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Childhood Trauma Linked to Risk for Chronic Fatigue Syndrome

Published: January 5, 2009

A boy lying on a sofa

A study conducted by researchers from the Centers for Disease Control and Prevention (CDC) and Emory University School of Medicine has identified childhood trauma as a significant risk factor for the development of chronic fatigue syndrome (CFS).

The results of the study, published in Archives of General Psychiatry, confirm that childhood trauma (sexual abuse and emotional maltreatment) is associated with a six-fold increased risk for CFS. The study also found that low levels of cortisol, a hallmark biological feature of CFS, are associated with childhood trauma. Cortisol is frequently referred to as the "stress hormone" and diminished levels result in abnormal responses to stress.

Low cortisol levels a marker

"The study indicates that low cortisol levels may actually be a marker for the risk of developing CFS rather than being a sign of the syndrome itself," said Christine M. Heim, PhD, lead author of the study and Associate Professor in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine.

"These results are pivotal to understanding the underlying pathophysiology of CFS. More importantly, 6 of 10 people suffering from CFS have been severely abused as children. Physicians must consider this possibility when evaluating patients and devising a treatment plan. CFS patients who were abused as children need to understand that their traumatic childhood experiences are common among other CFS patients," said William C. Reeves, MD, MSc, principal investigator of the study and Chief of the Chronic Viral Diseases Branch at CDC.

CDC and Emory University collaborate

CDC is currently collaborating with the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine to conduct a 3-day in-hospital study of persons with CFS. This clinical study (nearing completion) will study 30 people with CFS and 60 well controls from the Georgia population sample. This study utilizes functional magnetic resonance imaging (fMRI) to evaluate brain activity and neural circuit activation in response to cognitive stressors and endocrine, immune and autonomic nervous system function in response to social stressors. The objective is to better understand the pathophysiology of the illness and identify targets for therapeutic intervention.

Preventing child maltreatment before it starts, so that children have the opportunity to grow healthy and strong is a key priority for CDC. To achieve this, CDC is working with a variety of partners to support a range of research activities, early intervention, and prevention programs at the national, state, and local levels.

"Children who are abused or neglected suffer physical and emotional injuries," said Ileana Arias, PhD, director of CDC's National Center for Injury Prevention and Control. "We now know that some types of chronic diseases may surface years later as well. This research adds to that growing body of knowledge and reinforces that we must stop child maltreatment before it begins. Creating safe, stable, and nurturing relationships (SSNRs) between children and adults is an effective buffer to reduce the risk for maltreatment."

The study analyzed data from 113 people with CFS, and a control group of 124 people without CFS, drawn from a sample of almost 20,000 Georgians. The results confirm earlier findings from a 2006 study conducted in Wichita, Kansas.

Study participants underwent detailed medical and psychiatric evaluations and completed a self-reported questionnaire on five different types of childhood trauma including emotional, physical and sexual abuse, and emotional and physical neglect. Researchers also collected saliva samples from participants to record levels of cortisol over one hour after awakening, typically an individual's highest cortisol levels for the day.

Early diagnosis encouraged

CFS affects as many as 2.5 percent of U.S. adults, most have been ill for 5 years, but little is known about the causes and development of the condition. Risk factors include female sex, genetic predisposition, certain personality traits and physical and emotional stress. This debilitating and complex disorder is characterized by profound fatigue that is not improved by bed rest and that may be worsened by physical or mental activity. The fatigue must be accompanied by at least 4 of 8 case defining symptoms the most common being: post-exertional fatigue lasting more than 24 hours, unrefreshing sleep, impaired memory or concentration, diffuse muscle or joint pain. CDC studies have found that 25 percent of CFS patients are unemployed or on disability because of the illness and that families in which an individual suffers from CFS forego about $20,000 annually in lost earnings and wages. In spite of this severe impairment, fewer than half have consulted a physician for the illness. Early diagnosis and management can substantially improve the probability of recovery.

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