Emotional Regulation in Women with Chronic Fatigue Syndrome and Depression: Internal Representations and Adaptive Defenses 2018

[Pechius]

God help us:

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.

https://www.ncbi.nlm.nih.gov/pubmed/30249136

 

[andypants]

Just the title is enough for me.

 

[Roy S]

by the same people:
CONCLUSION:
Findings refute reducing CFS to somatization, but there is a subgroup of CFS whose lacking access to emotional distress is associated with heightened physical symptomatology.
https://www.ncbi.nlm.nih.gov/pubmed/30152867

J Clin Psychol. 2018 Aug 28. doi: 10.1002/jclp.22692. [Epub ahead of print]
Chronic fatigue syndrome and the somatic expression of emotional distress: Applying the concept of illusory mental health to address the controversy.
Bram AD1,2,3, Gottschalk KA4, Leeds WM3,5.
Author information
1
Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts.
2
Boston Psychoanalytic Society and Institute, Newton, Massachusetts.
3
Veritas Foundation for Clinical Research, Topeka, Kansas.
4
Department of Counseling Services, Human Relations Service, Wellesley, Massachusetts.
5
Pulmonary & Sleep Associates, Topeka, Kansas.
Abstract
OBJECTIVE:
The process of somatization in chronic fatigue syndrome (CFS) was investigated using the concept of illusory mental health (IMH). IMH involves self-reporting low emotional distress alongside performance-based assessment of distress.

METHOD:
We studied IHM and physical symptoms in 175 women across four groups: (a) CFS plus depression; (b) CFS with no depression (CFS-ND); (c) depressive disorder without CFS; and (d) healthy controls (HC). IMH was assessed using a self-report measure plus the performance-based Early Memory Index (EMI).

RESULTS:
CFS-NDs were no more likely to have IMH compared with HCs. Among the CFS-NDs, IMH was associated with more physical symptoms. For CFS-NDs, EMI added meaningfully beyond self-reported mental health in predicting physical symptoms.

CONCLUSION:
Findings refute reducing CFS to somatization, but there is a subgroup of CFS whose lacking access to emotional distress is associated with heightened physical symptomatology.

© 2018 Wiley Periodicals, Inc.

 

[Philipp]

I have a few questions on this stuff. Hopefully someone can help me understand!

The study's premise was that difficulties metabolizing emotions psychologically would be associated with their greater somatic expression.

How do I 'metabolize emotions psychologically' if I do not have difficulties with it?

How do I properly measure 'Adaptive Defenses'?

How do I adjust for luck if I want to measure 'resilience' by how many distressing relationships people recall?

 

[Hutan]

by the sane people:

That's a generous assumption given that they think a concept of illusory mental health is going to sort out the controversy about CFS.

Although, to be fair, the conclusion of the second study (by the same authors) could be worse.

 

[Roy S]

That's a generous assumption given that they think a concept of illusory mental health is going to sort out the controversy about CFS.

Although, to be fair, the conclusion of the second study (by the same authors) could be worse.

You are quick! I edited my typo right away. Just woke up.

 

[Sly Saint]

yeah well, what do they expect.

do a search on depression in women with cancer:

"Diagnosis of breast cancer is an extremely unpleasant and unbelievable experience for each person that can disrupt family life (Vedat et al., 2001). Meanwhile, fears and worries about the death and recurrence of the disease, mental impairment, financial concerns and family problems lead to the emergence and increase of severity of psychiatric disorders such as depression (Kai-na et al., 2011; Shakeri et al., 2015; Dowlatabadi et al., 2016). Eventually, depression as a mental disorder affects the thoughts, physical symptoms, occupational performance, and finally the quality of life of patients (Goudarzian et al., 2017; Hosseinzadeh-Khezri et al., 2014; Motamedi et al., 2015)."

Depression in Women with Breast Cancer
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844601/

similar searches for Multiple Sclerosis and Depression bring up similar reports except 'they' are now looking at whether the actual illness (MS) can 'produce' depression (Co-morbidity with depression is around 50% similar figures for Parkinsons). Other research speculates about the role of inflammation with developing depression.

the thing that gets me is there is no definitive biomarker for depression either.

 

[Trish]

The study's premise was that difficulties metabolizing emotions psychologically would be associated with their greater somatic expression.

I see I'm not the only one stopped in my tracks by this one. How the f*** do you metabolise emotions psychologically? And how can that be classed as a scientific premise. At best it's a metaphor, at worst it's an insult.

