Discussion in 'Fibromyalgia Main Forum' started by blueskieslove, Jan 7, 2009.
Study Shows Sexual or Emotional Abuse May Be Risk Factor for Chronic Fatigue Syndrome
By Salynn Boyles
WebMD Health News
Reviewed By Louise Chang, MD
Jan. 5, 2009 -- Experiencing serious trauma during childhood may increase a person's risk for developing chronic fatigue syndrome later in life, a new study suggests.
In the study from the CDC and Atlanta's Emory University, patients with chronic fatigue syndrome (CFS) reported much higher levels of childhood trauma than people without the disorder.
Severe childhood trauma -- including sexual abuse, emotional abuse, and neglect -- was associated with a sixfold increase in CFS.
Chronic fatigue syndrome remains a poorly understood disorder, and the suggestion that early-life stresses play an important role in the disease remains controversial.
Harvard Medical School professor and CFS expert Anthony L. Komaroff, FACP, did not take part in the new study. But he tells WebMD that the findings make a strong case for childhood trauma altering brain chemistry in a way that makes some people more vulnerable to CFS.
"These researchers are definitely not saying that early-life trauma is the cause of chronic fatigue syndrome," he says. "To say that something is a risk factor is very different from saying that it is the cause."
Childhood Trauma and CFS
The newly reported study builds on previous research from the CDC and Emory team, which first suggested the link between early-life trauma and an increased risk for CFS.
CDC estimates suggest that as many as 2.5% of American adults have CFS, even though many have not been diagnosed.
In that study, researchers examined and interviewed 43 CFS patients and 60 people without the disorder living in Wichita, Kan.
Self-reported childhood trauma was associated with a three- to eightfold increased risk for CFS, with the highest risk seen in patients who had suffered from more than one early-life trauma.
The new study involved 113 CFS patients and 124 people without the disorder living in urban, suburban, or rural Georgia.
In addition to interviews to determine whether study participants had experienced childhood trauma, all participants underwent screening for depression, anxiety, and posttraumatic stress disorder.
The interviews revealed that:
* 62% of CFS patients reported being the victims of severe childhood traumas compared to 24% of study participants without CFS.
* 33% of CFS patients reported a childhood history of sexual abuse, compared to nearly 11% of study participants without CFS.
* 33% of CFS patients reported being the victims of emotional abuse, compared to 7% of study participants without CFS.
The researchers also tested all participants for levels of the hormone cortisol, which is associated with stress and the so-called "fight or flight" response.
Low cortisol levels may indicate that the body does not respond to stress normally, CFS researcher William Reeves, MD, of the CDC tells WebMD.
Reeves and colleagues found reduced cortisol levels in the CFS patients who had experienced childhood traumas, but not in CFS patients who did not report early-life exposure to trauma.
This suggests that early trauma may "rewire" the brain in a way that makes people more vulnerable to developing chronic fatigue syndrome in adulthood, he says, adding that the finding could have implications for diagnosis and treatment.
"We know that cognitive behavioral therapy works for many people with CFS, and this is especially true for people who have a history of childhood trauma," Reeves says.
Viral Triggers Likely
While 60% of CFS patients had a history of childhood trauma, Komaroff points out that 40% did not and that a significant number of the participants who had experienced severe childhood trauma did not develop chronic fatigue syndrome.
"The danger is that people will jump to the conclusion that early-life trauma causes CFS even though this study showed that a large number of people with CFS had no history of trauma," he says.
Komaroff believes, as many CFS researchers do, that multiple viruses trigger the disorder in people who are vulnerable due to genetics or other reasons.
"I don't believe that any single virus is the cause of CFS in the way that HIV is absolutely critical to causing AIDS," he says.
SOURCES: Heim, C. Archives of General Psychiatry, January 2009; vol 66: pp 72-80. William C. Reeves, MD, MSc, chief, chronic viral diseases branch, CDC. Anthony L. Komaroff, FACP, professor of medicine, Harvard Medical School. Archives of General Psychiatry, November 2006; vol 63: pp 1258-1266.
hooray for research!
The only abuse that I've suffered has come from getting bit by ticks multiple times and never getting a diagnosis. I was bit in 1969 during a trip to the Ozarks. Again in 1974 and again in 2001. The more bites the higher the bacterial load.
Rashes were written off as eczema, ringworm, spider bites, epilespy and sarcoidosis. I've seen roughly 209 doctors but only one has been treating it. I've almost completely regained my health after nearly 3 years of treatment.
After going from doctor to doctor and being abused and laughed at, I'd say the medical profession has been my source of abuse.
whats a tick have anything to do with it? the article has nothing to do with ticks?
The TICK missed this. Or doesn't care. Or doesn't understand "40%". Or just wished to comment. Or just??????????
"While 60% of CFS patients had a history of childhood trauma, Komaroff points out that 40% did not and that a significant number of the participants who had experienced severe childhood trauma did not develop chronic fatigue syndrome."
