Research abstract:
Chronic fatigue syndrome is a case definition for conditions of chronic, disabling physical and mental fatigue which are not fully explained by medical or psychiatric causes (NICE, 2007). There has been much controversy over both the case definition and its management (Lynch, 1994).
Some expert and patient groups have favoured other case definitions such as ME, CFIDS and believe that these may represent distinct groups with different aetiology. All of these case definitions are imperfect and may have limitations.
Implications for Assessment and Treatment:
In the UK the NICE clinical guidelines for the treatment of CFS (NICE, 2007) support the use of cognitive behaviour therapy (CBT) and graded exercise therapy (GET), based on the existing evidence from randomised controlled trials. However, a substantial proportion of patients do not benefit from these interventions.
Bearing in mind what has been found about the inter-relationship between a history of childhood adversity and fulfilling the case definition of CFS/ME it is perhaps unsurprising that not all patients may show treatment response to CBT and GET. This may reflect the complexity of the disorder, or the acceptability of these interventions to patients and their beliefs about illness causation.
For example, some patients with CFS have a history of childhood adversity or trauma and the CBT and GET interventions suggested are not specifically trauma focussed as would be therapies such as EMDR or trauma-focussed CBT which are treatments supported by NICE in PTSD (NICE, 2005).
Future research may need to consider whether patients with CFS and a possible trauma history differ from CFS patients without this history in terms of their outcome and in their response to CBT, GET and other interventions. Modification of treatment programmes to include sequential treatment approaches trauma focussed interventions (possibly before use of GET or CBT) or modifying existing treatment programmes to add this focus may be an important and fruitful area to study.
The relationship of trauma and CFS, by Sean P.J. Lynch in International Journal of Emergency Mental Health and Human Resilience vol 17, no.3 pp 661-663
