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"The prevalence and impact of early childhood trauma in Chronic Fatigue Syndrome"

Dolphin

Senior Member
Messages
17,567
J Psychiatr Res. 2013 May;47(5):664-9. doi: 10.1016/j.jpsychires.2013.01.021. Epub 2013 Feb 16.

The prevalence and impact of early childhood trauma in Chronic Fatigue Syndrome.

Kempke S1, Luyten P, Claes S, Van Wambeke P, Bekaert P, Goossens L, Van Houdenhove B.

Author information

Abstract*

BACKGROUND:

Although some studies have found high rates of early childhood trauma in Chronic Fatigue Syndrome (CFS), the role of early trauma in this condition remains controversial.

METHODS:

This study examined the prevalence of early childhood trauma and its impact on daily fatigue and pain levels over a 14-day period in a sample of 90 carefully screened CFS patients using a diary method approach.

Data were analyzed using multilevel analysis.

RESULTS:

More than half of the patients (54.4%) had experienced at least one type of early trauma, with the majority of these patients reporting multiple traumas.

Prevalence rates were particularly high for emotional trauma (i.e., emotional abuse and/or emotional neglect) (46.7%).

Moreover, total trauma scores and emotional abuse significantly predicted higher levels of daily fatigue and pain over the 14-day period, even when controlling for demographic features and depressed mood.

CONCLUSIONS:

This is the first study to demonstrate that early childhood trauma predicts increasing levels of core symptoms of CFS in the daily flow of life.

Moreover, findings of this study suggest that emotional trauma may be particularly important in CFS.
*I've given each sentence its own paragraph
 

Dolphin

Senior Member
Messages
17,567
I've just read this. I'm not sure I have any major thoughts that I wouldn't have been said before reading it.

I think recall bias is likely to be a big issue in the condition. I think this from my own personal experience where really relatively minor negative things that happened to me have come back to me since becoming severely ill. For example, I recall a neighbour complaining about us "playing ball" (probably curbs) on the road when I was around 10. There was no physical danger and I completely forgot about it and never thought about it again after that but it came back to me when I was ill. So I imagine people with ME/CFS who had the same experiences as somebody else might report it as a worse experience looking back.

Another reason why people might remember more events is one often has a lot of time to think and reflect with this illness including more likelihood of reminiscing about the past as there are often fewer things happening currently in one's life.

Also, one may search for reasons why one might have got ill and think hard about bad things in one's life that happened before becoming ill.

What was measured in this study were fatigue and pain. These are not perfect measures of severity of ME/CFS - they can be affected by reporting bias. Also, it seems quite possible that the direction of causation is in the other direction i.e. they found a correlation between fatigue or pain and trauma: one interpretation of this is that the trauma causes the fatigue or pain; an alternative possibility is the more fatigued one is or the more pain one feels, the more likely one will report trauma. This seems quite plausible to me (for the reasons mentioned above).

The authors haven't shown that any intervention in adulthood trying to deal with childhood trauma would make any difference to fatigue or pain levels, both for the reasons mentioned above or alternatively, that even if the trauma did have a true effect in the way they suggest, it may not be possible to reverse its effects now.
 
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Dolphin

Senior Member
Messages
17,567
One argument I've heard mentioned is Holocaust survivors weren't at increased risk of ME/CFS.

Also people in the past very likely faced more trauma than they do now. For example, corporal punishment in schools in Ireland anyway was the norm when my parents were growing up in the 1940s and 1950s, but is banned now, yet I'm not sure there is strong evidence anywhere (or even people postulating) that levels of the illness are dropping.
 
Messages
13,774
Yeah - retrospective with no control group with ill health makes it difficult to say much.

Also... I'd have thought a CFS diagnosis is likely to lead to more social problems than something like MS, due to the stigma, etc. People could be more likely to feel neglected/let down by others in a way which leads to them thinking more negatively of past events.

I did a quick google for MS and childhood trauma, and found a 2012 paper reporting a positive association. Retrospective too.

Psychosom Med. 2012 Apr;74(3):312-8. doi: 10.1097/PSY.0b013e31824c2013. Epub 2012 Mar 9.
Childhood trauma in multiple sclerosis: a case-control study.
Spitzer C1, Bouchain M, Winkler LY, Wingenfeld K, Gold SM, Grabe HJ, Barnow S, Otte C, Heesen C.
Author information
Abstract

OBJECTIVE:
To investigate the association between childhood trauma and multiple sclerosis (MS) by comparing histories of child abuse and neglect between patients with MS and adults from the general population in a cross-sectional case-control study. Previous research has demonstrated a connection between MS and a variety of emotional stressors, but childhood trauma, which is known to have long-lasting negative consequences for physical health decades into adulthood, has not been studied.