See also this version of the same report which I restrained myself from several "say what????????" comments.
every so often this issue is raised here - I wish it would stop..........please.
What a lot of rubbish.
It has been raised in reference to FM as well. If this stirs up issues for some readers here I encourage them to not read these postings.
I have no doubt that childhood abuse may cause some individuals with such a history to be more at risk than those this history. Just like anyone that has been sexually assualted is at a higher risk of being victimized again than a person who has not been assaulted. An individual who has a strong family history of high blood pressure is at higher risk of developing the disease than those without such a family history.
Finding the answers to our questions about these dd's are best served by a willingness to explore all possibilities; not by narrowing areas of examination.
I am an AMAC (adult molested as a child). I find this area of exploration important and useful. I do not want see this issue not raised again.
There have been interesting studies which show that early stress and/or poverty (which is very stressful) predisposes people to metabolic syndrome which includes diabetes, hypertension, high cholesterol, cancers...
The issue at hand is not whether or not stress contributes to illness. The issue is whether or not the research dollars allotted to ME (aka CFS) are being spent in a way which will lead to effective diagnostic tools and effective treatments.
This type of research is not inappropriate but it seems to be an area of overinvestigation while other aspects of the conditions go largely unexplored.
Also, given the CDC's widening of diagnostic criteria, all studied which choose their cohort using CDC standards will, by definition, include many who do not have and never have had ME. Therefore, its statistical relevance is questionable in the extreme.
It would be interesting if someone would do a survey of, say, people who have cancer or people who have M.S. and see if they, too, suffered from childhood trauma...
And if they did, what does that have to do with anything, anyway????
What are the "nuggets" in there? I guess I missed them....
Sometimes it's hard to understand what I read, but I don't understand why CBT would help CFS/ME. I can see how CBT would help me with overcoming my feelings of worthlessness from years of childhood abuse - I took co-dependency classes many years ago, and it was a big help.
But what is the connection to CFS/ME and how does it help me now?
here is one of the articles where i removed some fluff and left some info. i have googled cfs news almost every sigle day for the last 2 years, every day hoping to read that someone has found something or is even researching anything at all and 97% of the time there is ZIP, so i'm happy everytime for the publicity. and yes i think there is a connection to a diminished stress responce to cfs.
The study also states that the increased risk for chronic fatigue syndrome (CFS) might be based in biology. The reason:
There appears to be a connection between the nervous system and endocrine system abnormalities, called neuroendocrine dysfunction, in people with CFS who suffered childhood trauma, the researchers said.
They also have a diminished salivary cortisol response to stress. CFS does involve a diminished response to stress," he said.
An estimated 4 million people in the United States are thought to struggle with CFS, costing the nation some $9 billion annually, and each patient's family $20,000 a year in lost revenue, Reeves said.
"CFS is quite common," Reeves said. "It is a real illness. If you have the symptoms of CFS, see a provider. It's not all in your head -- it's not a crock."
They were also tested for saliva levels of the hormone cortisol; low cortisol levels can indicate reduced function of the body's neuroendocrine stress response system.
The researchers found that people who had experienced a childhood trauma were six times more likely to develop chronic fatigue syndrome, compared with non-traumatized individuals.
Among people with CFS who'd suffered childhood trauma, cortisol levels were lower. That was not the case among those with CFS who had not had a childhood trauma. The researchers said this finding indicates that stress early in life might cause a biological susceptibility to CFS.
Reeves's group hopes to extend the findings to new treatments for the condition.
Dr. Anthony L. Komaroff, a professor of medicine at Harvard Medical School and an expert on CFS, doesn't think childhood trauma causes CFS but, rather, might contribute to its development.
"Since a substantial fraction of people with CFS report no childhood abuse, and since none of the control subjects [in the new study] with childhood abuse had CFS, childhood abuse is not the cause of CFS," Komaroff said. "However, childhood abuse may alter brain chemistry in such a way that people are subsequently more vulnerable to developing CFS."
This is absolutely reprehensible; I've commented on Bill Reeve's from the CDC in the past, but in my strong opinion, he needs to be ousted now. I am outraged...
The CFIDS Association of America dealt with this same study in November 2006, and in the latest study, the researchers addressed NONE of the weaknesses that were identified back then.
The CFIDS Association is actively addressing this recent report with the CDC's Division of Media Relations, especially when other studies regarding physiological issues get little to no recognition.
The following url details this issue in 2006:
Board of Directors
The CFIDS Association of America
The following is the text of the previous url, detailing the response to this issue in November 2006.
Limited Studies of Early-Life Stress Put in Context
Two studies published in the November 6, 2006, issue of the Archives of General Psychiatry associate trauma in early life with CFS and CFS-like illness. However, each study has important limitations to consider and the authors’ conclusions should not be overgeneralized.
Both new studies focused on a narrow set of adverse events and excluded others, such as infection, serious injury and malnutrition, shown to be important in other conditions, and that warrant further exploration in CFS as well.
