Question

When I first developed ME, this was triggered by an infection. But I was also under a lot of physical stress (at work) and mental stress (at home) at the time. I know that ME isn’t just another type of stress disorder but stress does seem to play a role in both triggering and causing exacerbations in some people with ME. So what do we know about the role of stress in ME? And has there been any research into the role of stress?

Answer

There are two important points to note:

Chronic stress can disrupt the hypothalamic-pituitary-adrenal axis (an important method of hormone feedback and control) and the production of the stress hormone cortisol from the adrenal glands. So when a significant acute stressor then appears, like an infection, a past or current history of chronic stress could be creating fertile ground for an infection to trigger ME/CFS.

In addition, once ME/CFS has occurred, any form of ongoing chronic stress, or even an acutely stressful episode — relating to problems with doctors, family, benefits, finances, etc – is probably going to have a negative impact on any possible recovery process in ME/ CFS. It could also trigger a relapse or exacerbation of symptoms. Where stress is present, these factors do need to be addressed in the overall management of ME/CFS. The role of stress and immune system stressors – acute and chronic – on the body cannot, therefore, be ignored in ME/CFS. And this is clearly an area where useful research could be carried out.

More information

• We have an ME Association leaflet covering all aspects of stress and ME/CFS.
• Stress and ME/CFS is also covered in the ME Association Clinical & Research Guide (also known as the ‘purple book') and the Chief Medical Officer's Working Group Report on ME/CFS (2002).
• Dr Shepherd also discusses the role of stress (and a legal case involving stress) in his Living with ME Vermilion paperback.