METHODS:
The self-reported Childhood Trauma Questionnaire for the assessment of emotional, physical, and sexual abuse and emotional and physical neglect was administered to 234 patients with definite MS and 885 adults from the general population.

RESULTS:
After adjusting for sociodemographic factors and current depression, patients with MS scored significantly higher in all Childhood Trauma Questionnaire subscales apart from physical abuse and neglect than adults from the general population. Adjusted odds ratios for these types of childhood trauma were higher in the MS group than in controls, ranging from 2.0 for emotional neglect (95% confidence interval = 1.3-3.2) to 3.4 for emotional abuse (95% confidence interval = 2.0-5.7). Although childhood trauma was not associated with the degree of current MS-related disability, patients with MS with histories of physical and/or sexual abuse had significantly higher relapse rates than patients without early-life stress.

CONCLUSIONS:
Our findings suggest an association between childhood trauma and MS in this cross-sectional study. Larger prospective longitudinal studies are needed to clarify the relationship between early-life stress and the risk for MS in genetically susceptible individuals.

http://www.ncbi.nlm.nih.gov/pubmed/22408134

Alternatively, here's a blog post on two studies which reports no association between trauma/stress and MS (I think, only skimmed): http://www.medpagetoday.com/clinical-context/MultipleSclerosis/26761

In a lot of ways, it seems perfectly plausible that placing additional strain upon people when they're brains and bodies are developing so rapidly would lead to a greater risk of health problems later in life... but also, it seems very difficult to really show that this is the case, and anyway, I'm not sure how useful this knowledge is likely to be. If MS is associated with childhood trauma, what would we do about that? We don't really need a reason to think that we should try to avoid traumatising children.
 
Messages
13,774
First author recently did this retrospective on RA:

J Psychosom Res. 2013 Apr;74(4):296-300. doi: 10.1016/j.jpsychores.2012.10.007. Epub 2012 Nov 10.
Gender-specific association between childhood trauma and rheumatoid arthritis: a case-control study.
Spitzer C1, Wegert S, Wollenhaupt J, Wingenfeld K, Barnow S, Grabe HJ.
Author information
Abstract

OBJECTIVE:
Rheumatoid arthritis (RA) has been associated with a variety of emotional stressors, but findings remain inconclusive if RA is related to childhood trauma, which is known to have long-lasting negative consequences for physical health decades into adulthood. We investigated the association between childhood trauma and RA by comparing histories of child abuse and neglect between RA patients and adults from the general population in a cross-sectional case-control study.

METHODS:
331 patients with definite RA and 662 gender- and age-matched adults from the general population were administered the self-report Childhood Trauma Questionnaire (CTQ) for the assessment of emotional, physical and sexual abuse as well as emotional and physical neglect.

RESULTS:
Adjusting for gender and current depression, RA patients scored significantly higher in all CTQ subscales apart from sexual abuse and physical neglect than the controls. Adjusted odds ratios for these types of childhood trauma were higher in the RA group than in controls ranging from 2.0 for emotional neglect (95% confidence interval [CI]: 1.4-3.0) to 2.6 for emotional abuse (95% CI: 1.4-4.7). Gender-specific analyses revealed basically the same pattern for women, but not for men.

CONCLUSION:
Our findings suggest an association between childhood trauma and development of RA, particularly in women. This relationship may be mediated by dysregulations of neuro-endocrine-immune networks, but larger prospective studies are needed to clarify the association between early life stress and the risk for RA in genetically susceptible individuals.

Looked like lots of other stuff too. I wonder how much you get paid for doing this sort of stuff?
 

Dolphin

Senior Member
Messages
17,567
Given the above studies, it is clear that there are additional biases, but it might not merely be recall bias, but participation bias too - those who have had early childhood trauma may be more likely to be help-seeking and more likely to want to participate in studies.
For what it's worth, this study had more females (93.3%) than one would normally see in studies or expect from the male:female ratio in the general CFS population.

The authors say:
"The influence of referral bias also needs to be considered, particularly since this study was conducted in a setting that is known as a "psychosocially" oriented CFS center. However population-based studies (Heim* et al., 2006, 2009) found similar rates of emotional trauma in CFS, and in a previous study we did not find substantial differences between patients attending the current treatment center and those attending a "biologically" oriented CFS center (Van Houdenhove, Van Hoof, et al., 2009)

*The Heim studies used the empiric criteria for CFS (2.54% prevalence, 38% of people with major depression w/o CFS can satisfy criteria, etc.) so I don't find them of much value.
 
