 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.

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 three 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:

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. — Heins et al. (2011)

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.

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 or very severe ME. British doctor Sarah Myhill created the 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 exercise therapy and 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.. The 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, MAIMES petition and Stigma and discrimination.

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

See also

• Psychologization
• Biopsychosocial model
• Epidemiology
• Risk factors
• Onset of ME/CFS
• PTSD
• Medical Abuse In ME Sufferers petition

Learn more

• Adverse Childhood Experiences Study - CDC

See myalgic encephalomyelitis.

See chronic fatigue syndrome.

bias Bias in research is "a systematic deviation of an observation from the true clinical state". (Learn more: me-pedia.org)

chronic fatigue (CF) - Persistent and abnormal fatigue is a symptom, not an illness. It may be caused by depression, multiple sclerosis, fibromyalgia, chronic fatigue syndrome or many other illnesses. The term "chronic fatigue" should never be confused with the disease chronic fatigue syndrome.

Centers for Disease Control and Prevention (CDC) - The Centers for Disease Control and Prevention is a U.S. government agency dedicated to epidemiology and public health. It operates under the auspices of the Department of Health and Human Services.

See Centers for Disease Control and Prevention.

cognition Thought processes, including attention, reasoning, and memory.

stress Stress can by either physical or psychological, or both. Stress is either 1) a state of emotional or psychological strain or 2) the physical stress (pressure or tension) that a physical object such the human body is placed under, e.g., a stress test is a medical test that monitors the cardiovascular system during strenuous exercise.

National Academy of Medicine (NAM) - An American non-profit, non-governmental organization which provides expert advice to governmental agencies on issues relating to biomedical science, medicine and health. Formerly known as the Institute of Medicine (IOM).

somatic symptom disorder A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience.