Childhood stressors in the development of fatigue syndromes: a review of past 20 years of research

[Dolphin]

This was highlighted elsewhere on PR. I thought I'd give it its own thread so it can be found easier in future (rather than being a big fan of this angle)

Childhood stressors in the development of fatigue syndromes: a review of the past 20 years of research

Psychological Medicine / FirstView Article pp 1-15Copyright
DOI: http://dx.doi.org/10.1017/S0033291713002468 (About DOI),
Published online: 07 October 2013

A. Borsinia1, N. Hepgula1, V. Mondellia1, T. Chaldera2 and C. M. Pariantea1 c1

a1 Section of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK

a2 Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK
Abstract

Background

Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are both highly prevalent conditions associated with extreme disability and with the development of co-morbid psychiatric disorders, such as depression and anxiety.

Childhood stressors have been shown to induce persistent changes in the function of biological systems potentially relevant to the pathogenesis of both CFS and FM, such as the inflammatory system and the hypothalamic–pituitary–adrenal (HPA) axis.

In this review, we examined whether multiple forms of childhood stressors are contributing factors to the development of these disorders, and of the associated psychiatric symptoms.

Method

Using PubMed, we identified 31 papers relevant to this narrative review.

We included cohort studies and case-control studies, without any exclusion in terms of age and gender.

No study characteristics or publication date restrictions were imposed.

Results

Most studies across the literature consistently show that there is a strong association between experiences of childhood stressors and the presence of CFS and FM, with rates of CFS/FM being two- to three-fold higher in exposed than in unexposed subjects.

We also found evidence for an increased risk for the development of additional symptoms, such as depression, anxiety and pain, in individuals with CFS and FM with a previous history of childhood stressors, compared with individuals with CFS/FM and no such history.

Conclusions

Our review confirms that exposure to childhood stressors is associated with the subsequent development of fatigue syndromes such as CFS and FM, and related symptoms.

Further studies are needed to identify the mechanisms underlying these associations.

(Received March 11 2013)
(Revised August 29 2013)
(Accepted August 31 2013)

Key words
Anxiety; childhood abuse; childhood maltreatment; chronic fatigue syndrome; chronic pain; depression; fibromyalgia; stress

Correspondence

c1 Address for correspondence: Professor C. M. Pariante, Section of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Institute of Psychiatry, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK.

 

[Esther12]

We also found evidence for an increased risk for the development of additional symptoms, such as depression, anxiety and pain, in individuals with CFS and FM with a previous history of childhood stressors, compared with individuals with CFS/FM and no such history.

I started thinking about this, then decided it wasn't worth cajoling my tired mind over. So much of the research in this area seems really weak and, even if valid, uninteresting, particularly given the nature of CFS as a diagnosis.

 

[biophile]

I started thinking about this, then decided it wasn't worth cajoling my tired mind over. So much of the research in this area seems really weak and, even if valid, uninteresting, particularly given the nature of CFS as a diagnosis.

Me too Esther. It is disappointing that they did a narrative review not a systematic review. No mention of caveats in the abstract. Recall bias is a major problem in retrospective research on people who are suffering now.

Some of the CFS stress research was done using the notorious Reeves definition which saw prevalence estimates skyrocket by an order of magnitude.

There is also research into chronic pain which suggests that the association with stress tends to show up in retrospective research but not prospective research, even in the same group of people being studied.

CFS and FM are wastebasket diagnoses, and I'm betting this review does not consider issues with defining these entities.

 

[WillowJ]

NB:

http://www.ncbi.nlm.nih.gov/pubmed/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.

A closer examination of individuals in the chronic fatigue syndrome group revealed that significantly fewer individuals with CFS reported abuse as compared with those who did not.

It's worth having other illness controls and trying to diagnose ME, ME/CFS, or CFS compared to CF/ICF. Which probably most of the articles in that review did neither (educated guess; I didn't look).

As biophile mentioned, an example from FM:

http://www.ncbi.nlm.nih.gov/pubmed/23323642

There were no statistically significant relations between the health measures (disability, physical and mental health, and pain) and the PTLE [potentially traumatic life events].
...
There were significant differences across causal attribution status in the PTLE in childhood (F(2,47) = 3.590; p = .035; η2 par = .133), specifically between the group that made a psychological attribution and the group that made no attribution (C.I. 95%) 0.1805; 14.0468; (p = .043), with the former having a higher score of PTLE in childhood.

 

[Sean]

I would like to ban narrative reviews. They are nothing more than an excuse to cherry pick.

 

[peggy-sue]

Abuse in childhood results in a person who suffers from higher levels of stress far more in daily life than those who were not abused - they have had their abilty to trust in people messed around with,


They don't understand love or what it is. They most certainly don't feel they deserve it.

They do not know what "normal" is - they have never experienced it, but they spend their lives trying to pretend they are "normal".

Often, they get their ideas of "normality" from tv shows or books - not very reliable accounts!



Stress is very bad for ME.

It's just a double whammy for these folk.

 

[Roy S]

Meta-garbage in -- meta-garbage out?

Did they review this paper by Taylor and Jason?
http://www.ncbi.nlm.nih.gov/pubmed/11708672#
　
"A closer examination of individuals in the chronic fatigue syndrome group revealed that significantly fewer individuals with CFS reported abuse as compared with those who did not."

 

[peggy-sue]

Hmmmm...
This statement is not exactly clear about how the papers for review were selected - it can be read to mean that they only cherry-picked ones which supported the finding they wanted...

"In this review, we examined whether multiple forms of childhood stressors are contributing factors to the development of these disorders, and of the associated psychiatric symptoms."

 

[peggy-sue]

I cannot find their references - their "key words" are stated to be;

• Anxiety;
• childhood abuse;
• childhood maltreatment;
• chronic fatigue syndrome;
• chronic pain;
• depression;
• fibromyalgia;
• stress

Pubmed seems to be offline right now - I can't stick the keywords into a search to see if more than 31 papers come up.

My personal opinion is that all "meta-analyses" should be scrapped.
They are just garbage-in = garbage-out.

 

[Snow Leopard]

Yes they did include the Jason study and they claim it provided positive evidence for the association between childhood stressors and CFS!

They cite a previous meta-analysis of child abuse in general.

One risk factor suggested as being relevant to the onset of these disorders is the occurrence of childhood stressors. Childhood stressors, especially maltreatment and abuse, are highly prevalent in the general population: for example, a 2009 meta-analysis, examining 65 studies from 22 countries, reported the global prevalence of childhood sexual abuse (CSA) as 19.7% for females and 7.9% for males (Pereda et al. 2009). In addition, a UK survey of 2869 young adults found that maltreatment (both intra- and extra-familial) was experienced by 16% of the sample, with 11% of respondents reporting experiences of more severe forms of sexual abuse (May-Chahal & Cawson, 2005)

Only 10 studies were included for CFS and only eight of them were investigating CFS, the other two were investigating Bipolar disorder and Migranes!

The problem is that there are selection biases for participation in case-control studies (those who have suffered more stress/abuse are more vocal and more likely to want to participate), along with reporting biases. Some patients may falsely attribute childhood stress as a causative factor because it is one of the common narratives in our society and may answer accordingly.
Some of the prospective/longitudinal cohort studies could control for this, but the cohort studies have massive methodological issues of their own, with self-report diagnoses at best and questionnaire based answers being used as evidence for suffering from "chronic fatigue" at worst.

Where is Ioannidis when you need him?

The first study by Van Houdenhove et al. (2001) demonstrated that CFS or FM patients had a lower prevalence of childhood victimization, including CSA, when compared with RA/MS patients and healthy controls. This inconsistent result may be attributed mainly to the administration of a specific questionnaire when assessing experiences of CSA, the Questionnaire on Burdening Experiences, which has not been validated according to international standards.

Oh and questionable references eg:

The first such mechanism is inflammation, whereby childhood stressors lead to increased inflammation and the subsequent development of CFS (Maes & Twisk, 2010).

Yes, that Maes and Twisk paper. "Harvey and Wessely's (bio)psychosocial model versus a bio(psychosocial) model based on inflammatory and oxidative and nitrosative stress pathways."

They then mention a highly questionable HPA-axis based hypothesis and then go on to claim that the association of childhood stress with fatigue is mediated by cytokines and associated inflammation. (I guess they liked the Maes/Twisk paper after all)

PS, the word 'bias' was not used in the review at all. They did however mention:

One of the main limitations of our review is that the quality of the findings varied across the studies reviewed. Indeed, many of the studies, being case-control, were empirically weakened by the inability to examine cause and effect in the relationship between childhood abuse and CFS or FM. There was also no uniformity in the diagnostic criteria used for the assessment of childhood abuse and other clinical symptoms. Furthermore, sample sizes were often small and several studies did not include a control or a comparison group.