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Martial

Senior Member
Messages
1,409
Location
Ventura, CA
I think that having issues with PTSD can cause immune system dysregulation which can make people more susceptible to getting pre disposed conditions that are inherited but I don't understand the full point of the article.. Is it stating that CFS is a form of PTSD or symptoms from severe stress that turned physical? Or that the trauma and stress triggered susceptible individuals to getting M.E./CFS?

I know my major flare of symptoms with Lyme disease occurred around the same time period of some trauma and very high emotional stress.. Though it could have been that I also picked it up around the same time, or that the lyme made me more overtly emotional and not able to handle stress as well... The major issues all were triggered after antibiotic reactions of herxing though and not the emotional stress alone..

It is pretty obvious to understand how stress and emotional trauma can make people have a lot higher chance of a lot of different physical illnesses, the changes in sleep alone can do this.. There is always going to be more then one component though and at least for people with M.E. it seems there is some pre existing issue with immune response, and immune hyper stimulation, to what underlying factor is the big mystery... Methylation issues seems to be a good one, as well as mold toxins, gut infections, certain phantom parasites or infectious pathogens, etc..

I would say if anything the immune dysregulation caused by severe emotional stress would just be the tipping point in pushing someone to a state of ill health, while previously having the body struggle very hard to deal with some underlying infectious issue, or genetic mutation, or whatever other issue possible lol
 

Simon

Senior Member
Messages
3,789
Location
Monmouth, UK
Funny how those other-illness studies state in the abstract that they have found an association but that longitudinal/prospective studies are needed to establish any causal relationship - but nothing wasmentioned in the CFS study.

Did they give effect-sizes and p values for the associaiton?
 
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Roy S

former DC ME/CFS lobbyist
Messages
1,376
Location
Illinois, USA

I hope papers like this don't cause psychological harm in innocent family members. The following earlier paper would seem to provide some contradiction, IMO.

Predictors of post-infectious chronic fatigue syndrome in adolescents
 
Abstract
This study focused on identifying risk factors for adolescent post-infectious chronic fatigue syndrome (CFS), utilizing a prospective, nested case–control longitudinal design in which over 300 teenagers with infectious mononucleosis (IM) were identified through primary care sites and followed. Baseline variables that were gathered several months following IM, included autonomic symptoms, days in bed since IM, perceived stress, stressful life events, family stress, difficulty functioning and attending school, family stress, and psychiatric disorders. A number of variables were predictors of post-infectious CFS at six months; however, when autonomic symptoms were used as a control variable, only days spent in bed since mono was a significant predictor. Step-wise logistic regression findings indicated that baseline autonomic symptoms as well as days spent in bed since mono, which reflect the severity of illness, were the only significant predictors of those who met CFS criteria at six months.
 
The full paper is here: http://www.tandfonline.com/doi/full/10.1080/21642850.2013.869176
 
 

Ren

.
Messages
385
I would like to see a paper which discusses the trauma of chronic medical negligence/abuse upon CFS/ME patients. (Additionally, at what point does it become embarrassing for psych people to keep producing the same-old same-old?)

Otherwise, I wanted to add that I watched a video sometime back with a doctor (and/or researcher) discussing RA, and he (as best I recall and understood) said something to the effect that individuals were considered predisposed to RA but that an environmental trigger(s) seemed influential in tipping the scales.

The environmental trigger that he emphasized though was smoking, and he seemed excited bc he said the rates of RA were decreasing as smoking became less common. He could be wrong - I could be wrong - but I was left with the impression that zeroing in on smoking had been a big success for RA prevention.

I think (but am not sure) that he also mentioned something about how individuals who survived for example the early 20th century flu pandemic (or even polio later perhaps) may have had a stronger/more active (word choice?) immune system - and that increases in autoimmue diseases now could be related to some type of past selection process bc individuals with certain immune-system characteristics were more likely to have survived such pandemics and had children/grand-children/etc. until here we all are.

I thought I had bookmarked the above info, but when I looked for it recently, I couldn't find it. I've been meaning to ask about it on PR though because I was curious if those among us who are good with science might know something about it. The "it" being how past generations' exposures can affect future generations. Thanks for any additional thoughts.
 
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Ren

.
Messages
385
@Roy S - thank you for sharing the paper above.

