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Chronic Fatigue and Personality: A Twin Study of Causal Pathways and Shared Liabilities

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

The etiology of chronic fatigue syndrome (CFS) remains unknown. Personality traits influence well-being and may play a role in CFS and unexplained chronic fatigue.

Purpose

This study aimed to examine the association of emotional instability and extraversion with chronic fatigue and CFS in a genetically informative sample.

Methods

We evaluated 245 twin pairs for two definitions of chronic fatigue. They completed the Neuroticism and Extraversion subscales of the NEO Five Factor Inventory. Using a co-twin control design, we examined the association between personality and chronic fatigue.

Results

Higher emotional instability was associated with both definitions of chronic fatigue and was confounded by shared genetics. Lower extraversion was also associated with both definitions of fatigue, but was not confounded by familial factors.

Conclusions

Both emotional instability and extraversion are related to chronic fatigue and CFS. Whereas emotional instability and chronic fatigue are linked by shared genetic mechanisms, the relationship with extraversion may be causal and bidirectional.

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References

  1. Fukuda K, Straus SE, Hickie I, et al. The chronic fatigue syndrome: A comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. 1994;121:953-959.

    Article  PubMed  CAS  Google Scholar 

  2. Wessely S, Hotopf M, Sharpe M. Chronic fatigue and its syndromes. Oxford: Oxford University Press; 1998.

    Google Scholar 

  3. Ranjith G. Epidemiology of chronic fatigue syndrome. Occup Med (Lond). 2005;55:13-19.

    Article  CAS  Google Scholar 

  4. Steele L, Dobbins JG, Fukuda K, et al. The epidemiology of chronic fatigue in San Francisco. Am J Med. 1998;105:83S-90S.

    Article  PubMed  CAS  Google Scholar 

  5. van Geelen SM, Sinnema G, Hermans HJ, Kuis W. Personality and chronic fatigue syndrome: Methodological and conceptual issues. Clin Psychol Rev. 2007;27:885-903.

    Article  PubMed  Google Scholar 

  6. Kiecolt-Glaser JK, McGuire L, Robles TF, Glaser R. Psychoneuroimmunology and psychosomatic medicine: Back to the future. Psychosom Med. 2002;64:15-28.

    PubMed  Google Scholar 

  7. Maier SF, Watkins LR. Cytokines for psychologists: Implications of bidirectional immune-to-brain communication for understanding behavior, mood, and cognition. Psychol Rev. 1998;105:83-107.

    Article  PubMed  CAS  Google Scholar 

  8. Segerstrom SC, Miller GE. Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry. Psychol Bull. 2004;130:601-630.

    Article  PubMed  Google Scholar 

  9. Wessely S. Old wine in new bottles: Neurasthenia and ‘ME’. Psychol Med. 1990;20:35-53.

    Article  PubMed  CAS  Google Scholar 

  10. Wessely S. Neurasthenia and chronic fatigue: Theory and practice in Britain and America. Transcult Psychiatry. 1994;31:173-209.

    Article  Google Scholar 

  11. Greenberg DB. Neurasthenia in the 1980s: Chronic mononucleosis, chronic fatigue syndrome, and anxiety and depressive disorders. Psychosomatics. 1990;31:129-137.

    Article  PubMed  CAS  Google Scholar 

  12. Digman J. Personality structure: Emergence of the five-factor model. Annu Rev Psychol. 1990;41:417-440.

    Article  Google Scholar 

  13. Costa P, McCrae R. Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) professional manual. Odessa: Psychological Assessment Resources, Inc.; 1992.

    Google Scholar 

  14. Costa PT Jr, McCrae RR. Neuroticism, somatic complaints, and disease: Is the bark worse than the bite? J Pers. 1987;55:299-316.

    Article  PubMed  Google Scholar 

  15. Blakely AA, Howard RC, Sosich RM, et al. Psychiatric symptoms, personality and ways of coping in chronic fatigue syndrome. Psychol Med. 1991;21:347-362.

    Article  PubMed  CAS  Google Scholar 

  16. Buckley L, MacHale SM, Cavanagh JT, et al. Personality dimensions in chronic fatigue syndrome and depression. J Psychosom Res. 1999;46:395-400.

    Article  PubMed  CAS  Google Scholar 

  17. Christodoulou C, Deluca J, Johnson SK, et al. Examination of Cloninger’s basic dimensions of personality in fatiguing illness: Chronic fatigue syndrome and multiple sclerosis. J Psychosom Res. 1999;47:597-607.

    Article  PubMed  CAS  Google Scholar 

  18. Fiedler N, Lange G, Tiersky L, et al. Stressors, personality traits, and coping of Gulf War veterans with chronic fatigue. J Psychosom Res. 2000;48:525-535.

