self-esteem – American ME and CFS Society

The Cognitive Behavioral Treatment of Depression and Low Self-Esteem in the Context of Pediatric Chronic Fatigue Syndrome (CFS/ME): A Case Study

Abstract:

PROBLEM: Up to one in three young people with chronic fatigue syndrome (CFS/ME) also has depressive symptoms. It is not known how best to treat young people with this comorbidity.

METHOD: This case report seeks to describe and discuss the use of a cognitive behavioral approach for depression and low self-esteem in a 16-year-old girl with CFS/ME.

FINDINGS/CONCLUSION: Therapy was effective in remediating the young person’s mood difficulties, but appeared to exacerbate their CFS/ME symptoms. Therefore, it is crucial that CFS/ME and mood treatments are designed and trialed to ensure a complementary approach. Good communication and joint working between involved professionals is also important, and ideally, treatments for mood and for CFS/ME would be provided by the same team to facilitate this.

Source: Loades M. The Cognitive Behavioral Treatment of Depression and Low Self-Esteem in the Context of Pediatric Chronic Fatigue Syndrome (CFS/ME): A Case Study. J Child Adolesc Psychiatr Nurs. 2015 Nov;28(4):165-74. doi: 10.1111/jcap.12125. Epub 2015 Oct 16. https://www.ncbi.nlm.nih.gov/pubmed/26470755

Self-esteem mediates the relationship between maladaptive perfectionism and depression in chronic fatigue syndrome

Abstract:

Patients with chronic fatigue syndrome (CFS) often experience depression which may negatively affect prognosis and treatment outcome. Research has shown that depression in CFS is associated with maladaptive or self-critical perfectionism. However, currently, little is known about factors that may explain this relationship, but studies in nonclinical samples suggest that low self-esteem may be an important mediator of this relationship. The present study therefore examined whether self-esteem mediated the cross-sectional association between maladaptive perfectionism and severity of depression in 192 patients meeting Centres for Disease Control and Prevention criteria for CFS.

Patients completed self-report measures of maladaptive perfectionism, self-esteem, depression, and fatigue. Regression analyses and more direct tests of indirect effects (i.e., the Sobel test and bootstrapping) were used to test for mediation. Congruent with expectations, we found that self-esteem fully mediated the relationship between maladaptive perfectionism and depression in CFS. Findings from this study suggest that self-esteem may explain the link between maladaptive perfectionism and depression in CFS, which may have important implications for the treatment and prevention of depression in these patients.

Source: Kempke S, Luyten P, Van Houdenhove B, Goossens L, Bekaert P, Van Wambeke P. Self-esteem mediates the relationship between maladaptive perfectionism and depression in chronic fatigue syndrome. Clin Rheumatol. 2011 Dec;30(12):1543-8. doi: 10.1007/s10067-011-1772-8. Epub 2011 May 17. https://www.ncbi.nlm.nih.gov/pubmed/21584732

Psychiatric adjustment in chronic fatigue syndrome of childhood and in juvenile idiopathic arthritis

Abstract:

BACKGROUND: High rates of psychopathology and of personality problems have been reported in children and adolescents with chronic fatigue syndrome (CFS). It is not clear whether this is consequent on the experience of chronic physical ill health. We compare psychiatric adjustment in children with CFS and in children suffering from another chronic physical disorder (juvenile idiopathic arthritis or JIA).

METHOD: Our sample consisted of 28 children with CFS and 30 with JIA attending tertiary paediatric centres (age range, 11 to 18 years, mean 15, S.D. 2.3). In order to assess psychiatric status and functioning, we used the K-SADS psychiatric interviews, CGAS and Harter Self-Esteem Questionnaire with child subjects; behavioural questionnaires (CBCL) and child personality assessment interviews (PAS) with parent informants.

RESULTS: Psychiatric disorders in the year prior to interview had been present significantly more commonly in the CFS group (72% v. 34% in JIA) and were more impairing to them (CGAS scores of 45 v. 77). Most common diagnoses in both groups were depressive and anxiety disorders. Personality problems were also significantly more frequent in CFS subjects (48% disorder and 26% difficulty v. 11% and 11% in JIA). There were few differences between the two groups in self-esteem.

CONCLUSIONS: Psychopathology and personality problems are common in children and adolescents with severe forms of CFS and cannot be explained strictly through the experience of chronic physical illness.

Comment in: Costs, correlates and consequences of fatigue in children and adults. [Psychol Med. 2003]

Source: Rangel L, Garralda ME, Hall A, Woodham S. Psychiatric adjustment in chronic fatigue syndrome of childhood and in juvenile idiopathic arthritis. Psychol Med. 2003 Feb;33(2):289-97. http://www.ncbi.nlm.nih.gov/pubmed/12622307

Underlying self-esteem in chronic fatigue syndrome

Abstract:

OBJECTIVE: It has been suggested that people with chronic fatigue syndrome (CFS) have low self-esteem; however, this is not necessarily apparent when self-esteem is measured overtly. This study is the first to investigate underlying self-esteem using information-processing measures and overtly administered measures of self-esteem with this population.

METHODS: The study comprised 68 participants (24 CFS, 24 healthy volunteers, and 20 chronic illness volunteers). A Self-Statements Questionnaire (SSQ) and an Emotional Stroop Test (EST) using neutral, positive, and negative trait words were administered.

RESULTS: Participants with CFS reported lower self-esteem than the two comparison groups on overt measures. Overt responses, however, did not fully account for the full extent of the interference effect from the negative word Stroop compared to the positive word Stroop.

CONCLUSION: In contrast to previous studies, participants with CFS reported lower levels of self-esteem on overt measures than two comparison groups. It is suggested, however, that the extent to which participants reported low self-esteem did not fully reflect their underlying low self-esteem and that this may result from the use of rigidly held defence mechanisms. Further use of information-processing measures, in contrast to relying only on self-report measures, is advocated for future research.

Source: Creswell C, Chalder T. Underlying self-esteem in chronic fatigue syndrome. J Psychosom Res. 2002 Sep;53(3):755-61. http://www.ncbi.nlm.nih.gov/pubmed/12217449

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

Attributions and self-esteem in depression and chronic fatigue syndromes

Abstract:

There is considerable overlap in symptomatology between chronic fatigue syndrome (CFS) and affective disorder.

We report a comparison of depressive phenomenology and attributional style between a group of CFS subjects seen in a specialized medical setting, which included a high proportion with depression diagnosed by Research Diagnostic Criteria (RDC), and depressed controls seen in a specialized psychiatric setting.

Significant symptomatic differences between the depressed CFS group and depressed controls were observed for features such as self-esteem and guilt as well as attribution of illness. All the CFS groups tended to attribute their symptoms to external causes whereas the depressed controls experienced inward attribution.

This may have resulted from differences in the severity of mood disorder between the samples, but it is also suggested that an outward style of attribution protects the depressed CFS patients from cognitive changes associated with low mood but at the expense of greater vulnerability towards somatic symptoms such as fatigue.

Source: Powell R, Dolan R, Wessely S. Attributions and self-esteem in depression and chronic fatigue syndromes. J Psychosom Res. 1990;34(6):665-73. http://www.ncbi.nlm.nih.gov/pubmed/2290139