It seems to go well with a 2006 study that's been posted by CDC which also determined, "The syndrome [PVFS] was predicted largely by the severity of the acute illness rather than by demographic, psychological, or microbiological factors." http://www.bmj.com/content/333/7568/575
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
I would like to see a paper which discusses the trauma of chronic medical negligence/abuse upon CFS/ME patients. (Additionally, at what point does it become embarrassing for psych people to keep producing the same-old same-old?)

Otherwise, I wanted to add that I watched a video sometime back with a doctor (and/or researcher) discussing RA, and he (as best I recall and understood) said something to the effect that individuals were considered predisposed to RA but that an environmental trigger(s) seemed influential in tipping the scales.

The environmental trigger that he emphasized though was smoking, and he seemed excited bc he said the rates of RA were decreasing as smoking became less common. He could be wrong - I could be wrong - but I was left with the impression that zeroing in on smoking had been a big success for RA prevention.

I think (but am not sure) that he also mentioned something about how individuals who survived for example the early 20th century flu pandemic (or even polio later perhaps) may have had a stronger/more active (word choice?) immune system - and that increases in autoimmue diseases now could be related to some type of past selection process bc individuals with certain immune-system characteristics were more likely to have survived such pandemics and had children/grand-children/etc. until here we all are.

I thought I had bookmarked the above info, but when I looked for it recently, I couldn't find it. I've been meaning to ask about it on PR though because I was curious if those among us who are good with science might know something about it. The "it" being how past generations' exposures can affect future generations. Thanks for any additional thoughts.

This is called epigenetics and is of growing scientific interest.
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
I would be much happier with published studies on links between stress and illness carried out by biological scientists rather than by psychologists and published in psychology/psychiatry journals.

I suffered numerous life events and family stresses that are almost-guaranteed to cause problems both in children and in the adults that they become. These were not minor things - much worse than being told off or physically chastised - they are things that would commonly be described as likely to 'scar' a person for life. A small straw poll of ME sufferers that I conducted in a forum (obviously can't be viewed as proof of anything) found a high proportion of respondents with similar stressors - early separation from, and/or loss of, a mother or father, physical or emotional abuse or neglect from relatives, marital stress in parents, and often several of these factors combined.

It seems to be accepted fact that chronic stress causes abnormalities in the stress hormone and immune systems, although the evidence is perhaps not as good as it could be. The pattern may be:
  • Chronic stress raises cortisol levels for too long.
  • Chronically-elevated cortisol levels depress the immune system.
  • The stress hormone system then becomes exhausted and cortisol levels become abnormally low.
  • (Parts of) the immune system then rebound, resulting in chronic inflammation and an increased risk of autoimmune disease.
There is an article on stress and immune dysfunction in carers here:

http://psychcentral.com/news/2008/08/28/chronic-stress-genetically-alters-immune-system/2841.html

As a number of people here do not think that they have suffered sufficient early stress for that to be a factor in their illness, there are likely different patterns of causation. One of the many grounds on which to subgroup sufferers?

The fact that people who have lived through horrific events such as the Holocaust do not all get ME suggests that there are other risk factors, perhaps genetic or epigenetic or even congenital/resulting from effects in the womb.
 
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Iquitos

Senior Member
Messages
513
Location
Colorado
Consider the source: Journal of PSYCHOSOMATIC "research."

They are just trying to justify their existence. They might as well be reading tea leaves or chicken entrails.

These are the very people who insisted that polio, ulcers, epilepsy and even cancer (in the case of Freud) were pyschosomatic. They are vultures hanging around any medically unexplained illness, hoping to pick off a few patients and a lot more research dollars. What a waste!

I think they should all be committed to a mental institution as a danger to themselves or to society. ;-)
 

SilverbladeTE

Senior Member
Messages
3,043
Location
Somewhere near Glasgow, Scotland
1) the psychosomatic scum, they are voodoo superstition degenerates, won't give them respect, are desperate to hold us to justify their egos and income.
To hell with them

2) M.E. may or may not be linked to stressors, but I would only trust truly neutral research
however, as I have pointed out, you are far more likely to meet socially adept, driven, intelligent, compassionate etc in forums such as these!
Where as, many who have very ow self esteem, intelligence, too much despair, or are very quiet or whatever will not be heard, so you will not see a true representation of M.E. patients!

It's like going to a music festival of a specific type (jazz, rock etc) and saying "Ok the folk around mere are a true representative of fans of that genre"
Wrong! many will not have come, it may be a local event with local tastes, lost of folk don't like public events, some prefer live but others prefer studio music, etc etc

and note this: those who have suffered abuse but survived as *people*, fought back, over came it etc, are usually very bloody driven, strong willed people.