تجربیات دوران کودکی از بیماری و پدر و مادر در بزرگسالان مبتلا به سندرم خستگی مزمن

Objective: There are many similarities between chronic fatigue syndrome (CFS), the somatoform disorders and problems otherwise known as “medically unexplained symptoms.” There is some evidence to suggest that a combination of inadequate parenting and early illness experience may predispose the individual to develop medically unexplained symptoms in adult life. The aim of this investigation was to compare the contributions of childhood experiences of illness and parenting in adults with CFS with a fracture clinic control group. Method: A retrospective case control design was used. Thirty patients with a diagnosis of CFS and 30 patients attending a fracture clinic in an inner London teaching hospital completed questionnaires measuring parental care and protection and were interviewed about childhood experiences of illness. Results: There were no differences in childhood experience of illness in the two groups. However, logistic regression revealed that maternal overprotection and depression were associated with the diagnosis of CFS. Conclusion: The findings may represent risk factors for the development of CFS in adult life. It is possible that maternal overprotection in particular is related to the formation of belief systems about avoiding activity that operate to adversely influence behaviour in patients with CFS.

Chronic fatigue syndrome (CFS) is a poorly understood condition that is characterised by severe mental and physical fatigue and is associated with muscle pain and sleep disturbance. The prognosis for patients with CFS is poor without effective intervention [1] and no single cause of CFS has yet been established. While the biomedical search for a cause is important, the cognitive behavioural model of fatigue has provided one of the most useful contributions to date. This is because a cognitive behavioural approach is inclusive of a range of influences and incorporates a temporal perspective. Physical emotional, cognitive, social and behavioural factors are synthesised to provide a coherent explanation of vulnerability to, onset and maintenance of CFS [2]. As a result, analysis of the difficulties encountered in CFS has been translated into an effective treatment [3] and [4]. Overall, however, predisposing factors are poorly understood and require further investigation. Given that the somatoform disorders are characterised by “physical symptoms that suggest a general medical condition… and are not fully explained by a general medical condition” [5], the similarities between CFS, the somatoform disorders and other analogous problems, usually described as “medically unexplained symptoms,” are immediately apparent. Exposure to early illness experience, either directly or within the family, has been linked to the development of medically unexplained symptoms both in childhood [6] and [7] and adult life [8], [9], [10], [11] and [12]. Hypochondriacal anxiety in adult life has been linked to parental over concern and solicitude in childhood [9] and [13], and it is thought that iatrogenic factors such as hospitalisation at key developmental stages may be influential in the development of chronic forms of medically unexplained symptoms [14], [15] and [16]. It is possible that the available evidence about the effect of early illness experience and parenting in somatoform disorders and “medically unexplained symptoms” is relevant to the development of CFS. This study, therefore, hypothesized that patients with CFS would report more early illness experience than the fracture clinic controls and that there would be differences in parental care and protection between the two groups.