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Early adverse experience and risk for chronic fatigue syndrome: results from a population-based study

Heim C, Wagner D, Maloney E, Papanicolaou DA, Solomon L, Jones JF, Unger ER, Reeves WC
Early adverse experience and risk for chronic fatigue syndrome: results from a population-based study.
Archives of General Psychiatry 63:1258-1266, 2006.

Summary

Identification of risk factors for CFS is critical to guide pathophysiological research and devise targets for prevention. It is increasingly clear that CFS involves immunological and neuroendocrine perturbations and underlying risk factors include female sex, genetic predisposition and physical and emotional stressors. This study of 43 adults with CFS and 60 frequency matched controls (both groups identified from the general population of Wichita) found childhood trauma to be an important risk factor for CFS and the association demonstrated a graded response. Childhood trauma was associated with CFS severity and symptoms of depression, anxiety, and PTSD. Risk of CFS as a function of childhood trauma increased with altered emotional state. This supports the previously noted association of CFS with physiological perturbations. Stress early in life, during critical periods of heightened brain plasticity, permanently affects brain regions involved in cognitive-emotional processing and control of regulatory outflow systems (e.g. the endocrine, autonomic, and immune systems and this may convey vulnerability to stress later in life. Obviously early-life stress does not always lead to CFS and not everyone with CFS has suffered childhood adversity. Other dispositional factors such as genetics and resiliency are important. It will be important to conduct future studies that identify specific neurobiological pathways that translate dearly adverse experience into CFS.

Abstract

Context: Chronic fatigue syndrome (CFS) is an important public health problem. The causes of CFS are unknown and effective prevention strategies remain elusive. A growing literature suggests that early adverse experience increases the risk for a range of negative health outcomes, including fatiguing illnesses. Identification of developmental risk factors for CFS is critical to inform pathophysiological research and devise targets for primary prevention.

Objective: To examine the relationship between early adverse experience and risk for CFS in a population based sample of clinically confirmed CFS cases and nonfatigued control subjects. Design, Setting, and Participants : A case-control study of 43 cases with current CFS and 60 nonfatigued controls identified from a general population sample of 56 146 Wichita residents.

Main Outcome Measures: Self-reported childhood trauma (sexual, physical, and emotional abuse and emotional and physical neglect) and psychopathology (depression, anxiety, and posttraumatic stress disorder) by CFS status.

Results: The CFS cases reported significantly higher levels of childhood trauma and psychopathology compared with the controls. Exposure to childhood trauma was associated with a 3- to 8-fold increased risk for CFS across different trauma types. There was a graded relationship between the degree of trauma exposure and CFS risk. Childhood trauma was associated with greater CFS symptom severity and with symptoms of depression, anxiety, and posttraumatic stress disorder. The risk for CFS conveyed by childhood trauma increased with the presence of concurrent psychopathology.

Conclusions: This study provides evidence of increased levels of multiple types of childhood trauma in a population-based sample of clinically confirmed CFS cases compared with nonfatigued controls. Our results suggest that childhood trauma is an important risk factor for CFS. This risk was in part associated with altered emotional state. Studies scrutinizing the psychological and neurobiological mechanisms that translate childhood adversity into CFS risk may provide direct targets for the early prevention of CFS.

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