Professor & patients' paper on the solvable biological challenge of ME/CFS: reader-friendly version
Simon McGrath provides a patient-friendly version of a peer-reviewed paper which highlights some of the most promising biomedical research on ME/CFS ...
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Effects of early childhood trauma on HPA axis function in CFS patients

Discussion in 'Latest ME/CFS Research' started by Simon, Mar 17, 2015.

  1. Simon

    Simon

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    Effects of early childhood trauma on hypothalamic–pituitary–adrenal (HPA) axis function in patients with Chronic Fatigue Syndrome -
    Psychoneuroendocrinology - Kempke Feb 2015


    Decent study but reporting of findings are wishful and overstate case
    Actually, think it would be more accurate to say that this study provided significant evidence against the idea that childhood trauma plays a role in CFS via HPA axis dysfunction. I will try to explain why I think the authors have missinterpreted their findings, but first the full abstract:

    ABSTRACT

    BACKGROUND:
    There is a paucity of studies that have investigated the assumption that early childhood trauma is associated with hypothalamic-pituitary-adrenal (HPA) axis dysfunction in Chronic Fatigue Syndrome (CFS). The current study is the first to simultaneously investigate relationships among early childhood trauma, cortisol activity, and cortisol stress reactivity to psychosocial stress in a sample of well-screened CFS patients. We also examined whether self-critical perfectionism (SCP) plays a mediating role in the potential relationship between early trauma and neurobiological stress responses.

    METHODS:
    A total of 40 female patients diagnosed with CFS were asked to provide morning saliva cortisol samples (after awakening, 30min later, and 1h later) for seven consecutive days as a measure of cortisol activity. In addition, patients were exposed to the Trier Social Stress Test, a well-validated stress test, to investigate the relationship between early childhood trauma and cortisol stress reactivity. Before the start of the study, patients completed the Childhood Trauma Questionnaire-Short form (CTQ-SF) as a measure of early childhood trauma (i.e. sexual, physical and emotional traumatic experiences). SCP was measured with the Depressive Experiences Questionnaire (DEQ). Data were analyzed by calculating several indices of cortisol secretion (i.e. Cortisol Awakening Response and Area Under the Curve).

    RESULTS:
    There was no association between early childhood trauma and cortisol as measured over the 7-day period. However, emotional neglect was significantly negatively related to cortisol reactivity in the TSST. SCP did not significantly mediate this association.

    CONCLUSION:
    Findings of this study suggest that emotional neglect is associated with blunted HPA axis reactivity, congruent with the assumption that CFS may reflect loss of adaptability of the neuroendocrine stress response system in at least a subgroup of patients.
    ========

    First off, in my view this is a perfectly reasonable study to run. There is some evidence of a link between childhood trauma and CFS (though it's compromised by issues over diagnosis and case definition, and at best would only explain a minority of cases). The idea is that childhood trauma affects the HPA axis which in turn increases the risk of a number of illness - mostly psychological, they say, but some physical too. They set out to see if daily cortisol levels (cortisol is a stress hormone intimately involved in the HPA axis) were linked to childhood trauma in a sample of 40 adolescent patients. In particular they wanted to see if cortisol response was blunted (diminished) both on waking in the morning (when it naturally increases) and in response to a stress test - as a way of seeing if the HPA axis wasn't working as it should. So far, so good.

    However, they made a series of findings that undermined their theory, yet still concluded the theory was supported. Which made me wonder what the purpose was of doing the research.

    ... continued below
     
    Last edited: Mar 18, 2015
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  2. Simon

    Simon

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    Cortisol awakening response over 7 days - no link to trauma
    A strength of the study is that they measured cortisol response in the morning 7 days running. They said this is important as cortisol response varies a lot from day to day (previous studies only measured samples on a single day) but the effect of childhood trauma would be long-term, and so cortisol is better measured over a longer period for reliable results.

    In contrast with earlier studies, this one found no link between any of the five measures of childhood trauma (see graph below) and cortisol awakening response. Which is evidence against their main hypothesis:
    Don't forget that the authors specifically ran a 7-day test as they say single-day tests are not a good way to measure the association with trauma. So, using a new and better methodology they refuted the earlier findings of a link.

    Not much trauma in this sample
    Perhaps one reason they struggle to pick up an effect is that the levels of trauma in these patients is quite low, casting doubt on the idea that the illness is the result of trauma:
    upload_2015-3-17_10-8-4.png


    Link between cortisol response to a stress test and childhood trauma?
    The authors' other hypothesis was that there would be a reduced, and they said
    1. Risk of false positives due to many comparisons
    The authors looked for a correlation between 5 diffferent types of childhood trauma (see graph) and three different measure of cortisol response, fifteen comparisons in all. This is like having 15 bites of the cherry, increasing the chance of false positives: the standard significant test of p<0.05 used in this study is for a single comparison, and should have been adjusted to reflect so many comparisons. If it had been, it's unlikely either positive result (both for emotional neglect, p values of 0.021 and 0.029) would have reached significance.

