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Persistent Burnout Theory of Chronic Fatigue Syndrome

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DOI: 10.4236/nm.2016.72008    1,270 Downloads   2,014 Views   Citations
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There is no agreement on the etiology of chronic fatigue syndrome (CFS), and the main theories (behavioural and viral/immune) do not satisfactorily explain the condition. A growing body of evidence suggests that CFS may be caused by a dysfunction of the stress system—and the hypothalamic-pituitary-adrenal (HPA) axis in particular—as a result of chronic stress. CFS shares many similarities to occupational burnout, including similar symptoms, physiological abnormalities and triggers. After a brief review of the science of stress, burnout, central fatigue and CFS, I propose a model of CFS based on a state of persistent burnout that remains after the initial stressors have been removed. This persistence may be due to a combination of a dysregulation of the HPA axis, and behavioural factors. A novel treatment approach based on self-efficacy and positive goals is proposed.

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Jameson, D. (2016) Persistent Burnout Theory of Chronic Fatigue Syndrome. Neuroscience and Medicine, 7, 66-73. doi: 10.4236/nm.2016.72008.


[1] Fukuda, K., Straus, S.E., Hickie, I., Sharpe, M.C., Dobbins, J.G. and Komaroff, A. (1994) The Chronic Fatigue Syndrome: A Comprehensive Approach to Its Definition and Study. Annals of Internal Medicine, 121, 953-959.
[2] Afari, N. and Buchwald, D. (2003) Chronic Fatigue Syndrome: A Review. American Journal of Psychiatry, 160, 221-236.
[3] Deary, V., Chalder, T. and Sharpe, M. (2007) The Cognitive Behavioural Model of Medically Unexplained Symptoms: A Theoretical and Empirical Review. Clinical Psychology Review, 27, 781-797.
[4] Bansal, A.S., Bradley, A.S., Bishop, K.N., Kiani-Alikhan, S. and Ford, B. (2012) Chronic Fatigue Syndrome, the Immune System and Viral Infection. Brain, Behavior, and Immunity, 26, 24-31.
[5] Van Houdenhove, B., Luyten, P. and Kempke, S. (2013) Chronic Fatigue Syndrome/Fibromyalgia: A “Stress-Adapta tion” Model. Fatigue: Biomedicine, Health & Behavior, 1, 137-147.
[6] Malouff, J.M., Thorsteinsson, E.B., Rooke, S.E., Bhullar, N. and Schutte, N.S. (2008) Efficacy of Cognitive Behavioral Therapy for Chronic Fatigue Syndrome: A Meta-Analysis. Clinical Psychology Review, 28, 736-745.
[7] Vermeulen, R.C.W., Kurk, R.M., Visser, F.C., Sluiter, W. and Scholte, H.R. (2010) Patients with Chronic Fatigue Syndrome Performed Worse than Controls in a Controlled Repeated Exercise Study despite a Normal Oxidative Phosphorylation Capacity. Journal of Translational Medicine, 8, 93.
[8] Keller, B.A., Pryor, L.P. and Giloteaux, L. (2014) Inability of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients to Reproduce VO2 Peak Indicates Functional Impairment. Journal of Translational Medicine, 12, 104.
[9] Wiborg, J.F., Knoop, H., Stulemeijer, M., Prins, J.B. and Bleijenberg, G. (2010) How Does Cognitive Behaviour Therapy Reduce Fatigue in Patients with Chronic Fatigue Syndrome? The Role of Physical Activity. Psychological Medicine, 40, 1281.
[10] Friedberg, F. (2002) Does Graded Activity Increase Activity? A Case Study of Chronic Fatigue Syndrome. Journal of Behavior Therapy and Experimental Psychiatry, 33, 203-215.
[11] Hawkes, N. (2011) Dangers of Research into Chronic Fatigue Syndrome. BMJ, 342, d3780.
[12] Natelson, B.H. and Lange, G. (2002) A Status Report on Chronic Fatigue Syndrome. Environmental Health Perspectives, 110, 673.
[13] Herbert, T.B. and Cohen, S. (1993) Stress and Immunity in Humans: A Meta-Analytic Review. Psychosomatic Medicine, 55, 364-379.
