Does high ‘action-proneness’ make people more vulnerable to chronic fatigue syndrome? A controlled psychometric study

doi:10.1016/0022-3999(95)00008-9

Journal of Psychosomatic Research

Volume 39, Issue 5, July 1995, Pages 633-640

https://doi.org/10.1016/0022-3999(95)00008-9 Get rights and content

Abstract

Degree of premorbid ‘action-proneness’ was measured, using a self-administered questionnaire, in 35 patients suffering from chronic fatigue syndrome (CFS), all the members of ‘ME’-self help groups and all those meeting CDC-criteria of CFS. The results were compared with those of 30 chronic idiopathic musculoskeletal pain patients, 34 patients with a chronic organic condition, and 34 neurotic patients without primary somatic complaints. Statistical analysis showed that CFS patients described themselves as significantly more ‘action-prone’ than the last two groups, and to a degree which was comparable with the chronic pain group. The results could not be explained by concomitant depression and are in accordance with anecdotal reports of premorbid hyperactive lifestyle in CFS patients. Further investigations seem worthwhile to test the hypothesis that hyperactivity might be a predisposing factor for chronic illness behaviour in CFS patients.

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Cited by (76)

Psychological Mechanisms in Understanding and Treating Fatigue: Past, Present, Future
2022, Comprehensive Clinical Psychology, Second Edition
Fatigue is a common experience that has an important adaptive function, urging behavioral changes to support recovery. Sometimes, however, fatigue persists and becomes a chronic problem. This chapter takes a historical perspective on the science of fatigue, highlighting a shift from a resource depletion view to a motivational approach. It further reviews recent developments in theory and treatment of chronic fatigue in the field of clinical (health) psychology, identifying new challenges, and formulating research and clinical recommendations.
Features of mood associated with high body weight in females with fibromyalgia
2018, Comprehensive Psychiatry
Fibromyalgia (FM) is a common syndrome whose main characteristic is chronic widespread musculoskeletal pain, the severity of which is frequently worsened by concomitant obesity. Major depression (MD), particularly as part of a bipolar spectrum disorder (BSD), is associated with both obesity and FM.
To evaluate the relationship between lifetime MD, hypomanic symptoms and the body mass index (BMI) in patients with FM.
Of the 115 patients originally screened, 87 women with FM finally entered the study. Forty-nine patients (57%) had a lifetime diagnosis of MD, assessed by a structured clinical interview based on DSM-IV criteria, and four of them (4.6%) had a current MD episode. Lifetime hypomanic symptoms were measured by means of the self-rated Hypomania Checklist. According to the international criteria for BMI, FM patients were classified as under/normal-weight (61%), overweight (30%) and obese (9%).
62 patients (71.2%) with FM had a bipolar spectrum disorder (BSD). Thirty (48.3%) of them met criteria for bipolar II disorder, 32 (51,6%) for bipolar disorder NOS (18 FM patients with MD associated to sub-syndromal hypomanic syndrome and 14 with hypomanic syndrome without MD). No patient had a bipolar I disorder. Only one patient met the criteria for a major depressive disorder (MDD). There was no significant difference in mean BMI between the patients with and without a lifetime diagnosis of MD, but there was a positive association between the level of hypomanic symptoms and BMI values (p < 0.009). When hypomania was considered categorically as hypomanic syndrome there was no significant effect on BMI.
Our finding adds to previous evidence indicating that hypomanic symptoms are a central feature of FM. In the case of the early identification of high-level hypomanic symptoms, body weight should be closely monitored in order to prevent obesity and its detrimental impact on females with FM.
Differences in physical functioning between relatively active and passive patients with Chronic Fatigue Syndrome
2013, Journal of Psychosomatic Research
According to the Cognitive behavioral therapy (CBT) protocol for patients with Chronic Fatigue Syndrome (CFS), therapists are advised to categorize patients in relatively active and passive patients. However, evidence to support the differences in physical functioning between these subgroups is limited. Using the baseline data from a multicentre randomized controlled trial (FatiGo), the differences in actual and perceived physical functioning between active and passive patients with CFS were evaluated.
Sixty patients, who received CBT during the FatiGo trial were included. Based on the expert opinion and using the definitions of subgroups defined in the CBT protocols, the therapist categorized the patient. Data from an activity monitor was used to calculate actual physical functioning, physical activity, daily uptime, activity fluctuations and duration of rest during daily life. Perceived physical functioning was assessed by measuring physical activity, physical functioning and functional impairment with the Checklist Individual Strength, Short Form-36 and Sickness-Impact Profile 8.
Relatively active patients have a significantly higher daily uptime and show significantly less fluctuations in activities between days. Passive patients experience a significantly lower level of physical functioning and feel more functionally impaired in their mobility. However, no significant differences were found in the other actual or perceived physical functioning indices.
A clear difference in actual and perceived physical functioning between relatively active and passive patients with CFS as judged by their therapists could not be found. Future research is needed to form a consensus on how to categorize subgroups of patients with CFS.
Allostatic overload in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
2013, Medical Hypotheses
