Can sustained arousal explain the Chronic Fatigue Syndrome?
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BioMed Central
Open Access
Review
Can sustained arousal explain the Chronic Fatigue Syndrome? Vegard B Wyller*1, Hege R Eriksen2,3 and Kirsti Malterud4 Address: 1Division of Paediatrics, Rikshospitalet University Hospital, Oslo, Norway, 2Department of Education and Health Promotion, University of Bergen, Bergen, Norway, 3Unifob Health Bergen, Bergen, Norway and 4Research Unit for General Practice, Unifob Health Bergen, Bergen, Norway Email: Vegard B Wyller* - [email protected]; Hege R Eriksen - [email protected]; Kirsti Malterud - [email protected] * Corresponding author
Published: 23 February 2009 Behavioral and Brain Functions 2009, 5:10
doi:10.1186/1744-9081-5-10
Received: 4 November 2008 Accepted: 23 February 2009
This article is available from: http://www.behavioralandbrainfunctions.com/content/5/1/10 © 2009 Wyller et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract We present an integrative model of disease mechanisms in the Chronic Fatigue Syndrome (CFS), unifying empirical findings from different research traditions. Based upon the Cognitive activation theory of stress (CATS), we argue that new data on cardiovascular and thermoregulatory regulation indicate a state of permanent arousal responses – sustained arousal – in this condition. We suggest that sustained arousal can originate from different precipitating factors (infections, psychosocial challenges) interacting with predisposing factors (genetic traits, personality) and learned expectancies (classical and operant conditioning). Furthermore, sustained arousal may explain documented alterations by establishing vicious circles within immunology (Th2 (humoral) vs Th1 (cellular) predominance), endocrinology (attenuated HPA axis), skeletal muscle function (attenuated cortical activation, increased oxidative stress) and cognition (impaired memory and information processing). Finally, we propose a causal link between sustained arousal and the experience of fatigue. The model of sustained arousal embraces all main findings concerning CFS disease mechanisms within one theoretical framework.
Background Chronic Fatigue Syndrome (CFS) is characterized by unexplained and disabling fatigue, accompanied by symptoms such as musculoskeletal pain, impaired memory and concentration, headache and sleep problems [1]. Research on disease mechanisms has been conducted along several tracks (Table 1). Twin studies indicate a moderate heritability of CFS [2]. Recent molecular analyses report an association to polymorphisms of genes involved in autonomic and endocrine effector systems [3]. Personality traits such as perfectionism, conscientiousness and internalization may have an impact [4], as do illness perceptions such as a poor sense of personal control over symptoms and a strong focus
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