    2. Healthy people have a similar relationship between cortisol response and trauma scores
    Which sugggests that even if they did find a significant relationship between cortisol response to a stress test and childhood trauma, it wouldn't explain why people were ill.

    So overall the results are:
    - low levels of childhood trauma
    - lack of blunted cortisol response on awakening (disproving their first hypothesis)
    - dubious connection with the stress test, their second hypothesis (which even if significant also applies to healthy people)

    Which you might expect to lead the authors to at least reconsider their views on the role of childhood trauma in the illness. Not so:
    I think they may have overstated their case. Edit: And while I support their right to follow whatever hypothesis they wish, theres not a whole lot of point in doing research if you then ignore inconvenient findings.
     

    Attached Files:

    Last edited: Mar 20, 2015
  3. A.B.

    A.B. Senior Member

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    Another thing with this type of studies is that reduced HPA axis function might make people more prone to a gloomy anxious mood. Cortisol is known to improve mood. This could easily affect how they respond to questionnaires. "emotional abuse" and "emotional neglect" are much more open to interpretation than the other scores.
     
  4. Gijs

    Gijs Senior Member

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    I have ME/CVS/SEID and POTS, i didn't have any (childhood) trauma at all. The only trauma people with ME get is from doctors and psychotherapists who don't believe them and think it is all in their mind and start a process called gaslighting (mental abuse). Also getting no help from social security and the society or family can cause a big trauma.
     
  5. user9876

    user9876 Senior Member

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    There is a semantic game being played with these questionnaires. It is something that worried me in the PACE mediation study. They ask questions and then they attach labels but sometimes the questions could have other interpretations. One example is the HADS scale where they assume that doing less is a sign of depression rather than physical illness.

    In addition there are many statistical problems associated with just adding up question scores and assuming linearity.

    It would be nice to see scatter plots for these things as well as outliers can cause issues.

    What may be much more interesting than what they present is their 7 days cortisol testing. What is the variation, can it be explained in terms of daily activity levels (and is it a leading or lagging indicator). How do the levels compare with healthy people. If there is a lot of variation anyway then it may be hard to conclude much.
     
  6. duncan

    duncan Senior Member

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    Simon: "First off, in my view this is a perfectly reasonable study to run."

    Yeah, I'm going to have to disagree with you on that particular opinion.

    The premise of the study begs the question of whether psychology is the predominant variable in the CFS equation. The title alone comes precariously close to assuming there is a psychological etiology to CFS. Certainly, the execution of the study in some regards validates the myth.

    As I read the study, I felt like I'd just been courted by a cigar-puffing used car salesman, assumptive close and all.

    That these studies even exist does us a disservice. Each one should be protested as an injustice.

    Don't fool yourself for a second that even when they fail to establish a correlation, that these studies still do not levy enormous injury against our community. Their mere presence, the fact they were undertaken, reenforces the myth that our problems spring from some psychological phantom, are not real, and have no legitimate claim to "disease" in the supposition of their persistence.
     
  7. Jon_Tradicionali

    Jon_Tradicionali Alone & Wandering

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    I'm not sure why you feel that way.

    HPA axis has long been implicated with CFS.
    A study to investigate the HPA axis in patients is something I'd even donate to support.

    The HPA axis is located in the midbrain and compromises of three glands which affect and regulate the body in vast number of ways.

    You really think studies linking dysfunction of the midbrain with CFS/ME are redundant?
     
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  8. duncan

    duncan Senior Member

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    That is not what I wrote.

    I said studies trying to promote psychological mechanisms as being behind CFS, are not only misguided but harmful.

    Wanna take a guess at how many clinicians and even researchers will not even read the abstract, much less the actual study results, and just draw their opinion based on the title and the fact it is a psychological profile or effort??
     
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  9. Jon_Tradicionali

    Jon_Tradicionali Alone & Wandering

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    You disagreed with the need of this study to even be carried out...?

    I understand where you're coming from. We do need to veer away from psychology as much as possible.

    But I don't see how studying whether excess early trauma (which is when the brain is of high plasticity and easily influenced) can trigger a biological dysfunction of the brain can harm our community.
     
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  10. duncan

    duncan Senior Member

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    Because the trauma is emotional trauma, and not physical. And because I do not think it an honest exercise within ourselves to ignore the position of the authors, the assumptions they employ, and the particular contrived prism through which they view us.

    I believe many of these psych endeavors are not about pure Science and genuine scientific inquiry. I fear many are riddled with a deep-rooted and mortally flawed bias in their conception, prior to the reaching the press. Intent taints their authenticity.

    I think to turn a blind eye to these potential factors is dangerous and enabling.

    Plus, they are flat out wrong.
     