They finally conclude with.

Demonstrating a causal relationship between childhood abuse and an increased risk for the development of CFS and FM could have significant implications in terms of raising awareness, targeting more vulnerable individuals and identifying biological mechanisms underlying this putative causal relationship. Finally, it is important to note that these biological mechanisms, such as low cortisol, are potentially reversible as has been shown in a previous study of CBT (Roberts et al. 2009).

So in conclusion, it is a narrative review of questionable validity due to the lack of underlying evidence in all respects.

 

[SilverbladeTE]

Abuse in childhood results in a person who suffers from higher levels of stress far more in daily life than those who were not abused - they have had their abilty to trust in people messed around with,


They don't understand love or what it is. They most certainly don't feel they deserve it.

They do not know what "normal" is - they have never experienced it, but they spend their lives trying to pretend they are "normal".

Often, they get their ideas of "normality" from tv shows or books - not very reliable accounts!



Stress is very bad for ME.

It's just a double whammy for these folk.

I have to disagree with the way you describe abused kids and how that affects them
abuse, family backgrounds/culture etc, person's own mental/physical strengths/weaknesses and many other things all have major impacts on outcome
I wasn't sexually abused, nor was may Dad a cruel or cold blooded person, he'd just have complete psychotic rage breaks at the drop of a hat
when I was little (4 or 5?) I got a simple sliding bolt lock put on my door, I felt safe, it was my talisman to keep out the bogeyman....until he smashed the door down to get at me.
yet, as said he not a cruel person in fact he was kind, just very very messed up by awful things he had suffered
difference is, my mum was very loving and kind, her folks were very warm, full of *good* laughter (at self, enjoyment, not at other people's expense) etc (Dad's sister is a laugh riot, a great person but lives elsewhere, his mum was a cold person, not cruel or unkind just...distanced, but nto surprising again she had suffered)
that kindess, great friendship, warmth with rest of my folks made a huge difference to me, THAT is what can stop folk becoming utterly broken

so yes, that and other stuff has left me with real issues, but it wasn't until I had this damn illness bad for years that I got cranky, less compassionate at times, difficulty empathizing, etc.
as a kid I loved making new friends, yes it was not easy dealing with the constant fear and anxiety, but I was determined not to let it get me down and thank God I was warm hearted person by nature.
I recall when I was about 8, really getting uptight thinking if I avoid the cracks on the pavement all will be well...and even as a kid I knew this was bad wasn't just silly was a route to a ugly path and fought against that because I wanted peace so bad
etc.

I am a VERY passionate, I both senses of the word. lol it's kind of funny, the bullying I got at school was outrageous. I was very intelligent, logical about some things and gentle, bullies are about finding those who are different, because different = not part of the herd = easy victims
I have pointed ears...so the nickname "Spock" became associated with cruelty and bloody sadism, the ironic thing is the fictional Vulcan race were so stoical because they didn't want to unleash their destructive passions...same with me
though I enjoyed the emotional spectrum as to cut that out is to no longer be Human, no joy ugh, but I had huge fear/abhorrence of becoming like my Dad, losing control, a rampaging monster
But when the assholes did inally push me to far, I went bloody berserk on 'em, difference was I could limit it
hence the "Spock" nomeclature was very apt in the end
somewhere, someone is laughing at we silly Humans

So I really resent these useless bastards as usual blaming the victim, not doing their damn jobs, not doing their OWN research
this bastard illness they should have worked on treatments for, has shaken up and unlocked al my "Pandora's boxes" so I keep having to think/deal with shit I had put away years ago. Put away with the good therapy of going fishing, being creative, keeping myself fit etc not their damn crap and pills.
not saying a GOOD psychologist cannot help, or that some medication doesn't help some folks, as they do help *some*. Merely IMHO, most of psychiatry is absolute bollocks!

I do realize there are folk worse than me, some of you poor souls are bed bound or suffered sadistic abuse as kids etc, but dear God I am so sick and tired of this nightmare, one or other woe would be bad enough but not both
sigh

 

[peggy-sue]

Hiya Silverblade!

You are perfectly correct to correct me.

How it all works out does depend on the dynamics of the relationships and how each individual reacts.

