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.
Earlier root causes of chronic fatigue in this series included minimally underactive thyroid, chronic mono/Epstein-Barr infection, adrenal fatigue, and vitamin deficiencies. Several more will follow.
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
9 thoughts on “Root Causes of Chronic Fatigue, Part 5: Post-Traumatic Stress Disorder (PTSD)”
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Many people, with and without fibro, experience short-lived muscle aching after COVID immunization. Actually, I would take anything that might interfere with the immunizing process. One thing for certain however: patients with fibro who get COVID can get a very painful fibro flare and for this reason I do recommend getting immunized
Dr. David Edelberg
I have severe PTSD from 2 violent sex crimes ten years apart, one by a stranger at gunpoint. I got excellent therapy, was put on some anti anxiety and depression meds, continued therapy for years. Than I moved to the deep south, planning on staying a couple years to concentrate on renovating an old house to sell, than going back home up north. In summer of 2017, I went thru 4 traumas back to back. The death of a family member, the breakup of a long term relationship, losing the sale of the house due to being scammed. And my brother ending up on life support and squatters moving into his house while he was hospitalized. They were drug addicts and were selling all of his belongings while he was fighting to survive and recover in ICU an hour away. I had to handle that mess and dealt with lawyers, getting POA over him, courts and dealing with local police on a daily basis, reporting stuff missing from his home, and reporting that stuff I reported missing the day before was being sold online by the “head” squatter. Due to squatters rights here, I had to get POA and file an eviction notice on the squatters. The police here treated me like I was a no good criminal harrassing the poor innocent meth head squatters. I am white. I come from a family of Drs and Lawyers in the north. I am college educated and was just beginning my 3rd year of studies with a major in Law Enforcement and Criminal Justice when the 2nd violent sex assault happened to me in MI. I have never had issues with law enforcement, and even though I wasn’t able to get my degree in Law Enforcement and Criminal Justice due to PTSD, I still tried to be an upstanding citizen and a friend to the law enforcement community. While going thru the “squatter situation”, I was subject to harrassment and prejudice. “Go home yankee”, “You don’t belong here and are not welcome here”, Go back to where you came from if you don’t like the way we do things here yankee” and the like. This brought back memories from dealing with police 20 years prior, when I was kidnapped at gunpoint by a stranger, tortured and raped and left for dead in a field in TX. The police would not even take my report and treated me like I had done something to deserve this. The PTSD came back full force. I had planned on relisting my home as soon as I got the squatters out, and my brother was home and settled again. That day never came. The PTSD was so severe I was afraid to leave the house. I tried to find therapy but nobody took my insurance or was seeing new patients. Than I got the flu/bronchitis in Dec. 2017, ended up hospitalized and came home for 2 months on oxygen. I have been bedridden since. I was recently diagnosed with CFS after years of normal testresults, snide comments from my Dr. and being told to see a psychiatrist. So, I did see the psychiatrist he referred me to for an evaluation.He asked me 10 yes or no questions, mostly about my family history of mental illness. There wasn’t much. He than told me I needed shock treatment. I left his office in tears. Why couldn’t anyone tell me why I went from being an active woman to being bedridden in the course of 3 months?
My diagnosis of CFS was based on my test results, my physical history before and after I got sick, having a virus just before I got sick, and all of my symptoms. Because the Dr. that diagnosed me is out of state, she cannot treat me or prescribe meds without my living near her. Nobody within 3 hours of me is educated on ME/CFS and any clinical trials are too far away for me to be a part of. Your PTSD/CFS relationship is something I never considered, but would make so much sense. I am going to look into EMDR and find a reputable Dr. that does this. I would love to touch base with you to see what I should look for in an EMDR Dr. or if you have any referrals in my area. Thankyou so much for all you do.
I have Fibro. Does Cytokine levels have a negative effect on the side effects of the co-vid vaccine and is there anything I can do nutrition/supplement wise to ease the effects either before or after the vaccine?