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"Chronic Fatigue and Personality: A Twin Study of Causal Pathways and Shared Liabilities" (incl CFS)

Dolphin

Senior Member
Messages
17,567
Abstract: http://www.springer.com/medicine/journal/12160

If one clicks "look inside" one can see two pages, although it's just the introduction.

The 54 references can be seen at: http://link.springer.com/article/10.1007/s12160-012-9463-5 - it includes quite a few on CBT and GET: I would guess they are being plugged, esp. given Dedra Buchwald is involved, although not sure there is research connecting personality with CBT and GET.

Chronic Fatigue and Personality: A Twin Study of Causal Pathways and Shared Liabilities
Annals of Behavioral Medicine
January 2013

Brian Poeschla M.D.,
Eric Strachan Ph.D.,
Elizabeth Dansie Ph.D.,
Dedra S. Buchwald M.D.,
Niloofar Afari Ph.D.

Look Inside Get Access

Abstract*

Background

The etiology of chronic fatigue syndrome (CFS) remains unknown. Personality traits influence well-being and may play a role in CFS and unexplained chronic fatigue.

Purpose

This study aimed to examine the association of emotional instability and extraversion with chronic fatigue and CFS in a genetically informative sample.

Methods

We evaluated 245 twin pairs for two definitions of chronic fatigue.
They completed the Neuroticism and Extraversion subscales of the NEO Five Factor Inventory.
Using a co-twin control design, we examined the association between personality and chronic fatigue.

Results

Higher emotional instability was associated with both definitions of chronic fatigue and was confounded by shared genetics.
Lower extraversion was also associated with both definitions of fatigue, but was not confounded by familial factors.

Conclusions

Both emotional instability and extraversion are related to chronic fatigue and CFS.
Whereas emotional instability and chronic fatigue are linked by shared genetic mechanisms, the relationship with extraversion may be causal and bidirectional.

Brian Poeschla and Eric Strachan contributed equally to this work.

Author Affiliations
  • 1. Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Box 359911, Seattle, WA, 98104-2499, USA
  • 2. Center for Clinical and Epidemiological Research, University of Washington, Seattle, WA, USA
  • 3. Department of Anesthesiology, University of Washington, Seattle, WA, USA
  • 4. Department of Medicine, University of Washington, Seattle, WA, USA
  • 5. VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
  • 6. Department of Psychiatry, University of California, San Diego, CA, USA
*I've given each sentence its own paragraph
 

Dolphin

Senior Member
Messages
17,567
This journal takes Letters to the Editor if anyone was so inclined:

http://www.springer.com/medicine/journal/12160


Letters to the Editor

Annals of Behavioral Medicine publishes Letters to the Editor that offer opinion or interpretation of articles previously published in the journal. Letters should be limited to 500 words or less and should not have more than seven references. Tables and figures should be used only if absolutely necessary. It is customary for letters to be sent to the author(s) of the original work and the authors’ response may be published as a companion to the Letter to the Editor.
 

Dolphin

Senior Member
Messages
17,567
There is also an accompanying editorial, although none of the text is free.

Here is what one can see for free, for what it's worth:


Annals of Behavioral Medicine
January 2013

Getting Closer—Advancing the Study of Persons with Chronic Fatigue
Syndrome: a Comment on Poeschla et al.

Stefan M. van Geelen Ph.D.


References (9)


Godlee F. Ending the stalemate over CFS/ME. BMJ. 2011; 342: d3956. CrossRef

Millon C, Salvato F, Blaney N, et al. A psychological assessment of chronic fatigue syndrome/chronic Epstein-Barr virus patients. Psychol Health. 1989; 3: 131-141. CrossRef

Poeschla B, Strachan E, Dansie E, Buchwald DS, Afari N. Chronic fatigue and personality: A twin study of causal pathways and shared liabilities. Ann Behav Med. 2013. doi:10.1007/s12160-012-9463.