And if there are other relatives around who can offer some real unconditional love, the benefits of that cannot be underestimated

I wasn't sexually abused either - but I had a very weird mother. Total narccissist, alcoholic, and misogynist, I was the "scapegoat". Dad was an alcoholic too - driven to it by her.
She ruled the roost; we all had to pretend everything was normal and that we didn't even know they drank.
They sat in two different rooms, watching the same tv programmes.
Communication sometimes happened when essential, by them leaving notes for each other on the hall table.

Mother took the credit for anything I ever did achieve, but anything less than perfection and I was derided as being "Your father's daughter, nothing to do with her."

Love was not unconditional.

In fact she was weird about that too - she'd get plastered and start staggering around the house wailing and shrieking

"There is so much love!" and "You hurt me so much when I gave you life."

She made out she had this overriding misery in her life and it was all my fault.

I spent my childhood trying to work out what on earth I could have done, or what it was I was doing wrong, how on earth could I solve this problem of mother's dreadful misery?

I did discover, years later, what her "misery" was.

Dad wasn't rich enough. She wanted her best friend's husband. (She'd have had him too, if he had co-operated.)
She wanted a "title".

I don't want kids. Never have. She wanted me to have a baby to give it to her to look after.

The first time she met my OH, she took him aside and told him in secret; "She's never been "right", you know."

Getting the jitters just thinking about her!

 

[Mij]

Neglect is also a form of abuse, it actually changes the structure of a developing brain. I watched a program on this and they showed the differences in fMRI's, normal brain and abused brain.

SilverbladeTE your father sounds like mine. I finally realized later in life that he had a personality disorder from being neglected as a child. My mother's family was like your mother's family, warm, loving etc, I think this is what saved me as a child. My older sister on the other hand also developed a personality disorder.

 

[peggy-sue]

It really saddens me to see how globalisation has completely destroyed the reality of the large extended family all living close to each other - lots of aunts and uncles, cousins, grandparents around, for so many.

It's a very healthy atmosphere to grow up in. Lots of adults to love all the kids - so if one of the adults does fail, there are other to support and take up the slack -or at least to let the child know their parent was wrong.

Without that, the only source for the child is the failing adult - and a child places total trust in its parents.

Neglect is a truly vile form of abuse. Sexual abuse is not the only devastating kind.
But it does make titivating and lurid headlines.


I'm still trying to get to grips with the fact that I have been "adopted" by Michael's family - a (nearly-normal, ) but most importantly, loving and affectionate family. I can't quite believe that my "dream" has finally come true.

 

[Roy S]

Since fibromyalgia is included in this there is a recent paper with explanations on CBT's for FM on Prohealth showing some very small improvements.
　
Effectiveness of Cognitive Behavioral Therapies for Fibromyalgia: A Review
　
http://wwwprohealthcom/library/showArticle.cfm?libid=18379

Perhaps one of the more scientifically respected members would start a new thread? Perhaps with a title like "CBT's -- Honest Analyses

 

[kaffiend]

I was neither abused nor neglected as a child yet have CFS. Therefore childhood abuse is neither a necessary nor sufficient condition for the development of CFS.

As the biological evidence builds, the serious minded researchers will see these meta-analyses for what they are: Junk science.

 

[Esther12]

Since fibromyalgia is included in this there is a recent paper with explanations on CBT's for FM on Prohealth showing some very small improvements.
　
Effectiveness of Cognitive Behavioral Therapies for Fibromyalgia: A Review
　
http://wwwprohealthcom/library/showArticle.cfm?libid=18379

Perhaps one of the more scientifically respected members would start a new thread? Perhaps with a title like "CBT's -- Honest Analyses

Thanks. That link seemed broken, but this one works: http://www.prohealth.com/library/showArticle.cfm?libid=18379

I thought that I had seen that discussed on here already, but maybe not.

You can get the full text free here: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009796.pub2/abstract

 

[alex3619]

Meta-analyses do not have to be junk science, but often are. If the underlying science is well defined, the evidence is objective, then a meta-analysis improves the statistical examination of the data. Yet if the underlying science is more pseudo- than science, has highly subjective data, aimed to confirm their conclusions without testing them, or based on layers of unproven hypotheses (which the psychiatric pseudoscience known as psychogenic medicine is) then there is nothing substantive to put in the meta-analysis. So GIGO it is. Systemic bias just gets amplified in meta-analyses.