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Chronic Fatigue| Fibromyalgia| Pre-morbid Life-Styles

Posted Sep 18 2008 10:23am

Patients with Chronic Fatigue and Fibromyalgia, whom I have treated seemed to have special common traits and a literature search showed the following findings:

Generally considered a “precursor” of Chronic Fatigue Syndrome and Fibromyalgia is overwork since such patients have been described in these terms: “overactive, unable to set limits to the demands of others, high achievement motivation, obsessive–compulsive traits, perfectionism, type-A (like) behavior, workaholism, self-sacrificing tendencies,inability to express one's feelings”.

A study showed that indeed, 80–90% of the significant others of these patients agree with statements that the patients do focus on activity, drive, achievement, impatience and “to know how to set about work.” This quasiunanimous agreement consistently strengthens the image of Chronic Fatigue Syndrome and Fibromyalgia to be premorbidly passionate, strong-willed, energetic and driven, i.e., high “action-prone” individual.

There is even a higher tendency for significant others who showed a negative attitude to the patient’s illness to appraise the patients “action-proneness” than for those who are supporting and solicitous.   This ruled out the possibility of influence of personal bias that significant others may have on the results.

These results do not support the hypothesis that Chronic Fatigue Syndrome and Fibromyalgia patients retrospectively idealise their premorbid lifestyle or attitude towards activity.

High “action-proneness,” by promoting an “overactive” lifestyle, may be one of the factors that makes people more vulnerable to Chronic Fatigue Syndrome and Fibromyalgia, and also contributes to the onset and perpetuation of the illness.

People who engage in an “overactive” lifestyle may run a greater risk of acute or chronic physical overburdening by a negligent attitude towards the body, musculoskeletal overuse or sleep deprivation. Particularly those with childhood victimization experiences often show a tendency to exceed physical limits (in work or sports) as a way of coping, i.e., to maintain self-esteem, stabilise the affective equilibrium and prevent anxiety and depression.

Long-lasting physical or mental stress may, in susceptible individuals, eventually lead to neuroendocrine (mainly HPA axis) and immunological dysfunctioning, paving the way for various stress-related disorders and contribute to the neuronal sensitization of central pain mechanisms, resulting in the typical “general pain hypersensitivity” of fibromyalgia patients.

When illness deprives these patients from being able to use “overactivity” as their favourite coping strategy, fatigue and pain may be reinforced by chronic sympathetic arousal, hyperventilation and disturbances of the sleep-wake cycle.

Lifestyle adjustment and psychological counselling and support should always be central goals in cognitive–behavioral programs for these patients.  These patients are still prone to outbursts of over-activity when they may feel better perpetuating the chronic pain and suffering.

Reference: Van Houdenhove B. Neerinckx E. Onghena P. Lysens R. Vertommen H. Premorbid"overactive"lifestyleinchronicfatiguesyndromeandfibromyalgia. Anetiologicalfactororproofofgoodcitizenship?.Journal of Psychosomatic Research. 51(4):571-6, 2001.

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