McAdams D, Anyidoho NA, Brown C, et al. Traits and stories: Links between dispositional traits and narrative features of personality. J Pers. 2004; 72: 761-784. CrossRef

Van Geelen SM, Sinnema G, Hermans HJM, et al. Personality and chronic fatigue syndrome: Methodological and conceptual issues. Clin Psychol Rev. 2007; 27: 885-903. CrossRef

Miller TR. The psychotherapeutic utility of the five-factor model of personality: A clinician's perspective. J Pers Assess. 1991; 57: 415-433.CrossRef


Larun L, Malterud K. Identity and coping experiences in chronic fatigue syndrome: A synthesis of qualitative studies. Patient Educ Couns. 2007; 69: 20-28. CrossRef

Van Geelen SM, Fuchs CE, Van Geel R, et al. Self-investigation in adolescent chronic fatigue syndrome: Narrative changes and health improvement. Patient Educ Couns. 2011; 83: 227-233. CrossRef

Kato K, Sullivan PF, Evengård B, Pedersen NL. Premorbid predictors of chronic fatigue. Arch Gen Psychiatry. 2006; 63: 1267-1272. CrossRef

Journal
Annals of Behavioral Medicine DOI10.1007/s12160-013-9467-9
Print ISSN0883-6612Online ISSN1532-4796
PublisherSpringer-VerlagAdditional Links


Register for Journal Updates
Editorial Board
About This Journal
Manuscript Submission

Topics

Medicine/Public Health, general
Health Psychology
General Practice / Family Medicine

Industry Sectors

Health & Hospitals

Authors

Stefan M. van Geelen Ph.D. (1)

Author Affiliations

1. University Medical Center Utrecht, Utrecht, The Netherlands
 

Little Bluestem

All Good Things Must Come to an End
Messages
4,930
But what is cause and what is effect. Having a fatiguing disease would make a person less extraverted. The nueroendrocrine aspects of ME/CFS can produce emotional instability. They need a study to figure that out?

When I was going through my psychological phase, my therapist and I discussed the Myers-Briggs scale. I did not actually take the test. We rated me the same on all of the pairs, but one. I then realized that I was rating myself as I had been most of my life, while she was rating me as I was since she had known me. Unfortunately, I cannot remember on which pair we differed.
 

biophile

Places I'd rather be.
Messages
8,977
All I want for next Christmas is for research to stop using inappropriate psychometric questionnaires which conflate disease-related complications for evidence of psychopathology while the researchers confuse correlation with causation.

I must have been too naughty last year because all I wanted for last Christmas was the PACE data on the original definitions of "recovery" and "positive outcome" (which the authors promised when accepting 8 million dollars of public money) and that never appeared under the tree either despite repeated FOI requests from UK citizens.
 
Messages
15,786
A bit more info from the questionnaire used:
Extraversion is broken down into the subcategories of friendliness, gregariousness, assertiveness, activity level, excitement seeking, and cheerfulness. Gregariousness (enjoying crowds), activity level, and excitement seeking are likely to be heavily impacted by having ME/CFS.

Neuroticism is broken down into the subcategories of anxiety, anger, depression, self-consciousness, immoderation, and vulnerability. Self-consciousness can score high if you don't want to be the center of attention, and that as well as vulnerability would likely be impacted by having ME. High scorers in depression are defined to "lack energy and have difficulty initiating activities."

So yeah. Another questionnaire proving that ME/CFS patients have ME/CFS symptoms :p
 
Messages
445
Location
Georgia
Daffodil

The answer to your question is: yes, doctors think MS patients are emotionally unstable too. (I didn't check for lupus, but i'll bet the answer was yes.)

BTW "prosody" means when you talk very loudly, appearing to sound upset. People with MS apparently do this.


J Neuropsychol. 2012 Nov 5. doi: 10.1111/j.1748-6653.2012.02037.x. [Epub ahead of print]
Perception of affective prosody in patients at an early stage of relapsing-remitting multiple sclerosis.

The Perception of affective prosody in patients at an early stage of relapsing-remitting multiple sclerosis.
Kraemer M, Herold M, Uekermann J, Kis B, Daum I, Wiltfang J, Berlit P, Diehl RR, Abdel-Hamid M.
Source

Department of Neurology, Alfried Krupp von Bohlen und Halbach Hospital, Essen, Germany; Department of Psychiatry and Psychotherapy, LVR Clinics Essen, University of Duisburg-Essen, Essen, Germany.
Abstract

