Studies suggest that chronic fatigue may not only have the power to change a person’s personality but that certain personality traits may also put a person at higher risk of developing chronic fatigue. One recent study, in particular, examined the personalities of both people diagnosed with chronic fatigue syndrome and victims of medically unexplainable chronic fatigue not meeting criteria for chronic fatigue syndrome.Study participants diagnosed with chronic fatigue syndrome had to have experienced medically unexplainable fatigue that limited their daily activities for at least six months with four of the following symptoms: headache, muscle pain, joint pain, sore throat, tender lymph nodes, significant impairment of memory or concentration, unrefreshing sleep, and unusual postexertional malaise.
The study, published in Psychotherapy and Psychosomatics, found that chronic fatigue syndrome victims scored higher in neuroticism, a measure of vulnerability to negative emotional states such as anxiety or depression, than both people without fatigue and people with medically unexplainable fatigue. Victims of medically unexplainable fatigue, however, still scored higher in neuroticism scores than people without fatigue. The researchers also found a reverse pattern with extraversion, one’s level of activity and sociability. Chronic fatigue syndrome victims were the least extraverted, and people without fatigue were the most extraverted. Although these results were solely correlational, in another study, chronic fatigue syndrome patients rated themselves as higher on neuroticism and lower in extraversion when they were ill then when they were well.
The reduced levels of extraversion may indeed be a result of fatigue rather than a risk factor for fatigue. It is possible that neuroticism is also either a result of the fatigue itself or a result of the same factors which are causing the fatigue. On a psychological level, chronic fatigue may lead to greater emotional burden due to feelings such as worry, frustration, and aloneness that victims of chronic unexplainable fatigue often experience. This emotional burden might, in turn, lead to higher neuroticism scores. Chronic fatigue could alse cause or be the result of an impaired physiological response to stress.
The two groups of participants with chronic fatigue had similar levels of agreeableness and conscientiousness which were lower than the scores of people without fatigue. Agreeableness is a measure of the tendency to be cooperative and compassionate towards others, and conscientiousness is a measure of such traits as being organized, planful, and self-disciplined. Whether agreeableness and conscientiousness decrease after onset of the chronic fatigue or are risk factors for chronic fatigue is unclear.
The study also found that a disproportionately large number of chronic fatigue victims had personality disorders, or maladaptive behavior patterns. Twenty-nine percent of people with unexplainable fatigue and 28 percent of people with chronic fatigue syndrome had at least one personality disorder. The most common personality disorder found among people with chronic fatigue syndrome was obsessive-compulsive personality disorder, a personalitydisorder involving a maladaptive obsession with perfection, rules, and organization. Maladaptive behavior patterns may in fact be risk factors for developing chronic fatigue. A past study followed sets of twins for 25 years and found that high stress and emotional instability, which are both causes and results of maladaptive behavior patterns, increased the risk for developing chronic fatigue-like illness.
Interestingly, another study examined patients with multiple sclerosis, a fatiguing illness which, like chronic fatigue syndrome, has an unknown cause, and found that the multiple sclerosis patients had about as many personality disorders as the chronic fatigue syndrome patients. Maladaptive behavior patterns thus may be risk factors for both chronic fatigue and multiple sclerosis.
Although about a quarter of people with chronic fatigue syndrome are disabled enough that they are either unemployed or receiving disability compensation, only about half of people with this disorder actually consult a physician about their illness. This can perhaps be partly attributed to the lack of knowledge among physicians about the nature of unexplainable chronic fatigue as well as to the limited number of current treatments. Understanding thepersonality behind chronic fatigue will bring the victims of medically unexplainable chronic fatigue one step closer to getting proper help.