 

[NelliePledge]

I see I'm not the only one stopped in my tracks by this one. How the f*** do you metabolise emotions psychologically? And how can that be classed as a scientific premise. At best it's a metaphor, at worst it's an insult.

Beat me to it @Trish exact same words came into my head.

 

[Barry]

metabolizing emotions psychologically

I see I'm not the only one stopped in my tracks by this one. How the f*** do you metabolise emotions psychologically? And how can that be classed as a scientific premise. At best it's a metaphor, at worst it's an insult.

Random BS word generator.

 

[Mij]

1. Take responsibility for your present emotion.
2. Feel it in your body.
3. Label your feeling.
4. Express what you feel.
5. Share what you feel with someone you trust.
6. Release the toxic feeling through a ritual.
7. Celebrate the release and move on.

As you work through the steps, imagine that you are metabolizing the emotion.

 

[NelliePledge]

It’s outrageous how many ways can they come up with to blame us for this illness. Chalder & cronies saying we spend all our time focusing on symptoms then this crew reckon we’re pretending to be in ok mental health and that we’re not dealing with emotions. Utter utter bullocks.

 

[Arnie Pye]

1. Take responsibility for your present emotion.

Surely, people are not always responsible for the state they are in, either physically or emotionally.

A person who was abused in any way as a child will probably feel all sorts of emotions about their abuser - fury and terror, for example. To me, this seems to be a normal response of a person to a personal history of this type. How can they take responsibility for what happened to them?

If someone has a painful condition that a doctor can't or won't treat because they believe the patient is making it up, the patient has to deal with the pain and the fact that the condition itself may be getting worse and worse. How can the patient be responsible for that?

I've had people tell me that I am responsible for the way I feel about horrible things that have gone on in my life. All this does is make me feel even worse because I can't make myself feel responsible for those bad things or my reaction to them.

 

[ukxmrv]

I'm guessing that this is based on the Questionaires that keep getting sent to me by psychology students or researchers? They seem to come in waves and usually are posted to a Facebook page asking for volunteers.

Keep getting the same ones and the questions always ask if I "have someone to talk to" and similar questions. I'm guessing that the PWME who answered "no" to that type of question in this study and had higher levels of disability were judged as having "defensive functioning" and "lacking access to emotional distress".

That more severely disabled PWME might not have access to a social network or support partner because of the severity of their symptoms never seems to occur to these idiots

Also it never acknowledged that damage done to the severely affected and their families by the medical profession and the hate drummed up against the sick and disabled in society may be contributing to this.

 

[rvallee]

God help us:



https://www.ncbi.nlm.nih.gov/pubmed/30249136

So... if you take a group of patients, create a sub-group with additional depression, you observe that they have more depression.

Wow. Genius work. Get the Nobel all shiny for this groundbreaking research.

And WTF does metabolizing emotions mean? Metabolism is a specific concept in medicine, they can't just take a word that has one meaning and use it to give more credibility for a made-up concept. What is wrong with these people? This is money that could have been spent on real research!

 

[Invisible Woman]

they can't just take a word that has one meaning and use it to give more credibility for a made-up concept

A trick that they've clearly learned from.the BPSers. The word recovery for example.

This isn't medicine as you know it, we've stepped "through the looking glass"...

 

[Hoopoe]

And WTF does metabolizing emotions mean? Metabolism is a specific concept in medicine, they can't just take a word that has one meaning and use it to give more credibility for a made-up concept. What is wrong with these people? This is money that could have been spent on real research!

It's an analogy because they cannot clearly describe it. They have only a vague idea that emotions must somehow be processed because that's a freudian idea. Back then it was thought that the nervous system must produce some output for every input, and that suppressing output would lead to disease (that's where conversion disorder comes from). They wouldn't be able to describe in detail how this happens. And maybe emotions don't have to be processed at all, or the processing is more akin to forgetting.

 

[inox]

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.

Well, yeah - the sicker I am, the more flat my emotions are as well, and my ability to express myself. Everything takes energy.

Why on earth are these sort of studies always taking it for granted correlation is evidence for cause and effect - in their own preferred direction?

 

[Pechius]

Why on earth are these sort of studies always taking it for granted correlation is evidence for cause and effect - in their own preferred direction?

I know it's a rhetorical question, but I guess if they didn't, then all those studies would be pretty much completely useless. They should help to come up with hypotheses for clinical trials, nothing more. In reality, they're used to stigmatize illnesses and push for trials with terrible methodology based on thin air.

 

[alex3619]

they can't just take a word that has one meaning and use it to give more credibility for a made-up concept. What is wrong with these people?

Umm, isn't that their modus operandi?