Cognitive dysfunction is well known in patients suffering from multiple sclerosis (MS) and has been described for many years. Cognitive impairment, memory, and attention deficits seem to be features of advanced MS stages, whereas depression and emotional instability already occur in early stages of the disease. However, little is known about processing of affective prosody in patients in early stages of relapsing-remitting MS (RRMS). In this study, tests assessing attention, memory, and processing of affective prosody were administered to 25 adult patients with a diagnosis of RRMS at an early stage and to 25 healthy controls (HC). Early stages of the disease were defined as being diagnosed with RRMS in the last 2 years and having an Expanded Disability Status Scale (EDSS) of 2 or lower. Patients and HC were comparable in intelligence quotient (IQ), educational level, age, handedness, and gender. Patients with early stages of RRMS performed below the control group with respect to the subtests 'discrimination of affective prosody' and 'matching of affective prosody to facial expression' for the emotion 'angry' of the 'Tübingen Affect Battery'. These deficits were not related to executive performance. Our findings suggest that emotional prosody comprehension is deficient in young patients with early stages of RRMS. Deficits in discriminating affective prosody early in the disease may make misunderstandings and poor communication more likely. This might negatively influence interpersonal relationships and quality of life in patients with RRMS
 

Dreambirdie

work in progress
Messages
5,569
Location
N. California
Why don't they analyze these researchers. They sound like NARCISSISTS to me:

The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders, defines narcissistic personality disorder (in Axis II Cluster B) as:[1]

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
  1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
  2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  3. Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
  4. Requires excessive admiration
  5. Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
  6. Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
  7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
  8. Is often envious of others or believes others are envious of him or her
  9. Shows arrogant, haughty behavior or attitudes.
http://en.wikipedia.org/wiki/Narcissistic_personality_disorder
 
Messages
15,786
Having skimmed the full paper, it involves two groups: chronic fatigue (6 months fatigue) and "CFS-like illness", which seems to be what they're calling CDC CFS. They're waffling a bit on language (CFS-like, used an algorithm based on ...) but seem to be saying that there has to be chronic fatigue plus 4 out of the 8 additional symptoms - so I'm not sure why they aren't just calling it CFS.
 

valentinelynx

Senior Member
Messages
1,310
Location
Tucson
Daffodil

The answer to your question is: yes, doctors think MS patients are emotionally unstable too. (I didn't check for lupus, but i'll bet the answer was yes.)

BTW "prosody" means when you talk very loudly, appearing to sound upset. People with MS apparently do this.


J Neuropsychol. 2012 Nov 5. doi: 10.1111/j.1748-6653.2012.02037.x. [Epub ahead of print]
Perception of affective prosody in patients at an early stage of relapsing-remitting multiple sclerosis.

The Perception of affective prosody in patients at an early stage of relapsing-remitting multiple sclerosis.
Kraemer M, Herold M, Uekermann J, Kis B, Daum I, Wiltfang J, Berlit P, Diehl RR, Abdel-Hamid M.
Source


Abstract

Perhaps you were meaning to make a joke, but this is actually kind of an interesting abstract. "Perception of emotional prosody" refers to one's ability to understand how the rhythm of a person's speech indicates what the speaking person is feeling. E.g. the tone and rhythm you use when you say, "Well, that's just great!" strongly affects the meaning. With a certain kind of cognitive dysfunction (common in Autism Spectrum Disorders) the ability to interpret prosody and other people's emotional states is impaired. The abstract is discussing a neurological problem found in young people with relapsing-remitting MS.

Sorry if I misunderstood your emotional prosody... ;)
 
Messages
15,786
Twin-ness is entirely self-reported via mail. The question used to determine if they're identical twins is rather vague and weird: "As children, were you and your twin as alike as two peas in a pod, or of only ordinary family resemblance?" Leaves a lot of room for interpretation regarding appearance versus behavior or getting along with each other.

CF and CFS are basically a self-diagnosis based on a mailed questionnaire. Maybe that's why they're frequently calling it CFS-like illness instead of CFS. Also, the entry requirement was only fatigue of undefined duration. Thus some twin pairs might have no members with CF or CFS, and this seems likely as the numbers never quite add up. It also looks like CF patients without CFS act as controls for the CFS patients (bigger control group for CFS patients than CF patients), but some CF patients mysteriously disappear from the CFS analysis, which doesn't make sense if the CF patients with CFS end up in the CFS patient group, and CF patients without CFS end up in the control group.

They perform two types of analysis. One is comparing the CF or CFS twin of a pair to his/her corresponding twin that doesn't have the same symptoms. But they also compare the twins as a group ... all CF participants (includes the CFS participants) versus all non-CF participants, and all CFS participants versus all non-CFS participants. This second comparison would seem to lose much of the power that you get from a twin study, since twin pairs can be in the same group (both with CF, both with CFS, or both with neither), so that part sounds more like a typical comparison between patients and (healthy or fatigued) controls.

