Stressors, personality traits, and coping of Gulf War veterans with chronic fatigue

Abstract:

OBJECTIVES: preliminary surveys of Persian Gulf veterans revealed a significant prevalence of self-reported symptoms consistent with chronic fatigue syndrome (CFS). The purpose of this study was to compare self-reported life stressors, combat, and chemical exposures, personality and coping between Gulf War veterans with CFS and healthy veterans.

METHODS: following a complete physical, psychiatric, and neuropsychological evaluation, 45 healthy veterans, 35 veterans with CFS and co-morbid psychiatric disorder, and 23 veterans with CFS and no co-morbid psychiatric disorder completed questionnaires assessing war and non-war-related life stressors, self-reports of environmental exposure (e.g. oil well fires, pesticides), personality, and coping.

RESULTS: measures of personality, self-reported combat and chemical exposures, and negative coping strategies significantly differentiated healthy veterans from those with CFS.

CONCLUSION: a biopsychosocial model of veterans’ illness was supported by the fact that personality, negative coping strategies, life stress after the war, and environmental exposures during the war were significant predictors of veterans’ current physical function.

 

Source: Fiedler N, Lange G, Tiersky L, DeLuca J, Policastro T, Kelly-McNeil K, McWilliams R, Korn L, Natelson B. Stressors, personality traits, and coping of Gulf War veterans with chronic fatigue. J Psychosom Res. 2000 Jun;48(6):525-35. http://www.ncbi.nlm.nih.gov/pubmed/11033371

 

The role of personality in the development and perpetuation of chronic fatigue syndrome

Abstract:

OBJECTIVES: Qualitative evidence suggests that personality may have special relevance to the predisposition, precipitation and perpetuation of chronic fatigue syndrome (CFS). This study compares three dimensions of personality – perfectionism, self-esteem, and emotional control in the personality profiles of CFS patients (N=44) and a control group (N=44) without a history of CFS, matched for age and gender.

METHODS: Participants were assessed on the MPS [Frost RO, Marten P, Lahart C, Rosenblate R. The dimensions of perfectionism. Cognit Ther Res 1990;14:449-468.]; the Rosenberg Self-Esteem Scale [Rosenberg M. Society and the Adolescent Self-image. Princeton, NJ: Princeton Univ Press, 1965.]; the Courtauld Emotional Scale [Watson M, Greer S. Development of a questionnaire measure of emotional control. J Psychosom Res 1983;27:299-305.] and the Marlowe-Crowne Social Desirability Scale [Crowne DP, Marlowe D. A new scale of social desirability independent of psychopathology. J Consult Psychol 1960;24:349-354.].

RESULTS: Analyses revealed that the CFS group reported higher levels than the control group on the Total Perfectionism score and Doubts about Actions and the Concern over Mistakes subscales. Furthermore, the CFS group also reported lower self-esteem than the control group. No difference between the two groups was found on the dimensions of emotional control and social desirability response bias.

CONCLUSION: A developmental model of CFS, which considers the predisposing, precipitating, and perpetuating factors that may account for the course of the disorder irrespective of etiology, is proposed. In the context of the results, recommendations for practice and future research are discussed.

 

Source: White C, Schweitzer R. The role of personality in the development and perpetuation of chronic fatigue syndrome. J Psychosom Res. 2000 Jun;48(6):515-24. http://www.ncbi.nlm.nih.gov/pubmed/11033370

 

Examination of Cloninger’s basic dimensions of personality in fatiguing illness: chronic fatigue syndrome and multiple sclerosis

Abstract:

Relatively few studies have examined the personality characteristics of patients with chronic fatigue syndrome (CFS). The personality profiles of 38 CFS subjects were compared with 40 healthy controls and 40 subjects with multiple sclerosis (MS), a chronic illness that shares many symptoms with CFS (e.g., fatigue), but has a known neurological substrate. Subjects were examined within Cloninger’s biosocial theory of personality, which delineates basic dimensions of temperament. Both illness groups displayed similarly elevated levels of Harm Avoidance, and lower levels of Reward Dependence as compared with healthy controls. The MS group showed a lower level of Persistence than controls and CFS subjects. Implications for the relationship between chronic illness and personality are discussed.

