Self-critical perfectionism, stress generation, and stress sensitivity in patients wi

[leelaplay]

Self-critical perfectionism, stress generation, and stress sensitivity in patients with chronic fatigue syndrome: relationship with severity of depression.


kelly to CO-CURE


[kl: It is possible that patients labeled with CFS in this study do not
have CFS as it is defined using the original Fukuda criteria.
According to proponents of ecological momentary assessment (EMA), many
physical diseases have been reported to be associated with
psychosocial factors. In these diseases, assessment relies mainly on
subjective symptoms in natural settings. Therefore, it is important to
assess symptoms and/or relationships between psychosocial factors and
symptoms in natural settings. Symptoms are usually assessed by
self-report when patients visit their doctors. However, self-report by
recall has an intrinsic problem; "recall bias". Recently, ecological
momentary assessment (EMA) has been proposed as a reliable method to
assess and record events and subjective symptoms as well as
physiological and behavioral variables in natural settings. Although
proponents consider EMA is a useful method to assess stress-related
diseases, they acknowledged that this method has not been fully
acknowledged in the wider scientific community, especially by
clinicians.]

Psychiatry. 2011 Spring;74(1):21-30.

Self-critical perfectionism, stress generation, and stress sensitivity
in patients with chronic fatigue syndrome: relationship with severity
of depression.
Luyten P, Kempke S, Van Wambeke P, Claes S, Blatt SJ, Van Houdenhove B.

Abstract
Chronic Fatigue Syndrome (CFS) is a highly disabling disorder that is
part of a broader spectrum of chronic pain and fatigue disorders.
Although the etiology and pathogenesis of CFS largely remain unclear,
there is increasing evidence that CFS shares important
pathophysiological disturbances with mood disorders in terms of
disturbances in the stress response and the stress system.

From a psycho-dynamic perspective, self-critical perfectionism and
related personality factors are hypothesized to explain in part
impairments of the stress response in both depression and CFS.

Yet, although there is ample evidence that high levels of
self-critical perfectionism are associated with stress generation and
increased stress sensitivity in depression, evidence supporting this
hypothesis in CFS is currently lacking.

This study therefore set out to investigate the relationship between
self-critical perfectionism, the active generation of stress, stress
sensitivity, and levels of depression in a sample of 57 patients
diagnosed with CFS using an ecological momentary assessment approach.

Results showed, congruent with theoretical assumptions, that
self-critical perfectionism was associated with the generation of
daily hassles, which in turn predicted higher levels of depression.
Moreover, multilevel analyses showed that self-critical perfectionism
was related to increased stress sensitivity in CFS patients over a
14-day period, and that increased stress sensitivity in turn was
related to increased levels of depression.

The implications of these findings for future research and
particularly for the development of psychodynamic treatment approaches
of CFS and related conditions are discussed.

PMID: 21463167 [PubMed - in process]

 

[Enid]

I'd like to turn this on it's head and suggest "they" might learn from some good old fashioned self criticism. Haven't this lot anything better to fill their time - other than "fairy stories". Suggest a little stress all round (illness) and see how they fare on their own measures and stop playing their stupid mind games. Provocative stuff here shrewsbury with these psycho-dabblers !. Also suggest return to real Medicine for them all.

 

[Snow Leopard]

This study doesn't actually state much except those with CFS who are depressed have similar personality/"stress generation" tendencies as those who are depressed without CFS. It does not imply anything about the personalities of the 75% of CFS patients who do not have ongoing depression.

 

[Enid]

But I'm not, never was depressive - so where is this "study" getting anywhere. If any at all it is "clinical" not psycho - whole metabolism shuts down only. That's motabolism - well past any thinking of "perfectionism". Silverblade will have much to add I'm sure like p.......

 

[Hip]

Though the conclusions of this study are ludicrous, based on the idea that there are psychogenic causes for physical disease — an idea more appropriate to witchdoctors and ancient tribal medicine than modern 21st century science, the empirical finding of the study (namely that perfectionist traits are associated with ME/CFS) is likely valid, and this finding may be of relevance under an alternative interpretation. I will here offer such a alternative interpretation, based on an infectious etiology for perfectionism, as follows:

I can definitely attest to the fact that I had perfectionist traits long before I developed ME/CFS from a respiratory virus I caught.

I was always well aware of my perfectionist traits, and though they served me well in my professional life, I often speculated to myself what might make a person become something of a perfectionist. In my case, I concluded that adopting this perfectionist disposition was my strategy for coping with the bad memory and ADHD I always had. Perfectionism is an exaggerated focus in getting the details right and well-organized, and I believe this focus on detail and organization helps you to learn and remember the details when you have a bad memory and slow learning.

