Article Background: There is increasing evidence that Chronic Fatigue Syndrome (CFS) may reflect a dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis after a prolonged period of hyperactivity due to chronic stress/overload.

We and others have hypothesized that chronic stress and subsequent neurobiological alterations (i.e. HPA axis hyporeactivity) in CFS may result, at least in part, from elevated levels of self-critical (or maladaptive) perfectionism.

Perfectionism and stress reactivity in patients with chronic fatigue syndrome. Kempke S & Claes S. Psychoneuroendocrinology. 2015 Nov; 61:59