References
Buckley L, MacHale SM, Cavanagh JT, Sharpe M, Deary IJ, & Lawrie SM (1999). Personality dimensions in chronic fatigue syndrome and depression. Journal of psychosomatic research, 46 (4), 395-400 PMID: 10340240
Johnson SK, DeLuca J, & Natelson BH (1996). Personality dimensions in the chronic fatigue syndrome: a comparison with multiple sclerosis and depression. Journal of psychiatric research, 30 (1), 9-20 PMID: 8736462
Kato K, Sullivan PF, Evengård B, & Pedersen NL (2006). Premorbid predictors of chronic fatigue. Archives of general psychiatry, 63 (11), 1267-72 PMID: 17088507
Magnusson AE, Nias DK, & White PD (1996). Is perfectionism associated with fatigue? Journal of psychosomatic research, 41 (4), 377-83 PMID: 8971668
Nater UM, Jones JF, Lin J-MS, Maloney E, Reeves WC, & Heim C (2010). Personality Features and Personality Disorders in Chronic Fatigue Syndrome: A Population-Based Study. Psychotherapy and Psychosomatics, 79 (5), 312-318 PMID: 20664306
Pepper CM, Krupp LB, Friedberg F, Doscher C, & Coyle PK (1993). A comparison of neuropsychiatric characteristics in chronic fatigue syndrome, multiple sclerosis, and major depression. The Journal of neuropsychiatry and clinical neurosciences, 5 (2), 200-5 PMID: 8508039
Taillefer SS, Kirmayer LJ, Robbins JM, & Lasry JC (2003). Correlates of illness worry in chronic fatigue syndrome. Journal of psychosomatic research, 54 (4), 331-7 PMID: 12670610
White C, & Schweitzer R (2000). The role of personality in the development and perpetuation of chronic fatigue syndrome. Journal of psychosomatic research, 48 (6), 515-24 PMID: 11033370
Julnar Issa, BS
Ms. Issa is a former scientific researcher now focused on bringing the knowledge of research to the general public as a freelance writer. She holds a Bachelors degree in biomedical engineering with a minor in psychology.92 Responses
Hi Pochoams,
As I explained to some of the commenters below, the researchers were not trying to state that mental illness leads to chronic fatigue syndrome or that CFS is a mental illness. They were merely noting that a large percentage of CFS sufferers have had experiences with chronic stressors or psychological difficulties. This may be because of the mind-body connection. It is well-established that chronic stress weakens the body’s immune system and makes people vulnerable to physical illness.
This is not the fault of the sufferer. People cannot be blamed for any stressors or psychological difficulties that they experience in their lives.
CFS researchers have a long way to go before determining what single retrovirus or combination of factors causes the set of symptoms known as chronic fatigue syndrome. This research finding that the XMRV retrovirus appears to exist only in CFS sufferers in the North America and not in the UK may be of interest: http://www.ncbi.nlm.nih.gov/pubmed/20066031.
As I explained to some of the commenters below, the researchers were not trying to state that mental illness leads to chronic fatigue syndrome or that CFS is a mental illness. They were merely noting that a large percentage of CFS sufferers have had experiences with chronic stressors or psychological difficulties. This may be because of the mind-body connection. It is well-established that chronic stress weakens the body’s immune system and makes people vulnerable to physical illness.
This is not the fault of the sufferer. People cannot be blamed for any stressors or psychological difficulties that they experience in their lives.
CFS researchers have a long way to go before determining what single retrovirus or combination of factors causes the set of symptoms known as chronic fatigue syndrome. This research finding that the XMRV retrovirus appears to exist only in CFS sufferers in the North America and not in the UK may be of interest: http://www.ncbi.nlm.nih.gov/pubmed/20066031.
Willow says:Jason LA, Najar N, Porter N, Reh C. “Evaluating the Centers for Disease Control’s Empirical Chronic Fatigue Syndrome Case Definition”. Journal of Disability Policy Studies. September 2009 vol. 20 no. 2 93-100.
