I’ve been working on this chronic fatigue syndrome (CFS) series in large part because here at WholeHealth Chicago our practitioners see so many patients who say right up front, “I’ve been diagnosed with CFS and all my tests are normal.”
If you’re one of those patients, you might add that you’ve been to X number of doctors, seen Y number of alternative practitioners, and are taking Z supplements. You may then hand over a hillock of lab tests–repetitive, unimaginative, and unrevealing. I will always look through them, though, hoping to find something that was missed along the way.
It’s worth discussing post-traumatic stress disorder (PTSD) as a cause of chronic fatigue because the diagnosis is virtually never considered as a possibility by conventional physicians when you show up with your years of fatigue and normal tests.
Yet a thorough knowledge of your biography is essential in the process of getting you well and making some progress with your CFS. Was there anything like PTSD in the emotional history of your family? As with depression, anxiety, and other mood disorders, there is a very strong component of multigenerational PTSD.
Initially, post-traumatic stress disorder PTSD was thought to be a wartime phenomenon and it was called by a variety of names, including shell shock in World War 1 and combat neurosis in World War 2. Now, 70 years later, it’s well accepted that women with PTSD outnumber men 2 to 1.
The big however is that the relationship between PTSD and CFS has been a relatively recent discovery, most likely because of that annoying artificial barrier created by conventional medicine between what’s called physical illness and mental illness. A woman who is tired all the time will have her blood count and thyroid tested and measured a dozen times, only to be written off as a complainer, told she’s depressed, and sent to a therapist.
If she’s lucky enough to have mental health benefits, the sex abuse issue from when she was 11 will come up after a few weeks, but there’s no one around to connect the dots between that devastation and her PTSD/CFS.
Here’s what was discovered just a few years ago: fully 25% of patients with PTSD fulfill all the diagnostic criteria for CFS. And 25% of patients with CFS had at some time in their lives experienced trauma that could be responsible for the PTSD (childhood physical/sexual/psychological abuse and the like).
What we now know is that the PTSD/CFS combination occurs much more frequently in women than in men, probably due to the lesser amount of the stress- buffering neurotransmitter serotonin in the female brain. And because serotonin is involved, it’s worth noting that many people with PTSD and/or CFS can be helped by the SSRI group of antidepressant medications.
However, recent research is showing that both conditions can also be helped by cognitive behavioral therapy and EMDR (eye movement desensitization and reprocessing), which literally retrains your brain to move away from the site of trauma, replacing it with a safe place.
The fatigue of CFS is not surprisingly related to a poor response of the adrenal gland to cortisol (the adrenal fatigue we discussed here).
Most CFS/PTSD patients report muscle pain similar to fibromyalgia. Cytokines are molecules produced in the body that are involved in inflammation. You may have first heard the word during the Covid-19 pandemic in relation to the cytokine storm response some people had to the virus.
All three–CFS, PTSD, and fibro–have shown cytokine abnormalities. The newly released blood test for fibromyalgia actually does measure the cytokine levels in your blood most frequently associated with fibro. It’s very likely this same test could measure the cytokine response to PTSD and CFS.
Many generations of trauma
Keeping in mind our multigenerational susceptibility to PTSD and CFS, I need to share with you a most disturbing book. Indeed, Post Traumatic Slave Syndrome: America’s Legacy of Enduring Injury and Healing, by Dr. Joy DeGruy, requires a slow and careful read.
I came across this book about the same time I learned that the rates of both CFS and PTSD were higher among Black Americans, and especially Black women, than other ethnic groups. Dr. DeGruy makes a convincing argument that so many aspects of our lives, both White and Black—including lifespan inequalities, street perpetrators/victims, good schools/bad schools, and country clubs vs mass incarceration–have their roots in the almost 600-year history of slavery and the ongoing racism it spawned.
Here’s a link to Dr DeGruy’s website. I urge you to watch the two short videos there, especially if you’re at all wondering about the premise of her book.
The final point of this Health Tip being: whether you’ve got CFS, PTSD, fibro, or whether you’re just fine, and whether you’re White or Black, had a good childhood or lived a horror show, anytime you yourself think you’re complicated, kiddo, you’re just scratching the surface.
David Edelberg, MD