Maybe someone understanding statistics and numerical analysis could take a look at the numbers, because it seems kinda weird.
 
Messages
15,786
Looking more at the results now. Something interesting to keep in mind is that the average birth year is 1953 - these twins have an average age of 60 :eek: That probably opens up additional causes of fatigue which have nothing to do with ME/CFS.
For chronic fatigue of 6 months or longer, the means for emotional instability were similar for MZ twins who were discordant for the condition, but DZ twins differed by six points. Findings were similar for CFS-like illness, suggesting a pattern that is consistent with genetic confounding. For extraversion, mean differences for discordant MZ and DZ twin pairs were of similar magnitude and direction for both definitions of chronic fatigue. This pattern suggests a causal association between extraversion and chronic fatigue.
I'm not sure the "association between extraversion and CF" follows from the earlier statements. All they're really saying is that identical twins have the same results as each other, with or without CF, whereas non-identical twins have a bigger difference. The only reasonable conclusion from that is that identical twins are more likely to have similar "emotional instability" and extroversion compared to non-identical twins.

It's also a bit annoying that they say they "differ" but not whether CF participants or controls do better or worse. Also no scores are provided, so impossible to tell how they compare to what is normal for the questionnaire used. If they're going to support their claim that being unstable and/or introverted contribute to developing CF or CFS, and identical twins will have the same predisposition, there should be some way to compare the twins' scores to normal scores.

Because we found no fatigue-based mean difference in emotional instability within MZ pairs (see Table 2) and because MZ pairs made up about two thirds of the sample, our initial models to examine the individual-level association of emotional instability with both definition of chronic fatigue included an interaction term for zygosity×emotional instability in addition to the main effect terms for age, sex, zygosity, and emotional instability.
My impression is that they're saying they "controlled" for identical status (by basically removing the identical twins from the analysis), because there wasn't a correlation between fatigue and instability otherwise. Could this be a cute way of reducing the sample size without reducing the power of the results? Near the end they say "Despite the smaller number of DZ pairs, however, we found robust associations even in this subsample, suggesting that statistical power was not an issue." Sounds like they aren't sure if statistical power was an issue when effectively excluding the identical twins.

No difference between sets of identical twins regarding instability, only for non-identical twins, in sets were one but not both have CF and both don't have CFS.

Significant differences in extroversion between twins in sets where they don't both have the same CF or CFS. Not surprising, since we can't go out and do stuff. o_O And their conclusion reflects that:
Nevertheless, our finding of a potentially causal association, combined with Kato and colleagues’ finding that preexisting introversion did not increase the risk for subsequent development of fatiguing illness, suggests that introversion is likely to be the result of CFS rather than the cause.
But then they seem to suggest that "curing" the introversion will help cure the fatigue:
Clinically, therapeutic efforts can capitalize on this effect to reverse the slide toward greater introversion in everyday life —an outcome to which individuals with CFS may be prone. Consistent with this approach, several randomized clinical trials have demonstrated that cognitive–behavioral and graded exercise interventions that focus on increasing social and physical activity are efficacious in lowering fatigue and improving physical function in people with CFS.
So basically extroversion is more common in CF and CFS patients, but they admit it's a result of CFS, not a cause, even though they propose treating the extroversion to cause improvements in fatigue.

And emotional instability levels are more similar in identical than non-identical twins, and might or might not be statistically significant when comparing non-identical CF or CFS participants to their twins without the same diagnosis.
 

vamah

Senior Member
Messages
593
Location
Washington , DC area
Twin-ness is entirely self-reported via mail. The question used to determine if they're identical twins is rather vague and weird: "As children, were you and your twin as alike as two peas in a pod, or of only ordinary family resemblance?" Leaves a lot of room for interpretation regarding appearance versus behavior or getting along with each other.

I can tell you right now, if indentical/fraternal twins are identified only by questionaire then this study is bullshit. Any good study will do genetic testing to determine. There are twins who are so obviously fraternal (different eye and hair color) that this is unnecessary, but you need genetic testing to see if very similar twins are actually identical. Just as a side note, there is also a phenomenon of "semi-identical" twins, where twins are genetically identical but one of the X chromozomes "turns off" (this can only happen in girls) so that one twin only actually has the genes from one parent. (This is the kind of weird trivia that parents of twins know ;).)
 