    Last edited: Mar 17, 2015
  11. A.B.

    A.B. Senior Member

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    These psych studies are done to promote certain views, not to study nature. At least that's my impression.

    I read elsewhere that psych studies come to the conclusion they wanted in 90% of cases. Basically psych studies are mostly a formality to keep up the appearance of science.
     
    Last edited: Mar 17, 2015
  12. Sidereal

    Sidereal Senior Member

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    Neat study. Further evidence that childhood trauma plays no causative role in ME/CFS. Discussion (as usual) betrays the researchers' biases and a lack of understanding of their own results but that's par for the course in psychology really.
     
  13. Cheshire

    Cheshire Senior Member

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    The problem is not with studying brain dysfunction in ME/SEID.
    The issue is that the title voluntarily implies that a psychological component is playing a great role in CFS, a view at odd with the finding of this study.
    It's at best awkward, and certainly dishonnest.
     
  14. aimossy

    aimossy Senior Member

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    I think Simon's clear skill and ability to break down research like this is invaluable. He is able to objectively analyse the science within these research papers, which often shows the bias. He clearly has serious skill in this area and I don't think he is fooled for a second that they don't do damage, which is another important reason to have good critique of these papers.
     
  15. Jon_Tradicionali

    Jon_Tradicionali Alone & Wandering

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    Right, sure I can certainly see that aspect.

    Personally, anything implicating the brain with CFS/ME is of high interest and will always have my attention. If there is a psychological component, then that's unfortunate, but I won't dismiss the study without reading it's biological basis.
     
  16. Snowdrop

    Snowdrop Rebel without a biscuit

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    I can't count the number of times in the past I've seen questionnaire responses interpreted in a most convenient way. Each time from my own experience I found that there were potentially other very sound and valid reasons for a very different interpretation. Results from these types of studies blur the lines between psychology and creative writing.

    Yes, but protest how and to whom? With so little energy resources we need to focus and precisely target a response.

    There is a constant flow of psych research subverting legitimate avenues of investigation into this and other illnesses.
    Even when there is solid biological evidence the psych industry will co-op the physical findings to suggest that they originate from psychological issues.

    If only there was some way to unmask psychobabble as a self fulfilling prophesy. The interpreter imposing their will/POV on the data.
    How about a research study that suggests that those who are drawn to psychology (clinical and research) as a profession are drawn there due to a need to sort out their own traumas/issues/confusions/problems.

    (A small caveat--I have known personally several psychologists of various stripes. Once in a while there is a good apple in what is generally a bad batch. When dealing with the heady emotions of 'fixing' someone else it takes exceptional maturity. If my very basic understanding of statistics is anything to go by the sheer number of psych practitioners would not likely be capable of drawing only on the exceptional.)
     
  17. duncan

    duncan Senior Member

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    In my opinion, a group of qualified ME/CFSers should form an organization, or team, whose purpose will be to respond intelligently and promptly and authoritatively to studies and articles such as this.

    The team would respond specifically to the offending journal, but depending on the import of the piece, be ready to issue rebuttals and refutations to other industry-specific journals, as well as broad-based media.

    It would also ensure that positive and helpful research finds its way to the most appropriate sources., in the form of ariticles and press releases.

    This would be both a proactive and reactive body. It would monitor the press and medical journals, and respond where appropriate.

    I have suggested the same in the Lyme community. Lots of disparate efforts, but to date, nothing centralized.
     
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  18. Snowdrop

    Snowdrop Rebel without a biscuit

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  19. Snow Leopard

    Snow Leopard Hibernating

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    I don't think they are redundant, I just think that they aren't going to find any HPA axis related findings that are central to this illness (due to my own hypotheses and reading most of the papers that have studied the HPA axis in patients to date). Secondly, studies like this that measure just salivary or serum cortisol are mostly worthless when it comes to understanding the HPA axis. Differences in the wakening cortisol levels can be caused by simple differences, like different sleeping rhythms. Far deeper biological investigations are needed if the hypothesis (of disrupted HPA axis) is to be investigated.
    Measuring coritsol levels is just a pretend way of linking bio to psycho, but it never does it in a convincing way.
     
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  20. ukxmrv

    ukxmrv Senior Member

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    Isn't this one of those tests that asks patients what happened to them in the past? Did these patients receive counselling or something that could explain why they felt a recollection of emotional neglect in their past was the most appropriate response.

    Some PWCFS are neglected and abused by their families because of their illness. It might feel because of that emotional neglect was a feature in their earlier lives as well. If you had CBT or counselling this may have been the focus of it. I was certainly asked to examine the relationship between myself and my family when I went into counselling because I had ME.

    Once again it's an exercise of a patient ticking a box on a questionnaire. There is no test to prove this. We can't go back in a time machine and see if it occurred or not.
     
    Last edited: Mar 17, 2015
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