Emotional Regulation in Women with Chronic Fatigue Syndrome and Depression: Internal Representations and Adaptive Defenses

Abstract

Chronic fatigue syndrome (CFS) presents challenges in differential diagnosis and treatment. Complicating diagnosis is that its symptoms overlap with those of depression. This study applies psychoanalytic concepts to understand emotional regulation (ER) in women with CFS and/or depression. One hundred eighty-six women were assigned to four groups and compared: (a) CFS plus high er depression (CFS-HD); (b) CFS plus lower depression (CFS-LD); (c) depressive disorder (DD); and (d) healthy controls (HC). ER was operationalized by measures of capacity to form internal representations and adaptive defenses. The study’s premise was that difficulties metabolizing emotions psychologically would be associated with their greater somatic expression. Some support was found for the hypothesis that CFS participants would exhibit more impairment in representing emotions and in adaptive defenses compared to the DD and HC groups, but this held only for the CFS-HD group. Although CFS-LD participants were expected to be more purely somatizing than the CFS-HD group, they instead showed more sophisticated capacities for ER than that group and recalled less distressing early relationships, revealing more resilience. Still, however, we found support for somatization in some CFS sufferers: Within both the CFS-HD and the CFS-LD groups, weaknesses in representing emotions and in defensive functioning were associated with more severe physical symptoms. Clinically, the heterogeneity of CFS and those who suffer from it indicates the need for individual assessment and depression treatment.

Paradoxical outcomes in psychotherapy: Theoretical perspectives, research agenda and practice implications

“…They further proposed that such defensiveness may have health costs due to underlying psychological issues being presented as somatic symptoms. Links between illusory mental health and use of health-care services were observed by Cousineau and Shedler (2006) and illusory mental health has been identified in some patients receiving treatment for chronic fatigue syndrome (Bram et al, 2018(Bram et al, , 2019.…”

Effects of Acupuncture on Chronic Stress-Induced Depression-Like Behavior and Its Central Neural Mechanism

“…According to a previous study, about 10% of the world’s population has major depressive disorder (Riolo et al, 2005), and continued depression can lead to suicide, sleep disorders, anorexia, anxiety, and gangrene (Hammen, 2005). Depression is not only a serious disease per se but also has a major impact on the occurrence of other conditions, such as pain (Bair et al, 2003; Goldenberg, 2010), chronic fatigue syndrome (Bram et al, 2018), neurodegenerative disease (Modrego and Ferrández, 2004), and inflammatory diseases (Baerwald et al, 2019). The etiology of depression involves genetic, environmental, socioeconomic, and stress-related factors (Dunn et al, 2015).…”