Health rising blog post, by Cort Johnson, Dec 10, 2016: The Anxiety Question in Chronic Fatigue Syndrome and Fibromyalgia: Is the Autonomic Nervous System to Blame?

Anxiety type symptoms are common in chronic fatigue syndrome (ME/CFS), fibromyalgia, Gulf War Ilness (GWI), and postural orthostatic tachycardia syndrome (POTS). Dr. Baraniuk, an ME/CFS and GWI researcher, has long thought that researchers missed the boat by focusing on depression in ME/CFS; anxiety, he believes is far more prevalent.

That certainly fits my experience. Trouble concentrating, feeling tense or jumpy, anticipating the worst, irritability, restlessness, feeling like your mind’s gone blank, nausea, muscular tension, dizziness, restlessness, fatigue and problems in concentration, headache, abdominal pain, shortness of breath, sweating and frequent urination can all be found in anxiety, ME/CFS and fibromyalgia.

The “anxiety” in POTS, ME/CFS and FM: is it primarily emotional or physical?
The diseases are different. Flu-like symptoms are more common in ME/CFS and pain is much more intense in FM. Post-exertional malaise – a key symptom in ME/CFS – is never mentioned in connection with anxiety and is apparently not present. The crippling feelings of dread and fear often present in anxiety are rarely present in ME/CFS; many studies indicate that emotional issues contribute little to the functional problems in ME/CFS while physical issues dominate.

Still a common core of symptoms – feeling tense, trouble concentrating, muscle tension, dizziness, abdominal pain, shortness of breath, etc. – are found in ME/CFS, FM and anxiety. It’s as if the more extreme emotional symptoms have been stripped away leaving a body and mind on edge.  Emotional issues are often present, but at a “sub-clinical” level. They’re not enough to trigger a diagnosis of anxiety but are enough to be aggravating. Plus, similar problems of catastrophizing and hypervigilance are fairly common.

I recently experienced an ebbing of many of these symptoms – the muscular tension, the trouble concentrating, the restlessness, the chronic pain, the difficulty taking deep breaths- while using a device that stimulates the vagus nerve. That made me wonder if  autonomic nervous system problems could be behind many of these symptoms.

Given the continuing emphasis on behavioral approaches to ME/CFS and FM in some countries it’s an important question. A recent study from Belgium reported that 45% of ME/CFS patients had a mood disorder. A 2013 UK study stated that symptom focusing and beliefs about damage were particularly prevalent in ME/CFS patients with anxiety.

The article goes on to look at a study where the authors hypothesized that the anxiety type symptoms experienced by POTS patients were due to an over-awareness of their physical symptoms. The article then looks at other ways to produce anxiety-like states in ME/CFS. Read more

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