Now, given that many mental diseases and mental conditions such as ADHD are being linked to biochemical causes — particularly of late to infectious and brain inflammation-mediated causes — this makes me wonder whether my bad memory and ADHD (which led me to become a perfectionist) were themselves underpinned by some infection and inflammatory condition, much in the same way as ME/CFS is strongly linked to infectious etiologies and inflammation.

So, if I already had some infectious pathogen in my body, driving my bad memory, ADHD and perfectionism, this same pathogen might also predispose me to later acquiring ME/CFS. This would explain the statistical association between perfectionism and ME/CFS found in the study.

This alternative and better (even if I say so myself!) interpretation of the study's findings nicely explains this statistical association between perfectionism and ME/CFS in terms of them both being due to physical causes, most likely infection and brain inflammation.

 

[peggy-sue]

A respiratory tract infection CAUSED you to develop the personality trait of perfectionism?
I would very much doubt a causal relationship.

 

[Hip]

A respiratory tract infection CAUSED you to develop the personality trait of perfectionism?
I would very much doubt a causal relationship.

No, the respiratory virus (which soon spread to my stomach, intestines and various other mucous membranes, and also caused meningitis) appeared to be the trigger of my ME/CFS. (The same virus, incidentally, caused "ME/CFS-lite" symptoms in the 30 or so other people in my social circle who unfortunately also caught it.)


What I said was that long before my virally-precipiated ME/CFS, my ADHD and poor memory may themselves have been caused by some infectious pathogens acquired at a very early age. Perfectionism would probably not have been directly caused by such an infectious pathogen acquired at an early age, but, I suggest, perfectionism appeared as an appropriate learned response, as a way of dealing with my ADHD and poor memory. (Although there might also be a case for perfectionism being directly caused by infectious pathogens; that might make an interesting study, to see if there are such infectious associations. OCD is not entirely dissimilar to perfectionism, and 25% of OCD cases are thought attributable to Streptococcus sore throat.)

It is certainly known that ADHD and learning disorders are statistically associated with a range of pathogens: Streptococcus, Borrelia burgdorferi, febrile seizures due to HHV-6 or influenza A, as well as any viral infections during pregnancy and in early childhood. Ref: Etiologic Classification of Attention-Deficit/Hyperactivity Disorder.

 

[peggy-sue]

I have OCD too. I have always assumed that they are basically pretty much the same thing. Just folk use different words to describe it. Psychology is good at that sort of thing. Renaming something to pretend it's new.
And again, my OCD is because nothing I ever did was good enough. I just had to try harder and harder until "I did get it right".

I do not believe infections had anything to do with how I was "taught" to think or live.

 

[Firestormm]

I am a perfectionist. I have no trouble admitting to it. Is this like Alcoholic's Anonymouse?

I am perfecting my ability at trying to manage a life with my disability Oh and I don't have depression at the moment but any more of these bloody studies and I may well fall off that particular co-morbid cliff once again

 

[Hip]

I used to pretty interested in psychology years ago, including abnormal psychology. But it seems to me that throughout the whole history of psychology, very little success has been had in curing abnormal mental conditions, from anxiety to schizophrenia, using psychological interventions such as psychotherapy. (By contrast, research on normal psychology has proved pretty successful — which is why industries such as advertising often rely on psychological techniques.)

My experience of me and many friends catching a potent respiratory virus, and (in some cases) soon manifesting very severe mental symptoms like extreme anxiety and social withdrawal, has given me a lot of insight into the possible mental effects of chronic low-level infection.

This virus also manifested some clear physical symptoms in the people who caught it, so it was very obvious when someone had contracted this virus. But unfortunately in the case of many infections, the initial prodrome can be more or less asymptomatic, so you would not necessarily know that you have acquired a chronic infection.

Of course, in your case peggy-sue it may well be that your upbringing had significant impact on you developing perfectionist traits.

But how would you know if you had also asymptomatically acquired an infection in early childhood, that over the subsequent years precipitated some OCD/perfectionism in you — or at least played a part in precipitating these. You must have had a sore throat at least once as a child, and it is possible that you had a streptococcal sore throat that precipitated some OCD traits.