    Article  PubMed  CAS  Google Scholar 

  19. Johnson SK, DeLuca J, Natelson BH. Personality dimensions in the chronic fatigue syndrome: A comparison with multiple sclerosis and depression. J Psychiatr Res. 1996;30:9-20.

    Article  PubMed  CAS  Google Scholar 

  20. Kersh BC, Bradley LA, Alarcon GS, et al. Psychosocial and health status variables independently predict health care seeking in fibromyalgia. Arthritis Rheum. 2001;45:362-371.

    Article  PubMed  CAS  Google Scholar 

  21. Masuda A, Munemoto T, Yamanaka T, Takei M, Tei C. Psychosocial characteristics and immunological functions in patients with postinfectious chronic fatigue syndrome and noninfectious chronic fatigue syndrome. J Behav Med. 2002;25:477-485.

    Article  PubMed  Google Scholar 

  22. Kato K, Sullivan PF, Evengard B, Pedersen NL. Premorbid predictors of chronic fatigue. Arch Gen Psychiatry. 2006;63:1267-1272.

    Article  PubMed  Google Scholar 

  23. Charles ST, Gatz M, Kato K, Pedersen NL. Physical health 25 years later: The predictive ability of neuroticism. Health Psychol. 2008;27:369-378.

    Article  PubMed  Google Scholar 

  24. Courneya KSHL. Personality correlates of exercise behavior, motives, barriers and preferences: An application of the five-factor model. Pers Indiv Differ. 1998;24:625-633.

    Article  Google Scholar 

  25. De Moor MH, Beem AL, Stubbe JH, Boomsma DI, De Geus EJ. Regular exercise, anxiety, depression and personality: A population-based study. Prev Med. 2006;42:273-279.

    Article  PubMed  Google Scholar 

  26. Rhodes RE, Courneya KS, Bobick TM. Personality and exercise participation across the breast cancer experience. Psychooncology. 2001;10:380-388.

    Article  PubMed  CAS  Google Scholar 

  27. Zautra AJ, Fasman R, Reich JW, et al. Fibromyalgia: Evidence for deficits in positive affect regulation. Psychosom Med. 2005;67:147-155.

    Article  PubMed  Google Scholar 

  28. Chubb HL, Jones I, Hillier J, et al. Chronic fatigue syndrome—Personality and attributional style of patients in comparison to healthy controls and depressed individuals. J Ment Health. 1999;8:351-359.

    Article  Google Scholar 

  29. Diener E, Lucas R. Personality and subjective well-being. In: Kahneman D, Diener E, Schwarz N, eds. Well-being: The foundations of hedonic psychology. New York: Russell Sage; 1999:213-229.

    Google Scholar 

  30. Diener E, Suh EM, Lucas RE, Smith HL. Subjective well-being: Three decades of progress. Psychol Bull. 1999;125:276-302.

    Article  Google Scholar 

  31. Diener E, Oishi S, Lucas RE. Personality, culture, and subjective well-being: Emotional and cognitive evaluations of life. Annu Rev Psychol. 2003;54:403-425.

    Article  PubMed  Google Scholar 

  32. Lucas RE, Fujita F. Factors influencing the relation between extraversion and pleasant affect. J Pers Soc Psychol. 2000;79:1039-1056.

    Article  PubMed  CAS  Google Scholar 

  33. Fleeson W, Malanos AB, Achille NM. An intraindividual process approach to the relationship between extraversion and positive affect: Is acting extraverted as “good” as being extraverted? J Pers Soc Psychol. 2002;83:1409-1422.

    Article  PubMed  Google Scholar 

  34. Bagby R, Joffe R, Parker J, Kalemba B, Harkness K. Major depression and the five-factor model of personality. J Personal Disord. 1995;9:224-234.

    Article  Google Scholar 

  35. Bagby RM, Quilty LC, Segal ZV, et al. Personality and differential treatment response in major depression: A randomized controlled trial comparing cognitive-behavioural therapy and pharmacotherapy. Can J Psychiatry. 2008;53:361-370.

    PubMed  Google Scholar 

  36. White PD, Goldsmith KA, Johnson AL, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): A randomised trial. Lancet. 2011;377:823-836.

    Article  PubMed  CAS  Google Scholar 

  37. McGue M, Osler M, Christensen K. Causal inference and observational research: The utility of twins. Perspect Psychol Sci. 2010;5:546-556.

    Article  PubMed  Google Scholar 

  38. Buchwald D, Herrell R, Ashton S, et al. The Chronic Fatigue Twin Registry: Method of construction, composition, and zygosity assignment. Twin Res. 1999;2:203-211.

    PubMed  CAS  Google Scholar 

  39. Eisen S, Neuman R, Goldberg J, Rice J, True W. Determining zygosity in the Vietnam Era Twin Registry: An approach using questionnaires. Clin Genet. 1989;35:423-432.

