Fatigue in Multiple Sclerosis Is Associated With Childhood Adversities

Abstract

Fatigue is a common and disabling symptom in patients with Multiple Sclerosis (PwMS). Its pathogenesis, however, is still not fully understood. Potential psychological roots, in particular, have received little attention to date. The present study examined the association of childhood adversities, specific trait characteristics, and MS disease characteristics with fatigue symptoms utilizing path analysis. Five hundred and seventyone PwMS participated in an online survey. Standardized psychometric tools were applied. The Childhood Trauma Questionnaire (CTQ) served to assess childhood adversities. Trait variables were alexithymia (Toronto Alexithymia Scale; TAS-26) and early maladaptive schemas (Young Schema Questionnaire; YSQ). Current pathology comprised depression (Beck's Depression Inventory FastScreen; BDI-FS) and anxiety symptoms (State-Trait Anxiety Inventory; STAI-state), as well as physical disability (Patient determined Disease Steps; PDDS). The Fatigue Scale for Motor and Cognitive Functions (FSMC) was the primary outcome variable measuring fatigue. PwMS displayed high levels of fatigue and depression (mean FSMC score: 72; mean BDI-II score: 18). The final path model revealed that CTQ emotional neglect and emotional abuse remained as the only significant childhood adversity variables associated with fatigue. There were differential associations for the trait variables and current pathology: TAS-26, the YSQ domain impaired autonomy and performance, as well as all current pathology measures had direct effects on fatigue symptoms, accounting for 28.2% of the FSMC variance. Bayesian estimation also revealed indirect effects from the two CTQ subscales on FSMC. The final model fitted the data well, also after a cross-validation check and after replacing the FSMC with the Chalder Fatigue Questionnaire (CFQ). This study suggests an association psychological factors on fatigue in Multiple Sclerosis. Childhood adversities, as well as specific trait characteristics, seem to be associated with current pathology and fatigue symptoms. The article discusses potential implications and limitations.

Association of Fatigue Severity With Maladaptive Coping in Multiple Sclerosis: A Data-Driven Psychodynamic Perspective

“…A high specificity was obtained for the impact of early emotional abuse and neglect, as well as alexithymia. This result is in line with the publication by Pust et al ( 13 ) that focused on specific trait characteristics of PwMS with fatigue. Taken together, it can be hypothesized, based on the present results, that fatigue might reflect one facet of detached/avoidant coping that is distinct to depression and selectively related to adverse emotional childhood experiences.…”

“…Finally, to explain the variance of the Detached Protector mode, the influence of the CTQ childhood trauma subscales and alexithymia on this mode were analyzed. This analysis was performed post-hoc , following the results obtained by Pust et al ( 13 ) on the relation between childhood maltreatment, maladaptive schemas and fatigue symptoms. A linear regression analysis with the CTQ subscales and the TAS-26 as predictors and the Detached Protector mode as dependent variable was calculated.…”

“…This calls for studies, which also attempt to understand the functional nature of MS-fatigue from a non-somatic perspective, in particular focusing on psychological factors. Latest studies have uncovered a relation between early childhood adversities and particular trait characteristics with MS-fatigue ( 12 , 13 ). In our previous publication based on this sample ( 12 ), a specific pattern among the five childhood adversities subscales taken from the Childhood Trauma Questionnaire ( 14 , 15 ), and their association with specific trait characteristics and MS-fatigue could be identified: PwMS who reported emotional neglect and emotional abuse demonstrated impairments in autonomy and performance as well as high rates of alexithymia.…”

Comparison of the Effects of the Choice Theory and Behavioral Activation Therapies with and Without Guided Imagery Rescripting on the Adversity Quotient and Cognitive Emotion Regulation of MS Patients in Ahvaz, Iran

“…Perceiving psychological challenges and stressful conditions, MS patients experience low emotion regulation and AQ in the management of psychological challenges (27). Owing to the behavioral-motivational techniques of BA therapy, as well as mental exercises for mental acceptance, BA therapy integrated with guided ImRs could further improve the cognitive-emotional dimensions of MS patients.…”

Οι Ψυχολογικές Διαστάσεις Των Αυτοάνοσων Νοσημάτων

“…Μια άλλη ερμηνεία της κόπωσης σε αυτές τις δύο ομάδες ασθενών πιθανόν να προέρχεται από την συσσώρευση του στρες που ξεκινούσε από την παιδική τους ηλικία και από την έλλειψη κάποιου υποστηρικτικού δικτύου. Αυτή η ερμηνεία είναι σε συμφωνία με προηγούμενες έρευνες (Cho, Bower, Kiefe, Seeman, & Irwin, 2012.Mancuso, Rincon, Sayles & Paget, 2015. Pust et al, 2020.…”