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition characterised by diverse symptoms such as fatigue, pain, sleep disturbance and autonomic dysfunction. There remains to be a singular biomarker identified for this illness, hence numerous theories about its development and perpetuation have been posited in the literature. This brief report presents the model of ‘allostasis’ as a framework for understanding ME/CFS, specifically the notion that the physiological mechanisms employed in the body to deal with stress termed here as ‘allostatic states’ (e.g. elevation of inflammatory cytokines), may in and of themselves contribute to the perpetuation of the disorder. This theoretical assertion has important consequences for the understanding of ME/CFS and treatment; rather than searching for a singular pathogen responsible for this condition, ME/CFS can be conceptualised as a maladaptive stress disorder and interventions aimed at addressing the allostatic states may be incorporated into current symptom management programmes.
Symptom fluctuations and daily physical activity in patients with chronic fatigue syndrome: A case-control study
2011, Archives of Physical Medicine and Rehabilitation
Meeus M, van Eupen I, van Baarle E, De Boeck V, Luyckx A, Kos D, Nijs J. Symptom fluctuations and daily physical activity in patients with chronic fatigue syndrome: a case-control study.
To compare the activity pattern of patients with chronic fatigue syndrome (CFS) with healthy sedentary subjects and examine the relationship between the different parameters of performed activity (registered by an accelerometer device) and symptom severity and fluctuation (registered by questionnaires) in patients with CFS.
Case-control study. Participants were asked to wear an accelerometer device on the nondominant hand for 6 consecutive days. Every morning, afternoon, and evening patients scored the intensity of their pain, fatigue, and concentration difficulties on a visual analog scale.
Patients were recruited from a specialized chronic fatigue clinic in the university hospital, where all subjects were invited for 2 appointments (for questionnaire and accelerometer adjustments). In between, activity data were collected in the subject's normal home environment.
Female patients (n=67) with CFS and female age-matched healthy sedentary controls.
Not applicable.
Accelerometry (average activity counts, peak activity counts, ratio peak/average, minutes spent per activity category) and symptom severity (intensity of pain, fatigue, and concentration difficulties).
Patients with CFS were less active, spent more time sedentary, and less time lightly active (P<.05). The course of the activity level during the registration period (P interaction>.05), peak activity, and the staggering of activities (ratio peak/average) on 1 day were not different between groups (P>.05). Negative correlations (–.242 varying to –.307) were observed for sedentary activity and the ratio with symptom severity and variation on the same and the next day. Light, moderate, and vigorous, as well as the average activity and the peak activity, were positively correlated (.242 varying to .421) with symptom severity and variation.
The more patients with CFS are sedentary and the better activity is dispersed, the fewer symptoms and variations they experience on the same and next day. Inversely, more symptoms and variability is experienced when patients were more active that day or the previous day. The direction of these relations cannot be determined in a cross-sectional study and requires further study.
Psychopathology and Physical Activity as Predictors of Chronic Fatigue Syndrome in the 1958 British Birth Cohort: A Replication Study of the 1946 and 1970 Birth Cohorts
2011, Annals of Epidemiology
Citation Excerpt :
Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME) in the United Kingdom, is a syndrome that is primarily characterized by disabling postexertional fatigue, in addition to other symptoms such as musculoskeletal pain and sleep disturbance (1). The etiology of CFS/ME is not established, but there is some evidence linking the condition with premorbid psychopathology (2–4), and premorbid above average physical activity (5–7). A limitation of these findings is that most studies were cross-sectional and it is difficult to determine whether these associations reflect true premorbid risks or result from retrospective response bias.
In this study, we investigate whether prospective associations between psychopathology, physical activity, and chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) observed in the 1946 and 1970 birth cohorts were replicable in the 1958 British birth cohort.
Prospective study using the 1958 British birth cohort, which included 98.7% of births from 1 week in March 1958 in England, Wales, and Scotland. The outcome was self-reported CFS/ME by the age of 42 years, at which point 11,419 participants remained in the study. Psychopathology was assessed by the Rutter scales in childhood and the Malaise Inventory in adulthood. Physical activity was reported by the cohort member, mother and teacher in childhood and adulthood.
The prevalence of CFS/ME was 1.0% (95% confidence interval [CI] = 0.9–1.3) and the median age of onset was 34 years. Premorbid psychopathology at 23 years (odds ratio [OR] = 1.85, 95% CI = 1.06–3.22) and 33 years (OR = 2.81, 95% CI = 1.28–6.18) significantly increased the odds of developing CFS/ME, supporting the 1946 cohort findings. Childhood psychopathology, sedentary behavior in childhood, and persistent exercise in adulthood were not associated with CFS/ME.
In cohort studies premorbid psychopathology in adulthood is a replicated risk marker for CFS/ME, whereas premorbid extremes of physical activity are not.

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Short reportDoes high ‘action-proneness’ make people more vulnerable to chronic fatigue syndrome? A controlled psychometric study

Abstract

Pain

Chronic fatigue and chronic fatigue syndrome: clinical epidemiology and aetiological classification

Sporadic postinfectious neuromyasthenia

Can Med Assoc J

Persisting illness and fatigue in adults with evidence of Epstein-Barr virus infection

Ann Intern Med

From Paralysis To Fatigue

Culture and somatic experience —the social course of illness in neurasthenia and chronic fatigue syndrome

Psychosom Med

Psychologische aspecten van het fibromyalgie-syndroom. Literatuurstudie en vergelijkend retrospectief-empirisch onderzoek met het chronisch vermoeidheidssyndroom

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

Prevalence and psychodynamic interpretation of premorbid hyperactivity in patients with chronic pain

Psychother Psychosom

Premorbid physical hyperactivity and chronic idiopathic musculoskeletal pain

Eur J Pain

Chronic fatigue syndrome: a working case definition

Ann Intern Med

Short report
Does high ‘action-proneness’ make people more vulnerable to chronic fatigue syndrome? A controlled psychometric study