Previous studies have reported consistent associations between Neuroticism, maladaptive perfectionism and depression with severity of fatigue in Chronic Fatigue Syndrome (CFS). Depression has been considered a mediator factor between maladaptive perfectionism and fatigue severity, but no studies have explored the role of neuroticism in a comparable theoretical framework. This study aims to examine for the first time, the role of neuroticism, maladaptive perfectionism and depression on the severity of CFS, analyzing several explanation models.
There is increasing evidence that Chronic Fatigue Syndrome (CFS) is probably not caused or maintained by single variables and is probably the result of the interplay of several factors [1]. The consideration of psychological variables as factors that constitute a part of the nature of this illness is also convincing [2], [3], [4] and [5]. It has been argued that personality has been one of the most important psychological risk factors associated with this illness as a predisposing or perpetuating factor [2]. CFS patients have been frequently described as subjects with a high disposition to experience negative affect, emotional liability or feelings of worthlessness. According to this description, CFS patients obtain higher scores than unaffected subjects in neuroticism, becoming one of the most common personality traits observed within this disorder [6], [7], [8] and [9].
Another important psychological construct that has been regularly considered in CFS is perfectionism [1], [10], [11] and [12]. Many studies have found evidence that perfectionism is constituted by two factors: adaptive perfectionism, a positive striving for achievement and maladaptive perfectionism, a tendency to make overly critical self-evaluations [13], [14] and [15]. Both factors may have differential effects on health [15] and [16]. In a recent study only maladaptive perfectionism, mediated by depression symptoms, has been consistently positively associated with CFS [17]. The association between maladaptive perfectionism and neuroticism has been examined in several studies, obtaining positive correlations between both factors [18], [19], [20], [21], [22] and [23]. As a consequence of the consistent association between these two variables, some authors have referred to maladaptive or negative perfectionism as neurotic perfectionism [13], [24], [25] and [26].
Despite the contrasted association between neuroticism or maladaptive perfectionism with CFS severity, the relevance of both variables in CFS has been frequently pointed out with caution as a consequence of their common association with depression symptoms or depression comorbidity [2], [4], [7], [10] and [27]. Besides, depression is another factor commonly associated with CFS, although its role in the pathogenesis and perpetuation of CFS still remains unclear. It has been described that around one third of CFS patients are depressed [28] and [29] and some of the physical and psychological symptoms of CFS are similar to those of depression [2] and [30]. However, recent scientific advances have suggested that there are inflammatory and immunological differences between them, suggesting that CFS and depression are distinct yet interrelated conditions [31].
The role of neuroticism, maladaptive perfectionism, and depression in the severity of CFS has never been analyzed together before. The aim of this study, and in the context of a structural equation modeling, is to explore the fitness of different models testing different approximations with respect to CFS severity. As has been pointed out, the relevance of negative perfectionism on CFS seems to be mediated by severity of depression, but no information is available about the role of severity of depression on the association between Neuroticism and CFS severity. On the other hand, and according to the reported overlapping between neuroticism and negative perfectionism, it is examined, in a multivariate context of analysis, if both personality variables show an independent association or one of the two variables has a predominant or unique association with CFS severity.