 

Source: Christodoulou C, Deluca J, Johnson SK, Lange G, Gaudino EA, Natelson BH. Examination of Cloninger’s basic dimensions of personality in fatiguing illness: chronic fatigue syndrome and multiple sclerosis. J Psychosom Res. 1999 Dec;47(6):597-607. http://www.ncbi.nlm.nih.gov/pubmed/10661606

 

Personality and social attitudes in chronic fatigue syndrome

Abstract:

One hundred one chronic fatigue syndrome (CFS) patients attending a specialist CFS clinic were compared with 45 rheumatoid arthritis (RA) patients on a range of standardized questionnaire measures, to investigate whether CFS patients are characterized by particular personality traits or social attitudes.

No differences were found between CFS and RA patients in measures of perfectionism, attitudes toward mental illness, defensiveness, social desirability, or sensitivity to punishment (a concept related to neuroticism), on either crude or adjusted analyses. Alexithymia scores were greater in the RA patient group (p<0.05). Social adjustment, based on subjective assessment of overall restriction in activities and relationship difficulties, was substantially poorer in the CFS group (p<0.001). This was highly associated with depressive symptoms, but remained significant even after adjusting for depressive symptomatology.

There was no evidence from this study of major differences between the personalities of CFS patients and RA patients. The stereotype of CFS sufferers as perfectionists with negative attitudes toward psychiatry was not supported.

 

Source: Wood B, Wessely S. Personality and social attitudes in chronic fatigue syndrome. J Psychosom Res. 1999 Oct;47(4):385-97. http://www.ncbi.nlm.nih.gov/pubmed/10616232

 

Associations between perfectionism, mood, and fatigue in chronic fatigue syndrome: a pilot study

Abstract:

This study investigated possible associations between perfectionistic personality traits, mood, and fatigue in chronic fatigue syndrome (CFS). Forty CFS sufferers referred to tertiary care and 31 control healthy subjects completed the Multidimensional Perfectionism Scale (MPS), Chalder Fatigue Questionnaire, and Hospital Anxiety and Depression (HAD) scale.

Total perfectionism scores did not correlate with fatigue, anxiety, or depression in either group. Other-oriented MPS scores were significantly lower among CFS sufferers (p = .0019), especially women, and correlated negatively with physical fatigue levels overall (R = -0.27, p = .02). Total and socially prescribed MPS scores correlated with age for the CFS group alone (p = .05).

Possible reasons why this study did not confirm a positive association between perfectionism and CFS are discussed. The finding that CFS sufferers set lower standards and have lower expectations for significant others may have implications for rehabilitation and recovery from this disorder.

 

Source: Blenkiron P, Edwards R, Lynch S. Associations between perfectionism, mood, and fatigue in chronic fatigue syndrome: a pilot study. J Nerv Ment Dis. 1999 Sep;187(9):566-70. http://www.ncbi.nlm.nih.gov/pubmed/10496512

 

Personality dimensions in chronic fatigue syndrome and depression

Abstract:

Chronic fatigue syndrome (CFS) is a poorly understood condition. Possible etiological factors include infectious agents, psychiatric disorders, and personality characteristics. We examined personality dimensions in 30 nondepressed patients with CFS, 20 patients with major depressive disorder (MDD), and 15 healthy controls. On the NEO-FFI, patients with CFS scored significantly lower than healthy controls on the extroversion subscale. On the neuroticism dimension of the Eysenck Personality Questionnaire (EPQ), patients with MDD scored higher than those with CFS, who in turn scored significantly higher than the healthy controls. CFS patients rated themselves as higher on neuroticism and less extroverted when ill than when they were well. Our results suggest that high scores on neuroticism and low scores on extroversion in CFS could be a reaction to chronic illness.

 

Source: Buckley L, MacHale SM, Cavanagh JT, Sharpe M, Deary IJ, Lawrie SM. Personality dimensions in chronic fatigue syndrome and depression. J Psychosom Res. 1999 Apr;46(4):395-400. http://www.ncbi.nlm.nih.gov/pubmed/10340240

 

Personality dimensions in the chronic fatigue syndrome: a comparison with multiple sclerosis and depression

Abstract:

This study investigated the relative rates of personality disturbance in chronic fatigue syndrome (CFS). Individuals who met the CDC criteria for CFS were compared to two other fatiguing illness groups, mild multiple sclerosis and depression, as well as sedentary healthy controls.

Subjects were administered a structured psychiatric interview to determine Axis I psychiatric disorders and two self-report instruments to assess Axis II personality disorders and the personality trait of neuroticism.

