Treatment of Chronic Fatigue Syndrome: Findings, Principles and Strategies

Chronic fatigue syndrome (CFS) is a debilitating condition characterized by serious medically unexplained mental and physical fatigue. The high prevalence and both direct and indirect health costs of CFS patients represent a huge problem for contemporary health care. Moreover, the prognosis of CFS, even when treated, is often poor. In this paper, we first critically review current evidence based treatments of CFS. Second, we discuss the growing insights into the etiopathogenesis of CFS, and the need to translate and integrate these insights into future treatments. In particular, we formulate a pragmatic and empirically testable treatment approach, tailored to the individual needs of patients, which aims at restoring the mental and physical equilibrium of CFS patients by trying to bring about sustained life style changes

The role of personality and mentalization in person-environment transactions in Major Depressive Disorder (MDD) and Functional Somatic Syndromes (FSS)

This study is based on the hypothesis that Major Depressive Disorder (MDD) and functional somatic syndromes (FSS), such as chronic fatigue syndrome (CFS), may share common etiopathogenetic pathways (Luyten, Blatt, Van Houdenhove, & Corveleyn, 2006; Pae et al., 2008). In particular, research has suggested that life stress may be involved in the development and maintenance of both MDD and FSS (Van Houdenhove & Luyten, 2006, 2007). However, more research is needed concerning the role of psychosocial factors in the relationship between life stress, MDD and FSS as well as in the development of these conditions. This research project brings together two important psychodynamic frameworks that may shed further light on this relationship, i.e. Blatt’s two-configuration theory of normal and pathological personality development (Blatt, 2004; Luyten, Blatt, & Corveleyn, 2005) and Fonagy’s developmental model of mentalization (Bateman & Fonagy, 2006; Fonagy, Target, Gergely, & Jurist, 2002). A first set of studies is aimed at studying the impact of personality and mentalization on stress reactivity and stress generation in MDD and FSS. More concretely, we will first examine the role of personality and mentalization in the prediction of self-reported and neurobiological (i.e. salivary cortisol as a measure of hypothalamic- pituitary-adrenal axis functioning) stress reactivity and stress generation in CFS patients (N=70), MDD patients (N=70) and normal controls (N=70) using an Ecological Momentary Assessment (EMA) approach. Second, we will investigate the role of personality and mentalization in the prediction of stress reactivity and stress generation in CFS patients (N=48), MDD patients (N=48) and normal controls (N=48) using an experimental stress inducing procedure. A third series of studies aims to investigate the role of personality and mentalization in the intergenerational transmission of MDD and FSS. In particular, we will study longitudinal relationships between personality, mentalization, (early) life stress, parental styles, MDD and FSS in a sample of normal participants, i.e. biological parents (N=160), an at risk sample of adoptive parents and their adoptive child (N=130), and a sample of CFS patients (N=70) and their children. Results of this research project will enhance our understanding of the etiopathogenesis of both MDD and FSS, and may have also important implications for classification and treatment of these conditions.status: publishe

Early Adversity and Self-Critical Perfectionism in Chronic Fatigue Syndrome

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Self-Critical Perfectionism Predicts Lower Cortisol Response to Experimental Stress in Patients With Chronic Fatigue Syndrome

OBJECTIVE: Previous studies have suggested that self-critical perfectionism (SCP) may play a role in the development and maintenance of Chronic Fatigue Syndrome (CFS). In this study we investigated whether SCP is related to a hypofunction of the hypothalamic-pituitary-adrenal (HPA) axis, which has been shown to be a key factor in the pathophysiology of CFS. METHOD: We conducted a quasi-experimental study to examine the association between SCP (as measured with the Depressive Experiences Questionnaire) and stress reactivity in a sample of 41 female CFS patients. Participants were exposed to the Trier Social Stress Test (TSST). Both subjective stress and salivary cortisol levels were measured until 90 min after the TSST. We also examined the relationship between stress reactivity and illness characteristics (i.e., duration and severity of symptoms). RESULTS: The results showed that SCP was associated with increased subjective stress reactivity, but with decreased HPA-axis reactivity as indicated by a blunted cortisol response to the TSST. Furthermore, we found an inverse relationship between cortisol reactivity and symptom severity. There was no relationship between cortisol reactivity and illness duration. CONCLUSION: Our findings suggest that SCP is associated with loss of resilience of the neurobiological stress response system in CFS.status: publishe

Glucocorticoid receptor DNA methylation and childhood trauma in chronic fatigue syndrome patients

Although the precise mechanisms are not yet understood, previous studies have suggested that chronic fatigue syndrome (CFS) is associated with hypothalamic-pituitary-adrenal (HPA) axis dysregulation and trauma in early childhood. Consistent with findings suggesting that early life stress-induced DNA methylation changes may underlie dysregulation of the HPA axis, we previously found evidence for the involvement of glucocorticoid receptor (GR) gene (NR3C1) methylation in whole blood of CFS patients.status: publishe