The Centers for Disease Control and Prevention (CDC) recently developed an empirical case definition that specifies criteria and instruments to diagnose chronic fatigue syndrome (CFS) in order to bring more methodological rigor to the current CFS case definition. The present study investigated this new definition with 27 participants with a diagnosis of CFS and 37 participants with a diagnosis of a Major Depressive Disorder. Participants completed questionnaires measuring disability, fatigue, and symptoms. Findings indicated that 38% of those with a diagnosis of a Major Depressive Disorder were misclassified as having CFS using the new CDC definition. Given the CDC’s stature and respect in the scientific world, this new definition might be widely used by investigators and clinicians. This might result in the erroneous inclusion of people with primary psychiatric conditions in CFS samples, with detrimental consequences for the interpretation of epidemiologic, etiologic, and treatment efficacy findings for people with CFS.The difference between Fukuda (official CDC 1994 definition) and “Empirical”/Reeves surveys:
Fatigue
Fukuda–severe fatigue (defined as mental and physical exhaustion, not sleepiness and not lack of motivation) that patient reports is substantially reducing activities, is not resolved by rest, and is not from ongoing exertion. Must have lasted at least 6 months.
Reeves–above criteria is considered to be satisfied if two items from the standard MFI survey reveals relatively increased rate of either general fatigue or reduced activity not necessarily connected to fatigue.
Exhaustive fatigue is required under Reeves.
Reduction of activity:
Fukuda–decrease in activities secondary to specific CFS symptoms such as fatigue and cognition difficulties.
Reeves–decrease in activities relative to population, for any reason (including secondary to personal/emotional problems)
CFS symptoms causing the reduction in activity is not required under Reeves. Debilitation is not required (considers a full 25% of the population to have a pathological reduction of activities)
Fukuda CFS-diagnostic symptoms:
Fukuda–At least 4 of the symptoms must be concurrently present, not pre-dating fatigue (i.e. they must be related to the illness at hand). All 4 must be continuous or recurring.
Reeves–At least 4 of the symptoms must be present over the previous month, and the score of severity x frequency of combined symptoms must be at least 25 (any one symptom can get up to 16).
Reeves does not assess the comparative onset of these symptoms with “fatigue” (as they consider it above), and asks only about the previous single month, so the symptoms need not be related to the disease at hand. One doesn’t need 4 symptoms all continuous or recurring, or otherwise significant.
See also:
Jason L, Brown M, Evans M, Anderson V, Lerch A, Brown A, Hunnell J, Porter N. “Measuring substantial reductions in functioning in patients with chronic fatigue syndrome.” Disabil Rehabil. 2010 Jul 9.
Purpose. All the major current case definitions for chronic fatigue syndrome (CFS) specify substantial reductions in previous levels of occupational, educational, social, or personal activities to meet criteria. Difficulties have been encountered in operationalizing ‘substantial reductions.’ For example, the Medical Outcomes Study Short Form-36 Health Survey (SF-36) has been used to determine whether individuals met the CFS disability criterion. However, previous methods of using the SF-36 have been prone to including people without substantial reductions in key areas of physical functioning when diagnosing CFS. This study sought to empirically identify the most appropriate SF-36 subscales for measuring substantial reductions in patients with CFS. Method. The SF-36 was administered to two samples of patients with CFS: one recruited from tertiary care and the other a community-based sample; as well as a non-fatigued control group. Receiver operating characteristics were used to determine the optimal cutoff scores for identifying patients with CFS. Results. The SF-36 Role-Emotional subscale had the worst sensitivity and specificity, whereas the Vitality, Role-Physical, and Social Functioning subscales had the best sensitivity and specificity. Conclusion. Based on the evidence from this study, the potential criteria for defining substantial reductions in functioning and diagnosing CFS is provided.
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Just for you to know, a new human retrovirus called XMRV has been associated to 87% of CFS patients, and is present in 4% of healthy donors.
Wether XMRV ends up to be the physical cause of CFS or not, what is clear is that CFS patients do have an immune problem that allows XMRV to be present, and immune problem that is far to be related to a personality disorder!