The depressed group had significantly more personality disorders and elevated neuroticism scores compared with the other three groups. The CFS and MS subjects had intermediary personality scores which were significantly higher than healthy controls.

The CFS group with concurrent depressive disorder (34% of the CFS group) was found to account for most of the personality pathology in the CFS sample. The results are discussed in the context of the relationship between personality variables and fatiguing illness.

 

Source: Johnson SK, DeLuca J, Natelson BH. Personality dimensions in the chronic fatigue syndrome: a comparison with multiple sclerosis and depression. J Psychiatr Res. 1996 Jan-Feb;30(1):9-20. http://www.ncbi.nlm.nih.gov/pubmed/8736462

 

MMPI profiles of patients with chronic fatigue syndrome

Abstract:

Fifty-three patients with chronic fatigue syndrome (CFS) and 43 healthy nonpatient controls completed the Minnesota Multiphasic Personality Inventory (MMPI). All subjects varied in their degree of seropositivity to active Epstein-Barr virus (EBV) as measured by their anti-early antigen titers. EBV titers were higher among CFS patients and were associated with being more symptomatic.

Differences in patient status were associated with statistically significant elevations on 8 of 9 clinical scales, 4 of which also showed clinically significant elevations (T scores > or = 70): scales 1, 2, 3, and 8. These results are discussed in terms of their implications for intervention strategies associated with MMPI-based CFS subtypes.

 

Source: Schmaling KB, Jones JF. MMPI profiles of patients with chronic fatigue syndrome. J Psychosom Res. 1996 Jan;40(1):67-74. http://www.ncbi.nlm.nih.gov/pubmed/8730646

 

Somatization, illness attribution and the sociocultural psychiatry of chronic fatigue syndrome

Abstract:

In addition to epidemiological and neurobiological perspectives on the relationship between chronic fatigue syndrome (CFS) and psychiatric disorders there has been increasing interest in the role of cognitive-behavioural, psychological, psychodynamic and social factors in the psychiatric aspects of this syndrome. These factors may be important in the initiation and/or maintenance of CFS and play important roles in the misdiagnosis of primary psychopathology as CFS. They may be important targets for intervention and treatment.

This paper examines the relevance of the following issues for better understanding the relationship between CFS and the results of psychiatric studies: (1) the concepts of somatization and abnormal illness behaviour; (2) the role of patients’ illness attributions; (3) psychological and psychodynamic constructs such as depressive vulnerability occurring in individuals dependent upon achievement for the maintenance of self-esteem and euthymic mood, perfectionism, and helplessness; (4) the role of personality characteristics and styles; (5) the potential iatrogenic role of the health care system in producing disability in individuals with a diagnosis of CFS; (6) the role of the media and other sociocultural forces in the patient’s choice of the CFS label; and (7) the impact of the CFS label on the patient. The importance of differentiating between initiating and maintaining or perpetuating factors is emphasized.

 

Source: Abbey SE. Somatization, illness attribution and the sociocultural psychiatry of chronic fatigue syndrome. Ciba Found Symp. 1993;173:238-52; discussion 252-61. http://www.ncbi.nlm.nih.gov/pubmed/8491101

 

Neuropsychological and psychiatric abnormalities in myalgic encephalomyelitis: a preliminary report

Abstract:

Ten patients attending one general medical hospital clinic who fulfilled operational criteria for the diagnosis of myalgic encephalomyelitis (ME) and with a history longer than three months, underwent a series of standardized neuropsychological and psychiatric tests. Nine were able to complete the tests and were individually matched with a normal control group for age, sex, educational background and premorbid intelligence. The ME subjects showed inferior performance to the controls on two tests of verbal memory. Their personality scores displayed less extraversion and less psychoticism. This is the first report of objective neuropsychological abnormalities in patients with ME, suggesting a discrete deterioration of short-term memory. The findings may also suggest a concurrent psychiatric component of the condition, but the direction of causality remains to be clarified.

 

Source: Riccio M, Thompson C, Wilson B, Morgan DJ, Lant AF. Neuropsychological and psychiatric abnormalities in myalgic encephalomyelitis: a preliminary report. Br J Clin Psychol. 1992 Feb;31 ( Pt 1):111-20. http://www.ncbi.nlm.nih.gov/pubmed/1559114