    Article  PubMed  CAS  Google Scholar 

  40. Torgersen S. The determination of twin zygosity by means of a mailed questionnaire. Acta Genet Med Gemellol (Roma). 1979;28:225-236.

    CAS  Google Scholar 

  41. Bouchard TJ Jr, McGue M. Genetic and environmental influences on human psychological differences. J Neurobiol. 2003;54:4-45.

    Article  PubMed  Google Scholar 

  42. Kendler KS, Karkowski LM, Prescott CA. Causal relationship between stressful life events and the onset of major depression. Am J Psychiatry. 1999;156:837-841.

    PubMed  CAS  Google Scholar 

  43. Friedman HS, Booth-Kewley S. The “disease-prone personality”. A meta-analytic view of the construct. Am Psychol. 1987;42:539-555.

    Article  PubMed  CAS  Google Scholar 

  44. Stanwyck DJ, Anson CA. Is personality related to illness? Cluster profiles of aggregated data. Advances. 1986;3:4-15.

    Google Scholar 

  45. Yousfi S, Matthews G, Amelang M, Schmidt-Rathjens C. Personality and disease: Correlations of multiple trait scores with various illnesses. J Health Psychol. 2004;9:627-647.

    Article  PubMed  CAS  Google Scholar 

  46. Lucas RE, Diener E, Grob A, Suh EM, Shao L. Cross-cultural evidence for the fundamental features of extraversion. J Pers Soc Psychol. 2000;79:452-468.

    Article  PubMed  CAS  Google Scholar 

  47. Cantor N, Norem J, Langston C, et al. Life tasks and daily life experience. J Pers. 1991;59:425-451.

    Article  Google Scholar 

  48. Deale A, Chalder T, Marks I, Wessely S. Cognitive behavior therapy for chronic fatigue syndrome: A randomized controlled trial. Am J Psychiatry. 1997;154:408-414.

    PubMed  CAS  Google Scholar 

  49. Fulcher KY, White PD. Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. BMJ. 1997;314:1647-1652.

    Article  PubMed  CAS  Google Scholar 

  50. Moss-Morris R, Sharon C, Tobin R, Baldi JC. A randomized controlled graded exercise trial for chronic fatigue syndrome: Outcomes and mechanisms of change. J Health Psychol. 2005;10:245-259.

    Article  PubMed  Google Scholar 

  51. Prins JB, Bleijenberg G, Bazelmans E, et al. Cognitive behaviour therapy for chronic fatigue syndrome: A multicentre randomised controlled trial. Lancet. 2001;357:841-847.

    Article  PubMed  CAS  Google Scholar 

  52. Sharpe M, Hawton K, Simkin S, et al. Cognitive behaviour therapy for the chronic fatigue syndrome: A randomized controlled trial. BMJ. 1996;312:22-26.

    Article  PubMed  CAS  Google Scholar 

  53. Price JR, Mitchell E, Tidy E, Hunot V. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev. 2008; (3):CD001027.

  54. Edmonds M, McGuire H, Price J. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2004; (3):CD003200.

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Acknowledgments

This research was supported by National Institutes of Health awards U19AI38429 (Buchwald) and R01AR51524 (Afari). Drs. Strachan, Buchwald, and Afari are supported in part by award RC2HL103416 (Buchwald). Dr. Strachan is supported in part by R21AI81347. Dr. Afari is also supported by the VA Center of Excellence for Stress and Mental Health.

Conflict of Interest

The authors have no conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Box 359911, Seattle, WA, 98104-2499, USA

    Brian Poeschla M.D. & Eric Strachan Ph.D.

  2. Center for Clinical and Epidemiological Research, University of Washington, Seattle, WA, USA

    Eric Strachan Ph.D. & Dedra S. Buchwald M.D.

  3. Department of Anesthesiology, University of Washington, Seattle, WA, USA

    Elizabeth Dansie Ph.D.

  4. Department of Medicine, University of Washington, Seattle, WA, USA

    Dedra S. Buchwald M.D.

  5. VA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA

    Niloofar Afari Ph.D.

  6. Department of Psychiatry, University of California, San Diego, CA, USA

    Niloofar Afari Ph.D.

Authors
  1. Brian Poeschla M.D.
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  2. Eric Strachan Ph.D.
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  3. Elizabeth Dansie Ph.D.
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  4. Dedra S. Buchwald M.D.
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  5. Niloofar Afari Ph.D.
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Corresponding author

Correspondence to Brian Poeschla M.D..

Additional information

Brian Poeschla and Eric Strachan contributed equally to this work.

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Poeschla, B., Strachan, E., Dansie, E. et al. Chronic Fatigue and Personality: A Twin Study of Causal Pathways and Shared Liabilities. ann. behav. med. 45, 289–298 (2013). https://doi.org/10.1007/s12160-012-9463-5

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  • DOI: https://doi.org/10.1007/s12160-012-9463-5

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