[14] Papadopoulos, A.S. and Cleare, A.J. (2012) Hypothalamic-Pituitary-Adrenal Axis Dysfunction in Chronic Fatigue Syndrome. Nature Reviews Endocrinology, 8, 22-32.
[15] Fries, E., Dettenborn, L. and Kirschbaum, C. (2009) The Cortisol Awakening Response (CAR): Facts and Future Directions. International Journal of Psychophysiology, 72, 67-73.
[16] Salit, I.E. (1997) Precipitating Factors for the Chronic Fatigue Syndrome. Journal of Psychiatric Research, 31, 59-65.
[17] Silverman, M.N., Pearce, B.D., Biron, C.A. and Miller, A.H. (2005) Immune Modulation of the Hypothalamic-Pitui tary-Adrenal (HPA) Axis during Viral Infection. Viral Immunology, 18, 41-78.
[18] Rohleder, N., Wolf, J.M. and Kirschbaum, C. (2003) Glucocorticoid Sensitivity in Humans-Interindividual Differences and Acute Stress Effects. Stress: The International Journal on the Biology of Stress, 6, 207-222.
[19] Van Houdenhove, B., Neerinckx, E., Onghena, P., Lysens, R. and Vertommen, H. (2001) Premorbid “Overactive” Lifestyle in Chronic Fatigue Syndrome and Fibromyalgia: An Etiological Factor or Proof of Good Citizenship? Journal of Psychosomatic Research, 51, 571-576.
[20] Van Houdenhove, B., Eede, F.V.D. and Luyten, P. (2009) Does Hypothalamic-Pituitary-Adrenal Axis Hypofunction in Chronic Fatigue Syndrome Reflect a Crash in the Stress System? Medical Hypotheses, 72, 701-705.
[21] Gaab, J., Hüster, D., Peisen, R., Engert, V., Schad, T., Schürmey, T.H. and Ehlert, U. (2002) Low-Dose Dexamethasone Suppression Test in Chronic Fatigue Syndrome and Health. Psychosomatic Medicine, 64, 311-318.
[22] Miller, G.E., Chen, E. and Zhou, E.S. (2007) If It Goes Up, Must It Come Down? Chronic Stress and the Hypothalamic-Pituitary-Adrenocortical Axis in Humans. Psychological Bulletin, 133, 25-45.
[23] Charmandari, E., Tsigos, C. and Chrousos, G. (2005) Endocrinology of the Stress Response. Annual Review of Physiology, 67, 259-284.
[24] Fries, E., Hesse, J., Hellhammer, J. and Hellhammer, D.H. (2005) A New View on Hypocortisolism. Psychoneuroendocrinology, 30, 1010-1016.
[25] Nijhof, S.L., Rutten, J.M., Uiterwaal, C.S., Bleijenberg, G., Kimpen, J.L. and Putte, E.M. (2014) The Role of Hypocortisolism in Chronic Fatigue Syndrome. Psychoneuroendocrinology, 42, 199-206.
[26] Roberts, A.D., Papadopoulos, A.S., Wessely, S., Chalder, T. and Cleare, A.J. (2009) Salivary Cortisol Output before and after Cognitive Behavioural Therapy for Chronic Fatigue Syndrome. Journal of Affective Disorders, 115, 280-286.
[27] Hall, D.L., Lattie, E.G., Antoni, M.H., Fletcher, M.A., Czaja, S., Perdomo, D. and Klimas, N.G. (2014) Stress Management Skills, Cortisol Awakening Response, and Post-Exertional Malaise in Chronic Fatigue Syndrome. Psychoneuroendocrinology, 49, 26-31.
[28] Demerouti, E., Bakker, A.B., Nachreiner, F. and Schaufeli, W.B. (2001) The Job Demands-Resources Model of Burnout. Journal of Applied Psychology, 86, 499-512.
[29] Chida, Y. and Steptoe, A. (2009) Cortisol Awakening Response and Psychosocial Factors: A Systematic Review and Meta-Analysis. Biological Psychology, 80, 265-278.
