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David Baxter

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Childhood Trauma, Stress Linked to Adult Chronic Fatigue Syndrome
November 10, 2006
by Laurie Barclay, MD

Two separate population-based trials, both published in the November issue of the Archives of General Psychiatry, suggest that childhood trauma/stress and emotional instability are connected to adult development of chronic fatigue syndrome (CFS).

"The causes of CFS are unknown and effective prevention strategies remain elusive," write Christine Heim, PhD, from the Centers for Disease Control and Prevention (CDC), Emory University School of Medicine in Atlanta, Georgia, and colleagues. "A growing literature suggests that early adverse experience increases the risk for a range of negative health outcomes, including fatiguing illnesses. Identification of developmental risk factors for CFS is critical to inform pathophysiological research and devise targets for primary prevention."

This case-control study compared 43 cases with current CFS with 60 nonfatigued controls identified from a general population sample of 56,146 adult residents of Wichita, Kansas. Primary endpoints were self-reported childhood trauma (sexual, physical, and emotional abuse, and emotional and physical neglect) and psychopathology (depression, anxiety, and posttraumatic stress disorder).

Compared with controls, the CFS cases reported significantly higher levels of childhood trauma and psychopathology. Exposure to childhood trauma was associated with a 3- to 8-fold increased risk for CFS across different trauma types, and there was a graded relationship between the degree of trauma exposure and CFS risk. Childhood trauma was associated with greater severity of CFS symptoms, as well as with symptoms of depression, anxiety, and posttraumatic stress disorder. The presence of concurrent psychopathology increased the risk for CFS conveyed by childhood trauma.

"This study provides evidence of increased levels of multiple types of childhood trauma in a population-based sample of clinically confirmed CFS cases compared with nonfatigued controls," the authors write. Our results suggest that childhood trauma is an important risk factor for CFS.... Studies scrutinizing the psychological and neurobiological mechanisms that translate childhood adversity into CFS risk may provide direct targets for the early prevention of CFS."

Study limitations include small sample size, the possibility that CFS cases with childhood trauma were more likely to participate in the survey than were CFS cases without childhood trauma or controls with childhood trauma, reliance on retrospective and uncorroborated self-reports of childhood experiences, focus on familial childhood trauma and not on occurrences outside the family or other types of events such as childhood illnesses, lack of differentiation between contact sexual abuse and noncontact harassment, and failure to consider effects of adulthood traumas and life stresses that might mediate the relationship between childhood adversity and CFS.

"Our observations lend support for the hypothesis that CFS represents a disorder of adaptation that is promoted by early environmental insults, leading to failure to compensate in response to challenge," the authors conclude. "Integrating our findings with results from developmental neuroscience emphasizes the need to revise prevailing dichotomous approaches that differentiate between psychological and biological contributors to CFS."

The Chronic Fatigue Syndrome Program of the US CDC conducted this study. The authors have disclosed no relevant financial relationships.

The second study, by Kenji Kato, PhD, from Karolinska Institutet in Stockholm, Sweden, and colleagues, prospectively evaluated the association of premorbid self-reported stress and personality with chronic fatigue?like illness.

Using the Swedish Twin Registry, the investigators conducted a prospective, nested case-control study in a population-based community sample of 19,192 twins born between January 1, 1935, and December 31, 1958. Computer-assisted telephone interviews conducted between 1998 and 2002 obtained information about current CFS-like illnesses. Using a questionnaire mailed in 1972-1973, the investigators evaluated self-reported stress, based on a single question, and personality scales of emotional instability and extraversion in the Eysenck Personality Inventory. They estimated relative risks with case-control analyses matched for age and sex, and co-twin control analyses comparing discordant pairs.

Matched case-control analyses revealed that higher emotional instability and self-reported stress in the premorbid period were associated with higher risk for chronic fatigue?like illness (odds ratios, 1.72 and 1.64, respectively). In co-twin control analyses, relative risk for emotional instability decreased to 1.02, but relative risk of stress increased dramatically to 5.81. Extraversion was not associated with fatigue.

"Elevated premorbid stress is a significant risk factor for chronic fatigue?like illness, the effect of which may be buffered by genetic influences," the authors write. "Emotional instability assessed 25 years earlier is associated with chronic fatigue through genetic mechanisms contributing to both personality style and expression of the disorder. These findings suggest plausible mechanisms for chronic fatiguing illness."

Study limitations include inability to distinguish between direct causality and confounding, cases diagnosed by telephone interviews without clinical assessment, possible recovery or recall bias, and stress measured only once based on a subjective self-report.

"Our findings suggest that although both stress and emotional instability are important, emotional instability has endogenous, moderating effects mediated by familial factors whereas stress has exogenous, direct effects on the occurrence of chronic fatigue," the authors conclude.

Arch Gen Psychiatry. 2006;63:1258-1266.
 

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