We zijn er uit...
Reeves en kollega's van het CDC en de Emory School hebben vastgesteld dat
ME/CVS gepaard gaat met persoonlijkheidsafwijkingen
die kunnen verklaren waarom patiënten een aversie tegen CGT/GET hebben.
T.a.v. de oorzaak en gevolg-vraag
(veroorzaakt ME/CVS psychische klachten of zijn psychische klachten de oorzaak van ME/CVS)
kiest men "vanzelfsprekend" voor het laatste.
De persoonlijkheidsafwijkingen kunnen volgens de auteurs
de "weigerachtige houding" t.o.v. CGT/GET (en dientengevolge het gebrek aan succes),
"ongezond gedrag" en het gebrek aan een stabiele sociale omgeving verklaren.
Je moet het maar kunnen patiënten "een gebrek aan een stabiele sociale omgeving" te verwijten.
O ja, 70% heeft géén persoonlijkheidsafwijkingen!
Aangezien je voor die groep geen verklaring hebt, moet je daar maar zo veel mogelijk zwijgen.
Categorically, 29% of our participants with CFS had a personality disorder,
compared to 7% of the well controls.
Interestingly, the occurrence of personality disorders in our study was substantially lower than in these other studies.
We believe this is best explained by the fact that previously published studies enrolled parti-cipants from primary or tertiary care centers, whereas our study was population-based.
Patients recruited from primary or tertiary care centers may have more comorbid conditions than subjects recruited from the community.
Also, decreased agreeableness and conscientiousness scores were found in CFS.
Both personality traits might affect compliance with treatment regimes.
In this context, it is relevant to note that studies comparing CFS to other chronic illnesses, such as multiple sclerosis, did not find differences regarding the prevalence of comorbid personality disorders [9, 10].
Personality disorders are therefore unlikely to be specific to CFS, but might be related to the chronicity and severity of an illness.
The question arises
whether personality dispositions are a premorbid risk factor,
or whether they are a consequence of the chronicity and severity of the illness known as CFS
(and comorbid conditions), or both.
While some authors have raised the possibility that personality alterations are merely sequelae of the illness itself , a recent study in a population-based sample of twins found that emotional instability assessed 25 years earlier was predictive of a later diagnosis of chronic fatigue .
In contrast, a recent analysis using data from the British birth cohort study found that personality factors such as neuroticism and extraversion did not predict a diagnosis of CFS .
It needs to be noted, though, that this study relied on self-reported diagnoses of CFS.
Although we found that personality disorders and maladaptive personality features were relatively common in persons with CFS,
more than 70% of our CFS sample did not fulfill the diagnosis for a personality disorder.
For example, cognitive behavioral therapy and graded exercise therapy are widely held to be the most effective treatments for CFS although their results are inconsistent .
The maladaptive personality features that we describe interfere with the ability to follow directions and maintain the self-motivation needed for cognitive behavioral therapy and graded exercise therapy to be effective.
Personality features and personality disorders in chronic fatigue syndrome: A population-based study
Psychother Psychosom 2010;79:312–318. doi: 10.1159/000319312.
Urs M. Nater a, b, James F. Jones a, Jin-Mann S. Lin a, Elizabeth Maloney a, William C. Reeves a, Christine Heim b
- Chronic Viral Diseases Branch, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, and
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Ga. , USA
Chronic fatigue syndrome (CFS) presents unique diagnostic and management challenges.
may be a risk factor for CFS and
may contribute to the maintenance of the illness.
501 study participants were identified from
the general population of Georgia:
113 people with CFS,
264 with unexplained unwellness but not CFS (insufficient fatigue, ISF) and
124 well controls.
We used the Personality Diagnostic Questionnaire, 4th edition, to evaluate
DSM-IV personality disorders.
We used the NEO Five-Factor Inventory to assess
personality features (neuroticism, extraversion, openness, agreeableness and conscientiousness).
The Multidimensional Fatigue Inventory measured 5 dimensions of fatigue, and
the Medical Outcomes Survey Short Form 36 measured 8 dimensions of functional impairment.
Twenty-nine percent of the CFS cases had at least 1 personality disorder,
compared to 28% of the ISF cases and 7% of the well controls.
The prevalence of
paranoid, schizoid, avoidant, obsessive-compulsive and depressive personality disorders
were significantly higher in CFS and ISF compared to the well controls.
The CFS cases had significantly higher scores on neuroticism,
and significantly lower scores on extraversion
than those with ISF or the well controls.
Personality features were correlated with selected composite characteristics of fatigue.
Our results suggest that
CFS is associated with an increased prevalence of
maladaptive personality features and personality disorders.
This might be associated with
being noncompliant with treatment suggestions,
displaying unhealthy behavioural strategies and
lacking a stable social environment.
Since maladaptive personality is not specific to CFS,
it might be associated with illness per se rather than with a specific condition.