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.
- 1 Childhood trauma / child abuse and ME/CFS
- 2 Child abuse and idiopathic chronic fatigue, not CFS
- 3 Adverse Childhood Experiences
- 4 Adult trauma and stress as a trigger for ME/CFS
- 5 Notable studies
- 6 Talks, interviews and blogs
- 7 Media coverage
- 8 See also
- 9 Learn more
- 10 References
Childhood trauma / child abuse and ME/CFS[edit | edit source]
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.
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[edit | edit source]
Taylor & Jason (2001) investigated possible links between different types of child abuse and 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 & Jason concluded that CFS did not have a significant link with any form of child abuse history.
Adverse Childhood Experiences[edit | edit source]
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[edit | edit source]
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[edit | edit source]
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[edit | edit source]
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[edit | edit source]
- 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)."
- 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).
- 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)
- 2019, Socioeconomic Deprivation, Adverse Childhood Experiences and Medical Disorders in Adulthood: Mechanisms and Associations(Full text)
Talks, interviews and blogs[edit | edit source]
- 2009, Chronic fatigue syndrome & child abuse: Disordered patients or disordered research? - Pamela Weintraub, Psychology Today
Media coverage[edit | edit source]
See also[edit | edit source]
- Biopsychosocial model
- Risk factors
- Onset of ME/CFS
- Medical Abuse In ME Sufferers petition
Learn more[edit | edit source]
References[edit | edit source]
- "Wounds and Injuries". medlineplus.gov. Retrieved Feb 13, 2019.
- "Trauma". The Free Dictionary. Retrieved Feb 14, 2019.
- "injury". The Free Dictionary. Retrieved Feb 14, 2019.
- "psychologically". The Free Dictionary. Retrieved Feb 14, 2019.
- Heim, Christine; Nater, Urs M.; Maloney, Elizabeth; Boneva, Roumiana; Jones, James F.; Reeves, William C. (Jan 1, 2009). "Childhood Trauma and Risk for Chronic Fatigue Syndrome: Association With Neuroendocrine Dysfunction". Archives of General Psychiatry. 66 (1): 72. doi:10.1001/archgenpsychiatry.2008.508. ISSN 0003-990X.
- Institute of Medicine (US), Beyond Myalgic Encephalomyelitis / Chronic Fatigue Syndrome - Redefining an Illness, National Academies Press (US), Feb 2015.
- Clark, James E.; Davidson, Sean L.; Maclachlan, Laura; Newton, Julia; Watson, Stuart (2017), "Rethinking childhood adversity in chronic fatigue syndrome", Fatigue: Biomedicine, Health & Behavior, doi:10.1080/21641846.2018.1384095
- Invest in ME Research (July 2017). "Response to NICE 10 year surveillance (2017) – Chronic fatigue syndrome/myalgic encephalomyelitis". www.investinme.org. Retrieved Feb 7, 2019.
- Gjone, Helene; Wyller, Vegard Bruun (2009). "Chronic fatigue in adolescence—autonomic dysregulation and mental health: an exploratory study". Acta Paediatrica. 98 (8): 1313–1318. doi:10.1111/j.1651-2227.2009.01323.x. ISSN 1651-2227.
- Taylor, R. R.; Jason, L. A. (Oct 2001). "Sexual abuse, physical abuse, chronic fatigue, and chronic fatigue syndrome: a community-based study". The Journal of Nervous and Mental Disease. 189 (10): 709–715. ISSN 0022-3018. PMID 11708672.
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.
- CDC (Feb 5, 2019). "About Adverse Childhood Experiences | Violence Prevention | Injury Center". Centers for Disease Control and Prevention. Retrieved Feb 24, 2019.
- CDC (Feb 7, 2019). "Adverse Childhood Experiences | Violence Prevention | Injury Center". Centers for Disease Control and Prevention. Retrieved Feb 24, 2019.
- CDC (Feb 5, 2019). "About the CDC-Kaiser ACE Study". Centers for Disease Control and Prevention. Retrieved Feb 24, 2019.
- Heins, Marianne J.; Knoop, Hans; Lobbestael, Jill; Bleijenberg, Gijs (Dec 2011). "Childhood maltreatment and the response to cognitive behavior therapy for chronic fatigue syndrome". Journal of Psychosomatic Research. 71 (6): 404–410. doi:10.1016/j.jpsychores.2011.05.005. ISSN 1879-1360. PMID 22118383.
- Carruthers, BM; van de Sande, MI; De Meirleir, KL; Klimas, NG; Broderick, G; Mitchell, T; Staines, D; Powles, ACP; Speight, N; Vallings, R; Bateman, L; Bell, DS; Carlo-Stella, N; Chia, J; Darragh, A; Gerken, A; Jo, D; Lewis, DP; Light, AR; Light, KC; Marshall-Gradisnik, S; McLaren-Howard, J; Mena, I; Miwa, K; Murovska, M; Stevens, SR (2012), Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners (PDF), ISBN 978-0-9739335-3-6
- "CDC Public Health Grand Rounds - Chronic Fatigue Syndrome - Advancing Research and Clinical Education" (PDF). cdc.gov. p. 6.
- Murphy, Frances M.; Lee, Kyung Y.; Mahan, Clare M.; Natelson, Benjamin H.; Kang, Han K. (Jan 15, 2003). "Post-Traumatic Stress Disorder and Chronic Fatigue Syndrome-like Illness among Gulf War Veterans: A Population-based Survey of 30,000 Veterans". American Journal of Epidemiology. 157 (2): 141–148. doi:10.1093/aje/kwf187. ISSN 0002-9262.
- Dube, Shanta R.; Fairweather, DeLisa; Pearson, William S.; Felitti, Vincent J.; Anda, Robert F.; Croft, Janet B. (Feb 2009). "Cumulative Childhood Stress and Autoimmune Diseases in Adults". Psychosomatic Medicine. 71 (2): 243–250. doi:10.1097/PSY.0b013e3181907888. ISSN 0033-3174. PMC . PMID 19188532.
- Brown, David W.; Anda, Robert F.; Tiemeier, Henning; Croft, Janet B.; Edwards, Valerie J.; Felitti, Vincent J.; Giles, Wayne H. (Nov 1, 2009). "Adverse Childhood Experiences and the Risk of Premature Mortality". American Journal of Preventive Medicine. 37 (5): 389–396. doi:10.1016/j.amepre.2009.06.021. ISSN 0749-3797.
- Morris, Gerwyn; Berk, Michael; Maes, Michael; Carvalho, André F.; Puri, Basant K. (Jan 26, 2019). "Socioeconomic Deprivation, Adverse Childhood Experiences and Medical Disorders in Adulthood: Mechanisms and Associations". Molecular Neurobiology: 1–25. doi:10.1007/s12035-019-1498-1. ISSN 1559-1182.
- Weintraub, Pamela (Jan 13, 2019). "Chronic fatigue syndrome & child abuse: Disordered patients or disordered research?". Psychology Today. Retrieved Feb 10, 2019.
Bias - Bias in research is "a systematic deviation of an observation from the true clinical state".
Myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.