Childhood Trauma Ups Risk of Chronic Fatigue Syndrome 

TUESDAY, Nov. 7/06 (HealthDay News) - Childhood trauma, along with stress or emotional instability at any point in one's life, might be risk factors for chronic fatigue syndrome.

So say two studies in the November issue of the Archives of General Psychiatry.

"We're not talking about a bunch of stressed-out people. We're talking about the biological underpinnings of a real and very debilitating illness," said Dr. Nancy Klimas, a professor of medicine at the University of Miami Miller School of Medicine, who was not involved with either study. "We're trying to remove the stigma of a psychiatric overlay and put it back in biology, where it belongs."

Although intriguing, experts added that the results are preliminary.

"These are interesting elementary papers," said Dr. Charles Goodstein, a psychoanalyst and clinical professor of psychiatry at New York University School of Medicine. "These studies bear out what we have learned in medicine and in psychiatry: Illnesses of all types are determined in large part by an interplay of genetically determined predispositions and environmental factors."

"CFS remains an elusive condition," Goodstein continued. "It seriously incapacitates patients, but physicians are stumped by the lack of objective signs on physical examination."

Some 1 million people in the United States are estimated to suffer from chronic fatigue syndrome (CFS), costing the nation some $9 billion annually, and each family $20,000 a year in lost earnings. The condition is more common in women aged 40 to 59, and is marked by a cluster of debilitating symptoms, including unexplained fatigue, problems sleeping, problems with memory and concentration, and pain.

The illness was first recognized in the late 1980s and, initially dubbed the "yuppie flu," suffered from a credibility crisis. The U.S. Centers for Disease Control and Prevention on Friday unveiled an awareness campaign intended to remedy that problem.

Still, the condition remains a mysterious one and, despite more than 4,000 studies and two decades of research, the cause remains elusive, as do effective treatments.

Anecdotal evidence suggests that stress may be a triggering factor, but there has been little systematic study of the issue.

This new report is part of a larger study undertaken by the CDC, which surveyed the population in Wichita, Kan., over a four-year period from 1997 to 2000.

The authors of the current paper conducted in-depth assessments of 43 people with CFS, comparing them with 60 control subjects, all identified from an initial sample of more than 56,000 adults residing in Wichita. In addition to multiple medical tests, participants completed questionnaires on childhood trauma and psychiatric symptoms such as depression and anxiety. Five different types of childhood trauma were addressed - sexual, physical, emotional, emotional neglect and physical neglect.

People with CFS reported much higher levels of childhood trauma and psychiatric symptoms, compared with the control participants. In fact, childhood trauma exposure in general was associated with a three-to-eight-fold greater risk for CFS. But emotional neglect and sexual abuse were the most powerful predictors of who would develop CFS. The risk of having CFS increased by 77 percent for each additional type of childhood trauma a person experienced, the researchers found.

Those who had experienced more trauma were more likely to have more severe symptoms of CFS. And those who had other psychiatric symptoms along with childhood trauma were also at greater risk.

"It's important to see that CFS has subgroups," Klimas said. "It's really important not to merge all these observations into one solid, big group."

The information may one day help identify people at risk for chronic fatigue syndrome. "Not all people with CFS had histories of childhood trauma, and not all of the people who had childhood trauma had CFS," explained study author Christine Heim, assistant professor of psychiatry and behavioral sciences at Emory University, in Atlanta. "It's not the whole picture. There must be some sort of resilience, and if we knew what those were, that would be important for prevention."

The second study looked at 19,192 Swedish twins, 1,570 of whom had chronic fatigue syndrome. Twins who experienced emotional instability and stress were more likely to have CFS. Individuals who reported that their life was stressful were 64 percent to 65 percent more likely to develop CFS than people who did not make such a report. Stress increased a twin's risk of developing CVS five-fold.

From:   http://www.cbc.ca/cp/HealthScout/061107/6110718U.html

Chronic fatigue syndrome (CFS) might be caused by a temporary 'brain injury' during the early, inflammatory stages of glandular fever, according to Australian scientists.

"We believe that parts of the brain which control perception of fatigue and pain are damaged during the acute infection phase of glandular fever," says lead researcher, Professor Andrew Lloyd from the University of New South Wales <http://www.unsw.edu.au/>.

The researchers, who publish their study this week in the Journal of Infectious Diseases <http://www.journals.uchicago.edu/JID/home.html>, believe the Epstein-Barr virus, which causes glandular fever, might trigger CFS in some people.

While most people with glandular fever recover in several weeks, disabling symptoms including prolonged fatigue can last for at least six months, known as CFS.

The scientists found the virus itself does not cause this ongoing fatigue but they hypothesise that a 'hit and run' brain injury does.

"If you're still sick several weeks after infection, it seems the symptoms aren't being driven by the activity of the virus in the body, it's happening in the brain," Lloyd says.

The study is the first to follow patients within a few weeks of acute glandular fever infection for a year.

It tracked 39 people including eight who were sick for at least six months, and 31 who recovered quickly.

Levels of virus in the blood were no different in patients who recovered quickly from those whose fatigue lasted more than six months.

"It's not the virus or an ongoing inflammatory response directed at the virus causing ongoing symptoms. But an inflammatory process in the acute illness might disturb brain function and make it stay symptomatic," Lloyd says.

The mystery of CFS

Lloyd says CFS affects one in 100 Australians and millions worldwide.

It is a group of symptoms for which there is no medical or psychiatric explanation including unrefreshing sleep, muscle and joint pain, concentration and memory difficulties and prolonged fatigue.

People with CFS are often unable to work or attend school.

Theories about causes range from muscle and immune system to psychiatric problems, hormonal changes and the growing body of data linking infectious diseases, including glandular fever, as a trigger.

The scientists will test their hypothesis by doing brain scans on study participants.

For more information on CFS, see the ME/Chronic Fatigue Syndrome Association of Australia's website <http://www.mecfs.org.au/>.

http://www.abc.net.au/science/news/stories/s1581422.htm

November 3, 2006 - For 16 years, chronic fatigue syndrome has kept Julia Morichelli from living life to its fullest.

"Literally doing your laundry was exhausting. You couldn't even do any housework, for me it was a big deal," Morichelli said.

She tried not to let it affect her job as a professional fitness instructor, but few of the doctors she sought could help her.

"'Chronic fatigue and fibromyalgia that's what you've got, and we don't know why,'" Morichelli said.

Chronic fatigue syndrome suffers from an image problem. Morichelli, like other patients, faces doctors who don't "buy into" the illness and friends who just don't understand. On Friday, the Centers for Disease Control announced it's taking chronic fatigue syndrome seriously and hopes others do too.

"This is a disease that has been shrouded in mystery, nobody really knew whether it was real or not real," Dr. Julie Gerberding of the Centers for Disease Control, said.

The main symptoms of chronic fatigue syndrome are being severely tired and suffering from muscle pain. Other symptoms can include joint pain, headache, and frequent sore throats.

"They'll have almost like a mononucleosis. They sleep for 13 to 14 hours, just an overwhelming fatigue," Dr. Daniel Arkfeld, of the USC Keck School of Medicine, said.

Dr. Arkfeld says the government taking a lead role will hopefully provide more answers.

"Chronic fatigue syndrome is an entity that has been poorly defined in the past," Dr. Arkfeld said.

The fact that researchers can't reach a consensus about what causes it means patients must endure various kinds of treatments. Morichelli found help through a mix of conventional and alternative therapy. She's hopes the CDC's campaign will save other patients from years of suffering.

"I'm just so glad that finally someone is taking this seriously. It could lead to advances in treatments for it," Morichelli said.