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Early Life Stress and Adult CFS

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It is a well-established fact that experiences during early life shape the development of the brain, particularly during sensitive periods. Adverse experiences can ‘program’ the development of certain brain regions that are involved in the regulation and integration of hormonal, autonomic and immune responses to challenges later in life. Such challenges may encompass infections, physical stresses or emotional challenges.

Approximately 14% of children in the U.S. are subjected to some form of maltreatment, and in 2007, over 3 million reports of childhood abuse and neglect were investigated. Childhood trauma, defined as abuse, neglect, or loss, is a stressor that affects the physical and mental well-being of humans from infancy throughout the lifespan. In various animal and human studies childhood trauma has been associated with low resting cortisol levels, altered stress response, increased inflammatory markers, and cognitive impairment.

Childhood abuse has been connected to a wide range of disorders, such as depression, anxiety disorders, and substance abuse problems, but also more classic medical diseases such as cardiovascular disease. Of note, markedly elevated levels of pain and fatigue have been reported in studies of survivors of childhood abuse.

Chronic fatigue syndrome (CFS) is a debilitating illness that can sometimes occur in response to a stressor or a challenge. For example, there have been reports of people developing CFS after being in a serious car accident. Other examples of challenges are increased rates of CFS in Gulf war veterans and triggered relapses of CFS in persons affected by Hurricane Andrew.

Upon stress exposure, our central nervous system will activate hormone and immune responses that help the body to maintain balance during stress. There is evidence that childhood maltreatment may alter the way how the body’s regulatory systems respond to stress. Early adversity may thus increase a person’s risk to develop adult CFS, particularly in response to challenges. Therefore, childhood trauma may be an important risk factor for adult CFS. Research has shown that when adults with CFS and without CFS were asked about childhood trauma, those with CFS self-reported higher levels of childhood maltreatment. In particular, for women, emotional and sexual abuse during childhood was associated with a greater risk of developing CFS later in life.

Of note, a risk factor is not "the cause" of a disorder; it increases the relative risk, but is not present in all cases. The cause of CFS is still unknown, but childhood trauma might be factor that contributes to adult CFS risk in a subset of people. While these findings are important and have the potential to help many people, it is important to realize that not all persons with adult CFS experienced maltreatment as a child. Childhood maltreatment is just one risk factor for CFS and does not explain how other people with CFS (who did not experience such trauma) developed the illness.

The results from this research are important because healthcare providers can help people with a history of childhood maltreatment. For some people that have both a past of childhood maltreatment and CFS, talk therapy may be beneficial. While more research is needed on CFS and childhood maltreatment, patients are encouraged to talk to their healthcare provider about their physical and mental health history.

  • Fuller-Thomson E, Sulman J, Brennenstuhl S, and Merchant M. Functional Somatic Syndromes and Childhood Physical Abuse in Women: Data From a Representative Community-Based Sample. Journal of Aggression, Maltreatment & Trauma Volume 20, Issue 4, May 2011, pages 445-469.
  • Clark C, Goodwin L, Stansfeld SA, Hotopf M, White PD. Premorbid risk markers for chronic fatigue syndrome in the 1958 British birth cohort. Br J Psychiatry. 2011 Oct;199:323-9. Epub 2011 Aug 18.
  • Johnson SK, Schmaling KB, Dmochowski J, Bernstein D.An investigation of victimization and the clinical course of chronic fatigue syndrome. J Health Psychol. 2010 Apr;15(3):351-61.
  • Tietjen GE, Brandes JL, Peterlin BL, Eloff A, Dafer RM, Stein MR, Drexler E, Martin VT, Hutchinson S, Aurora SK, Recober A, Herial NA, Utley C, White L, Khuder SA. Childhood maltreatment and migraine (part III). Association with comorbid pain conditions. Headache. 2010 Jan;50(1):42-51. Epub 2009 Oct 21.
  • Heim C, Nater UM, Maloney E, Boneva R, Jones JF, Reeves WC. Childhood trauma and risk for chronic fatigue syndrome: association with neuroendocrine dysfunction. Arch Gen Psychiatry. 2009 Jan;66(1):72-80.
  • Heim C, Newport DJ, Mletzko T, Miller AH, Nemeroff CB. The link between childhood trauma and depression: insights from HPA axis studies in humans. Psychoneuroendocrinology. 2008 Jul;33(6):693-710. Review.
  • Binder EB, Bradley RG, Liu W, Epstein MP, Deveau TC, Mercer KB, Tang Y, Gillespie CF, Heim CM, Nemeroff CB, Schwartz AC, Cubells JF, Ressler KJ. Association of FKBP5 polymorphisms and childhood abuse with risk of posttraumatic stress disorder symptoms in adults. JAMA. 2008 Mar 19;299(11):1291-305.
  • Heim C, Wagner D, Maloney E, Papanicolaou DA, Solomon L, Jones JF, Unger ER, Reeves WC. Early adverse experience and risk for chronic fatigue syndrome: results from a population-based study. Arch Gen Psychiatry. 2006 Nov;63(11):1258-66.

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