Psychiatric morbidity in the chronic fatigue syndrome

Ciccone, Donald S.; Busichio, Kim; Vickroy, Michael; Natelson, Benjamin H.

doi:10.1016/s0022-3999(02)00525-1

Cited by 28 publications

(5 citation statements)

References 27 publications

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“…Our findings are reminiscent of previous studies which showed that almost 40% of CFS patients had at least 1 personality disorder [7810]. Interestingly, both our study and 2 of the earlier studies found obsessive-compulsive personality disorder to be the most common personality disorder [78].…”

Section: Discussionsupporting

confidence: 87%

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Personality Features and Personality Disorders in Chronic Fatigue Syndrome: A Population-Based Study

Nater

Jones²,

Lin³

et al. 2010

Psychother Psychosom

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Background: Chronic fatigue syndrome (CFS) presents unique diagnostic and management challenges. Personality may be a risk factor for CFS and may contribute to the maintenance of the illness. Methods: 501 study participants were identified from the general population of Georgia: 113 people with CFS, 264 with unexplained unwellness but not CFS (insufficient fatigue, ISF) and 124 well controls. We used the Personality Diagnostic Questionnaire, 4th edition, to evaluate DSM-IV personality disorders. We used the NEO Five-Factor Inventory to assess personality features (neuroticism, extraversion, openness, agreeableness and conscientiousness). The Multidimensional Fatigue Inventory measured 5 dimensions of fatigue, and the Medical Outcomes Survey Short Form 36 measured 8 dimensions of functional impairment. Results: Twenty-nine percent of the CFS cases had at least 1 personality disorder, compared to 28% of the ISF cases and 7% of the well controls. The prevalence of paranoid, schizoid, avoidant, obsessive-compulsive and depressive personality disorders were significantly higher in CFS and ISF compared to the well controls. The CFS cases had significantly higher scores on neuroticism, and significantly lower scores on extraversion than those with ISF or the well controls. Personality features were correlated with selected composite characteristics of fatigue. Conclusions: Our results suggest that CFS is associated with an increased prevalence of maladaptive personality features and personality disorders. This might be associated with being noncompliant with treatment suggestions, displaying unhealthy behavioral strategies and lacking a stable social environment. Since maladaptive personality is not specific to CFS, it might be associated with illness per se rather than with a specific condition.

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Section: Discussionsupporting

confidence: 87%

“…Published studies have reported around 40% of persons with CFS as having personality disorders, a relatively high occurrence [78910]. These studies considered personality on a categorical basis.…”

Section: Introductionmentioning

confidence: 99%

Personality Features and Personality Disorders in Chronic Fatigue Syndrome: A Population-Based Study

Nater

Jones²,

Lin³

et al. 2010

Psychother Psychosom

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“…Stratifying patients by presence or absence of psychiatric comorbidity did not reveal significant subgroup differences in spinal fluid abnormalities, neuropsychological test results, ventricular lactate, cortical glutathione or cerebral blood flow. Thus, this study joins several prior others that found that the presence of psychiatric illness is not related to illness severity as reflected by illness course 16,17 , cognitive processing 18 , or physical function 19 . This result is very important because it indicates that neither the phenomenology of CFS nor its biology is driven by psychiatric diagnosis.…”

Section: Discussionsupporting

confidence: 72%

“…Ventricular lactate and cortical glutathione were altered to the same degree in CFS as in patients with major depressive disorder 15 ; moreover levels of ventricular lactate were elevated to the same magnitude in CFS as in fibromyalgia 23 , a medically unexplained syndrome that overlaps with CFS 19 . While this means that neither brain chemical can be used as a specific biomarker for CFS, the inference is that both illnesses may share a pathophysiological link related to oxidative stress.…”

Section: Discussionmentioning

confidence: 94%

Multimodal and simultaneous assessments of brain and spinal fluid abnormalities in chronic fatigue syndrome and the effects of psychiatric comorbidity

Natelson

Mao

Stegner³

et al. 2017

Journal of the Neurological Sciences

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The purpose of this study was to investigate whether CFS patients without comorbid psychiatric diagnoses differ from CFS patients with comorbid psychiatric diagnoses and healthy control subjects in neuropsychological performance, the proportion with elevated spinal fluid protein or white cell counts, cerebral blood flow (CBF), brain ventricular lactate and cortical glutathione (GSH). The results of the study did not show any differences in any of the outcome measures between CFS patients with and without psychiatric comorbidity, thus indicating that psychiatric status may not be an exacerbating factor in CFS. Importantly, significant differences were found between the pooled samples of CFS compared to controls. These included lower GSH and CBF and higher ventricular lactate and rates of spinal fluid abnormalities in CFS patients compared to healthy controls. Thirteen of 26 patients had abnormal values on two or more of these 4 brain-related variables. These findings, which replicate the results of several of our prior studies, support the presence of a number of neurobiological and spinal fluid abnormalities in CFS. These results will lead to further investigation into objective biomarkers of the disorder to advance the understanding of CFS.

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“…A family history of CFS/ME and certain personality traits are also noted to be increased in those with CFS/ME including conscientiousness and high personal and parental expectations [ 48 ]. Ciccone et al [ 49 ] while noting a higher prevalence of psychiatric illness and personality disorder in CFS/ME did not find any major correlation between these and levels of physical functioning and disability. More recently we have noted an increased frequency of CFS/ME symptoms in those with borderline personality disorder which has not hitherto been reported.…”

Section: Introductionmentioning

confidence: 96%

Investigating unexplained fatigue in general practice with a particular focus on CFS/ME

Bansal

2016

BMC Fam Pract

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Unexplained fatigue is not infrequent in the community. It presents a number of challenges to the primary care physician and particularly if the clinical examination and routine investigations are normal. However, while fatigue is a feature of many common illnesses, it is the main problem in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). This is a poorly understood condition that is accompanied by several additional symptoms which suggest a subtle multisystem dysfunction. Not infrequently it is complicated by sleep disturbance and alterations in attention, memory and mood.Specialised services for the diagnosis and management of CFS/ME are markedly deficient in the UK and indeed in virtually all countries around the world. However, unexplained fatigue and CFS/ME may be confidently diagnosed on the basis of specific clinical criteria combined with the normality of routine blood tests. The latter include those that assess inflammation, autoimmunity, endocrine dysfunction and gluten sensitivity. Early diagnosis and intervention in general practice will do much to reduce patient anxiety, encourage improvement and prevent expensive unnecessary investigations.There is presently an on-going debate as to the precise criteria that best confirms CFS/ME to the exclusion of other medical and psychiatric/psychological causes of chronic fatigue. There is also some disagreement as to best means of investigating and managing this very challenging condition. Uncertainty here can contribute to patient stress which in some individuals can perpetuate and aggravate symptoms. A simple clinical scoring system and a short list of routine investigations should help discriminate CFS/ME from other causes of continued fatigue.

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Psychiatric morbidity in the chronic fatigue syndrome

Cited by 28 publications

References 27 publications

Personality Features and Personality Disorders in Chronic Fatigue Syndrome: A Population-Based Study

Personality Features and Personality Disorders in Chronic Fatigue Syndrome: A Population-Based Study

Multimodal and simultaneous assessments of brain and spinal fluid abnormalities in chronic fatigue syndrome and the effects of psychiatric comorbidity

Investigating unexplained fatigue in general practice with a particular focus on CFS/ME

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