[30] Pruessner, J.C., Hellhammer, D.H. and Kirschbaum, C. (1999) Burnout, Perceived Stress, and Cortisol Responses to Awakening. Psychosomatic Medicine, 61, 197-204.
[31] Boksem, M.A. and Tops, M. (2008) Mental Fatigue: Costs and Benefits. Brain Research Reviews, 59, 125-139.
[32] Noakes, T.D. (2012) Fatigue Is a Brain-Derived Emotion That Regulates the Exercise Behavior to Ensure the Protection of Whole Body Homeostasis. Frontiers in Physiology, 3, 1-13.
[33] De Lange, F.P., Kalkman, J.S., Bleijenberg, G., Hagoort, P., vd Werf, S.P., Van der Meer, J.W. and Toni, I. (2004) Neural Correlates of the Chronic Fatigue Syndrome—An fMRI Study. Brain, 127, 1948-1957.
[34] Leone, S.S., Wessely, S., Huibers, M.J., Knottnerus, J.A. and Kant, I. (2011) Two Sides of the Same Coin? On the History and Phenomenology of Chronic Fatigue and Burnout. Psychology and Health, 26, 449-464.
[35] Huibers, M.J.H., Beurskens, A.J.H.M., Prins, J.B., Kant, I.J., Bazelmans, E., Van Schayck, C.P., Bleijenberg, G., et al. (2003) Fatigue, Burnout, and Chronic Fatigue Syndrome among Employees on Sick Leave: Do Attributions Make the Difference? Occupational and Environmental Medicine, 60, i26-i31.
[36] Miller, E.K. and Cohen, J.D. (2001) An Integrative Theory of Prefrontal Cortex Function. Annual Review of Neuroscience, 24, 167-202.
[37] Herman, J.P. and Cullinan, W.E. (1997) Neurocircuitry of Stress: Central Control of the Hypothalamo-Pituitary-Adrenocortical Axis. Trends in Neurosciences, 20, 78-84.
[38] de Lange, F.P., Koers, A., Kalkman, J.S., Bleijenberg, G., Hagoort, P., van Der Meer, J.W. and Toni, I. (2008) Increase in Prefrontal Cortical Volume Following Cognitive Behavioural Therapy in Patients with Chronic Fatigue Syndrome. Brain, 131, 2172-2180.
[39] Furay, A.R., Bruestle, A.E. and Herman, J.P. (2008) The Role of the Forebrain Glucocorticoid Receptor in Acute and Chronic Stress. Endocrinology, 149, 5482-5490.
[40] White, P.D., Goldsmith, K.A., Johnson, A.L., Potts, L., Walwyn, R., DeCesare, J.C., Sharpe, M., et al. (2011) Comparison of Adaptive Pacing Therapy, Cognitive Behaviour Therapy, Graded Exercise Therapy, and Specialist Medical Care for Chronic Fatigue Syndrome (PACE): A Randomised Trial. The Lancet, 377, 823-836.
[41] Schwarzer, R. and Hallum, S. (2008) Perceived Teacher Self-Efficacy as a Predictor of Job Stress and Burnout: Mediation Analyses. Applied Psychology, 57, 152-171.
[42] Findley, J.C., Kerns, R., Weinberg, L.D. and Rosenberg, R. (1998) Self-Efficacy as a Psychological Moderator of Chronic Fatigue Syndrome. Journal of Behavioral Medicine, 21, 351-362.
[43] Maes, S. and Karoly, P. (2005) Self-Regulation Assessment and Intervention in Physical Health and Illness: A Review. Applied Psychology, 54, 267-299.
[44] Lavigne, G.L., Forest, J. and Crevier-Braud, L. (2012) Passion at Work and Burnout: A Two-Study Test of the Mediating Role of Flow Experiences. European Journal of Work and Organizational Psychology, 21, 518-546.
[45] Demerouti, E., Bakker, A.B., Sonnentag, S. and Fullagar, C.J. (2012) Work-Related Flow and Energy at Work and at Home: A Study on the Role of Daily Recovery. Journal of Organizational Behavior, 33, 276-295.

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