Adverse events in early childhood have been shown to be predisposing factors in other serious conditions, including cardiovascular disease, diabetes and depression. A report compiled by the National Scientific Council on the Developing Child at http://www.developingchild.net/papers/excessive_stress.pdf summarizes this literature in layman’s terms. No broader discussion of this literature is included in either paper and thus is being overlooked by the media.
Studies like these that rely solely on unverified self-report of childhood experiences occurring 35-50 years earlier, particularly of people with later-life physical and psychological health issues, have many limitations that are well-documented in the medical literature. Although the mean age of subjects in the Heim study was 50.5 years and subjects in the Kato study were 42 years or older, this limitation is only acknowledged in the Kato paper, as described below.
Christine Heim, PhD, of Emory University is the lead author of a study titled, "Early Adverse Experience and Risk for CFS: Results from a Population-Based Study." She is no longer affiliated with the Centers for Disease Control and Prevention’s CFS Research Group. Dr. Heim describes the small study of 43 CFS patients as "exploratory" and states that results "should be considered as preliminary." The researchers found that CFS cases reported significantly higher levels of childhood trauma and psychopathology compared to healthy controls. Exposure to childhood trauma was associated with three-to eight-fold increased risk for CFS across the trauma types assessed. The authors state, "our results also clearly demonstrate that not all cases of CFS have a history of childhood trauma."
The second study, by Kenji Kato, PhD, et al., of the Karolinska Institutet, presents similar findings from a study nested within a Swedish Twin Registry of 19,192 twin pairs born between January 1, 1935, and December 31, 1958. All twins were screened for the symptoms of CFS by telephone, but investigators did not conduct thorough physical and mental status exams to confirm CFS diagnosis. Thus, conclusions are based on "CFS-like illness," and not CFS as strictly defined. In all, 447 subjects fit the description of "CFS-like illness." Study results indicate an association between "emotional instability" and self-reported stress and chronic fatigue/CFS-like illness. In examining differences between twin pairs, the researchers reported that, "certain genetic propensities may ameliorate or exacerbate the effect of stress. At the same time, genetic influences on emotional instability also contribute to the development of fatiguing symptoms." The authors state that "a number of cases might have been misclassified owing to recovery or recall bias by the time of the interview."
As the November 3, 2006, announcements by CDC director Dr. Julie Gerberding underscore, the important story about CFS is much larger than any single study or pair of studies. The media coverage over the last week, of which only a small fraction relates to these studies, reflects the bigger picture too. That said, all people, including the subset of CFS patients described by these studies, whose lives have been affected by trauma in their childhood years certainly deserve compassion and careful study so that the biological and psychological impact of these early-life events is better understood.
Thanks for this!
What with the millions of people who live in the 3rd world who undego stress like people in America/Europe couldn't even imagine on a day to day basis. They don't seem to get CFS now do they? Or all of the soldiers who have fought in tons of wars that didn't get CFS... or all of the animals that get abused that don't get CFS... or... Stress may make you more succepitble to disease, and some diseases can modify the stress response, but that doesn't mean stress causes the disease... once you have it, you have to treat it, even if you got it when you were "stressed". Staying "not stressed" may well prevent you from getting sick in the future, but it doesn't mean you aren't sick now.
[This Message was Edited on 01/08/2009]
I'll expand on the situation more tomorrow (hopefully), as I am not feeling well. There is much more info with regard to the CDC's CFS research program -- or lack thereof...
It was extremely kind of you to post - sometimes it's hard to read through a long article and pick out the hopeful and good parts. Your post was easy to read and understand.
Thanks again and best of luck to you!
There are a LOT of risk factors, not only with FMS/CFIDS, but with other illnesses as well. Cancer often coincides with major life stresses, or just following them, according to studies. The problem is that cancer can lie undetected for many years, so the value of these kinds of studies is limited. The value of studies which rely on annecdotal info of childhood abuse/stress is limited as well.
To focus on only one risk factor seems to be a problem with finding what does cause our illnesses. Studies start with theories and then subjects are studied to confirm, or refute, the theories. I do believe there may be value in identifying risk factors but, as stated above, risk factors should not be confused with causes.
Researchers are turning more toward genetics to try to explain why some become ill and some do not, given the same risk factors. The problem is that it is a "chicken and egg" question because no one knows what comes first, genetics or events which may cause mutations and make people more suseptible to our illnesses. Researchers may have to look back many generations to find such events.
I believe that there are many risk factors, including trauma, stress, infections, and toxins. Our bodies may be able to recover from multiple events, only to succumb to one event which "pushes us over the edge." Once that happens, it can take years to recover and the treatment may require a very comprehensive approach. That seems to be the scenario in my own case. I can now look back into early childhood and see omens of things to come. FMS seems to go back at least two generations, and possibly three. I remember no abuse but that doesn't mean it didn't occur.
Thanks for posting this. It helps us to be aware of what research is being conducted.
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