A Different Take on the CFS link to Childhood Trauma Controversy

The following post was written by Jennie Spotila, in response to the article published in Forbes.com as well in response to my own short post about this article. Jennie is a frequent commenter on this blog, and gives lots of support and ideas. She also writes a fantastic blog of her own called Tumblyday.

There has been some media coverage of a study that claims childhood trauma creates an increased risk for CFS. As always, it is worthwhile to lok beyond the media hype to the facts themselves.

The study in question is Early Adverse Experience and Risk for Chronic Fatigue Syndrome: Results from a Population Based Study published in the Archives of General Psychiatry this November. The study compared 43 people with CFS to 60 healthy controls and assessed their rates of self -reported childhood trauma. The study concluded:

CFS cases reported significantly higher levels of childhood trauma was associated with 3- to 8-fold increased risk for CFS across different trauma types. There was a graded relationship between 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. Risk of CFS conveyed by childhood trauma increased with the presence of concurrent psychopathology.

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

There are a number of study limitations which must be noted in order to put the conclusions in context. First, the study notes “results of this exploratory study should be considered preliminary.” THe sample size was small, and “did not consider occurrences outside the family or other types of events, such as childhood illnesses. We also did not differentiate between contact sexual abuse and non-contact harassment. Finally, we did not consider effects of adulthood traumas and life stresses that might mediate the relationship between childhood adversity and CFS.”

The study’s conclusions also contradict the findings of an earlier study. Sexual abuse, physical abuse, chronic fatigue, and chronic fatigue syndrome: a community-based study was published in the Journal of Nervous and Mental Disorders in 2001. That study found, “Prevalence rates of sexual and physical abuse history among individuals with CFS were comparable with those found in individuals with other conditions involving chronic fatigue.”

Unlike the 2006 study, the 2001 paper compared patients with CFS to individuals with other fatiguing illnesses. This is a critical difference, because the only way to assess if childhood trauma causes and increased risk for CFS is to compare trauma rates of CFS patients with another patient group. Why is this critical? Because by comparing the CFS group to healthy controls, the 2006 study can not pinpoint the effect of trauma on the risk of CFS specifically, as opposed to illnesses in general. What if all patient cohorts report the same elevated rate of childhood trauma? There there is no specific increased risk of developing CFS.

This line of reasoning with conclusions drawn by the National Scientific Council on the Developing Child. In fact, the Council reports that:

frequent of sustained activation of brain systems that respond to stress can lead to heightened vulnerability to a range of behavioural and physiological disorders over a lifetime. These undesirable outcomes can include a number of stress related disorders affecting both mental (eg. depression, anxiety disorders, alcoholism, drug abuse) and physical (eg. cardiovascular disease, diabetes, stroke) health. See Excessive Stress Disrupts the Architecture of the Developing Brain.

What is the bottomline of all of this science-speak? The 2006 study and resulting media coverage claim that childhood abuse and neglect creates an increased risk of developing CFS. There is a long history of doctors and other experts claiming that CFS is a psychological disorder. While the 2006 study does not make that claim, I fear that others might. Furthermore, the study did not accurately analyze the prevalence of trauma history among CFS patients. The study should have followed the model of the 2001 study I quoted, which compared trauma history reported by CFS patients versus patients with other fatiguing disorders. That study found no increased level of trauma history in CFS patients.

To me, the important take away message is that childhood trauma of any kind can be damaging throughout life. As the National Council has reported, trauma in childhood leads to increase risk of all types of illnesses. It is common sense that trauma during the period of brain development and growth would have a continuing impact into adulthood. Childhood trauma raises the risk of developing any serious health problems later in life, not just CFS. In my opinion, the media should cover that story. Abuse and neglect is shamefully common in this country. Risk of developing health problems in adulthood is yet another reason that epidemic must be stopped.