I think science needs to look much more closely at infectious causes of abnormal mental states. It may not always be the infection itself that precipitates mental or neurological symptoms, but downstream effects of the infection, such as aberrant immune function caused by the pathogen, as it manipulates our immune system (immune evasion, as it is called), and particularly autoimmune inflammation precipitated by the pathogen, which can be very damaging. Lots of infectious agents are known to ramp up autoimmunity. Streptococcus is thought to precipitate OCD by causing an autoimmune attack on the basal ganglia. The basal ganglia, incidentally, is often implicated in ME/CFS.

 

[kurt]

I think Hip has a good point, there could certainly be some common elements between perfectionism and CFS that are biological in nature, correlation is not cause, but it is still correlation. Take Rich's methylation cycle block hypothesis for example, that correlates well with both ASD illnesses and CFS/ME related illnesses. And ASD conditions, like ADD/ADHD, for example, can certainly include perfectionistic traits if the person leans towards the OCD side of things. The same biological factors can be driving both behavioral and biochemical issues. The brain is a biological unit, after all.

 

[GcMAF Australia]

In a similar thread I have been pondering that maybe I spend too much time using my brain, and that this is perhaps self defeating. I am wondering if others feel the same.
Certainly inflammation affects the brain.

 

[alex3619]

Though the conclusions of this study are ludicrous, based on the idea that there are psychogenic causes for physical disease — an idea more appropriate to witchdoctors and ancient tribal medicine than modern 21st century science, the empirical finding of the study (namely that perfectionist traits are associated with ME/CFS) is likely valid, and this finding may be of relevance under an alternative interpretation. I will here offer such a alternative interpretation, based on an infectious etiology for perfectionism, as follows:

You might like to read:
http://forums.phoenixrising.me/index.php?entries/evil-spirit-therapy-for-cfs-a-satirical-chant.732/
http://forums.phoenixrising.me/index.php?entries/the-witch-the-python-the-siren-and-the-bunny.1149/

 

[alex3619]

In a similar thread I have been pondering that maybe I spend too much time using my brain, and that this is perhaps self defeating. I am wondering if others feel the same.
Certainly inflammation affects the brain.

Physical reconditioning is hard, it takes a year or more to recover from severe ongoing problems. Some never do. However reconditioning the brain takes a lifetime. If we are cured we might never get our full mental faculties back. Its important to try to retain as much of that as possible. The question is: how?

Bye, Alex

 

[Whit]

I don't think that's true Alex. The brain is incredibly resilient. And there's lots of new connections being made like how to deal with difficult situations.

As for this study, who's to say there even is a correlation. They seem to be bad researchers from what I can see, making conclusions without enough evidence. This kind of thing is really the worst kind of science. Just because something "makes sense" or "sounds nice" doesn't mean it's true.

 

[alex3619]

Hi Whit, the brain does indeed have plasticity. Brain retraining however is specific and takes years to decades. We don't have that time. Also plasticity options decline from age two or so, and decline further from age six. You can be fairly sure you can build up muscles again, but not so the brain. A lot of the more advanced brain retraining options also require intensive medical assistance over long periods of time. Bye, Alex

 

[biophile]

There is a difference between "perfectionism" worsening the management of an illness vs patients with that illness being generally characterized by perfectionism. IIRC for CFS research, evidence for the former is not that convincing, and the latter has already been debunked.

On the issue of physical reconditioning, living with ME/CFS and post-exertional symptomatology is probably much harder than what sedentary but otherwise healthy people would go through during fitness programs. In other words, remove ME/CFS and most of us will not have much difficulty reconditioning compared to what we have already struggled through. In fact, bring it on! When the period of time enduring illness starts being counted in decades, one or two years of reconditioning sounds quick by comparison.

On the issue of mental reconditioning, I have no doubt that illness during my formative years has significantly stunted my intellectual development. It is difficult to judge how much is permanent loss and how much is an issue with cognitive impairment and stamina which would resolve with recovery. I like to think that even if I missed out due to developmental deficiencies, there is still enough left over to be useful when cognitive impairments and reduced stamina are removed.

How to retain as much as possible? I guess by keeping as engaged as we can without worsening symptoms too much. Keeping connected surely helps somewhat, particularly when examining the research and formulating posts, etc. Sometimes I have wondered if the extra effort required for mental activity during ME/CFS-related impairments is a form of training, the results of which would become apparent when illness is removed (eg we may find it surprisingly easier to do things when recovered, although perhaps we would quickly adapt back).

 

[Calathea]

So doctors spend years urging us to overdo it and chiding us for not doing enough, and then blame us if we internalise this pressure? They should, at the very least, insert the word "iatrogenic" into their hypothesis.