Simon

Senior Member
Messages
3,789
Location
Monmouth, UK
Unfortunately this study tells us nothing about CFS as they failed to diagnose according to any recognised criteria:
The 1994 CDC case definition of CFS [1] was used to measure chronic fatigue of 6 months duration and CFS symptom criteria
Think that might have been a typo for 'abused'. The CDC '94 criteria requires a full clinical examination, full clinical history and an appropriate in-person psychiatric examination. And specified blood tests. None of these were done, hence no patients had confirmed CFS.

75% (118/158) of twins discordant for Chronic Fatigue were also discordant for CFS-like illness, which should have been a red light to the researchers since it suggests that CFS is very common relative to CF - it isnt. I'm too lazy to check the details, but the large Reyes CFS prevalence study used a similar questionnaire approach to screen for CFS-like illness. However, Reyes and colleagues went on to clinically assess the CFS-like patients and I think something like 80% of them turned out not have CFS. On this basis, it seems likely only a small fraction of CFS-like patients in this Twin study had CFS.
 

Enid

Senior Member
Messages
3,309
Location
UK
I feel and must add that anything to do with personality types and ME is a pie in sky, when will this lot get real.

"Liability" - a joke, I've spent 12 years mostly bedbound, going through potential loss of living and home trying not to be a liability on family and friends. I suggest this lot try it.
 
Messages
445
Location
Georgia
Perhaps you were meaning to make a joke, but this is actually kind of an interesting abstract. "Perception of emotional prosody" refers to one's ability to understand how the rhythm of a person's speech indicates what the speaking person is feeling. E.g. the tone and rhythm you use when you say, "Well, that's just great!" strongly affects the meaning. With a certain kind of cognitive dysfunction (common in Autism Spectrum Disorders) the ability to interpret prosody and other people's emotional states is impaired. The abstract is discussing a neurological problem found in young people with relapsing-remitting MS.

Sorry if I misunderstood your emotional prosody... ;)

Yes, sorry, you are right. Prosody is more a neurological impairment. But I do notice that many patients with CFS are completely tone deaf when comes to being quiet and letting others speak. I think this happens in doctors offices every day. Some take any second of silence to drone on and on about their condition, achievements, life sufferings. I can see why some practioners would think there is narcissistic personality disorder mixed in there. Or various personality disorder. (Not saying this with you in mind, Valentinelynx, pls dont' misconstrue )..
 
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15,786
But I do notice that many patients with CFS are completely tone deaf when comes to being quiet and letting others speak. I think this happens in doctors offices every day. Some take any second of silence to drone on and on about their condition, achievements, life sufferings. I can see why some practioners would think there is narcissistic personality disorder mixed in there.
Well, maybe that's your personal experience, but my own experience and what I hear from patients on the forum is usually quite different. Generally we forget half of the symptoms we need to have dealt with, and many ME patients don't bother with doctors at all anymore.

On the rare occasion that I do get to see a specialist, I'm often given a lecture or recommendation about exercise by someone that has no idea what ME/CFS is and I can barely get a word in edgewise to explain the effect that exercise has on me. I know that specialist is useless and will never see me again, so I don't bother trying explain anything in detail, usually just "Exercise makes me much worse." They look a little shocked or doubtful, and then we shake hands and I leave.

I also think it's rather nasty to characterize patient explanations as being "tone deaf", not "letting others speak" and taking "any second of silence to drone on and on". A lot of doctors have no idea what ME/CFS is and think "oh, fatigue. Antidepressant and/or sleeping pill." If they are not understanding the actual symptoms patients need help with, then I think some explaining is certainly warranted. Unless that antidepressant is all you really want.
 
Messages
445
Location
Georgia
Years ago I used to talk to many CFS patients, at various meetings and conferences I used to go to. They do exhibit a bit of narcissism and tend to drone on and one. All you have to do is ask is: so how are you doing? The result is a ten minute monolog and exclamation of victimhood. There is no internal filter on what might be too much information for a given situation. It prevents a rational exchange over what might be wrong with the patient. To patients visiting doctors: I have suggested they prepare a prioritized list of symptoms and not just unload, sometimes out of emotion, overwhelming a doctor, with myriad, sometimes contradictory symptoms. This will certainly get you the reputation you so fear in your previous post.