Chronic fatigue and personality: a twin study of causal pathways and shared liabilities

Is the Pandemic Wearing Us Out? A Cross-Sectional Study of the Prevalence of Fatigue in Adult Twins without Previous SARS-CoV-2 Infection

During the pandemic, mental health was not only impaired in people after a SARS-CoV-2 infection, but also in people without previous infection. This is the first study on twins without prior SARS-CoV-2 infection to estimate the influence of genetic components and shared as well as individual environments on pandemic-associated fatigue. The study sample included 55 monozygotic and 45 dizygotic twin pairs. A total of 34.5% reported an increase in fatigue since the pandemic. A significant correlation was shown between the responses within monozygotic (χ2[1] = 11.14, p = 0.001) and dizygotic pairs (χ2[1] = 18.72, p < 0.001). In all pandemic-associated fatigue dimensions, individual environment (ranging from e2 = 0.64 to e2 = 0.84) and heritability (ranging from h2 = 0.32 to h2 = 1.04) seem to have the highest impact. The number of comorbidities significantly correlated with physical fatigue (Spearman’s ρ = 0.232, p < 0.001) and psychological impairment due to pandemic measures with the total fatigue score (Spearman’s ρ = 0.243, p < 0.001). However, calculated ANCOVAs with these significant correlations as covariates showed no significant influence on the mean values of the respective fatigue dimensions. Susceptibility to pandemic-associated fatigue may be genetically and environmentally determined, while intensity is also influenced by individual components. The prevalence of fatigue is high even in individuals without prior SARS-CoV-2 infection. Future mental health prevention and intervention programs should be implemented to alleviate the impact of the pandemic on the global population.

The association of personality traits with poststroke fatigue in daily life: An exploratory experience sampling method and cross-sectional study

Fatigue is a frequently occurring and persistent symptom after stroke. Many biological, psychosocial, and behavioural factors are associated with poststroke fatigue, but research into associations with personality traits is relatively sparse. In this study, we explored whether personality traits were related to poststroke fatigue measured with conventional fatigue questionnaires as well as experience sampling methodology (ESM). Twenty-four individuals with stroke completed 10 daily questionnaires about momentary (here-and-now) fatigue for six consecutive days using the mHealth ESM application PsyMate^TM. Further, they completed questionnaires assessing personality (NEO-FFI and LOR-T) and fatigue (FSS). Results showed that higher extraversion (ß = -.44, SE = .12, p = .001; 95% CI = -.67-.19) and optimism (ß = -.18, SE = .06, p = .007; 95% CI = -.30-.05) were associated with lower momentary fatigue. No association was found between neuroticism and momentary fatigue, but higher neuroticism (r = 0.531, p = .008, 95% CI = .160-.759; r = .574, p = .003, 95% CI = .245-.767) was associated with higher scores on the retrospective FSS scales. We conclude that personality traits differentially influence poststroke fatigue, but this also depends on the way fatigue is measured (with retrospective or with momentary measures). When functional gains are not in line with expected progress during the rehabilitation treatment of fatigue, it may be appropriate to take into account how person characteristics are related to momentary fatigue.

Factors predicting videoconferencing fatigue among higher education faculty

The online remote learning revolution in the era of the pandemic has resulted in the massive explosion of videoconferencing technologies. The emergence of a new phenomenon of exhaustion and fatigue experienced during virtual meetings is evident. This study examined the predictors of videoconferencing fatigue among higher education faculty in the Philippines. A total of 322 faculty participated in this cross-sectional study. The online survey was administered using the Zoom Exhaustion and Fatigue scale as the primary data collection tool. Significant predictors of videoconferencing fatigue were identified using the multiple linear regression analysis. The results indicated that the videoconference fatigue composite score of the faculty was 3.35 out of 5 suggesting a moderate level of fatigue. Significant predictors of videoconferencing fatigue among higher education faculty include attitude, sense of being physically trapped, mirror anxiety, emotional stability domain of personality, interval between videoconferences, and duration of videoconferences. For better videoconferencing experience among faculty, mechanisms to ease fatigue during virtual meetings may be proposed based on the study result.

Put your feet up: The impact of personality traits, job pressure, and social support on the need for recovery after work

The need for recovery after work (NFR) is an important warning of work-related fatigue. NFR is linked to prolonged work-related efforts and depletion of resources, creating a need for temporary respite from work demands. The aim of the current study was to investigate the relationships between NFR and the five-factor model (FFM), comprising the personality traits of emotional stability (ES), extraversion (E), agreeableness (A), conscientiousness (C), and openness to experience (O). Perceived job pressure and perceived social support were included as mediators. The study was conducted using structural equation modelling (SEM) on cross-sectional data from a sample of 681 participants from several work sectors (N females = 376, N males = 305; M age = 46.9 years; SD = 11.1). The results showed that NFR was affected both directly and indirectly by FFM traits. High ES and high O contributed directly to reduced and increased NFR, respectively. High perceived social support contributed to reduced NFR, while high perceived job pressure contributed to increased NFR. High ES contributed indirectly to reduced NFR through perceived job pressure and social support, high O contributed indirectly to increased NFR through perceived social support, and high E contributed indirectly to increased NFR through perceived job pressure. A and C were not related to NFR. The findings demonstrate that personality traits, especially ES, are firmly related to NFR and highlight the importance of incorporating personality factors into studies of work environmental factors on NFR.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-02950-1.

Bedtime Procrastination Partially Mediates the Impact of Personality Characteristics on Daytime Fatigue Resulting From Sleep Deficiency

Getting good and sufficiently long sleep at night is important for health, effective functioning, and well-being. However, insufficient or delayed sleep are important and growing social problems that can lead to fatigue, poor performance, deterioration of well-being, circadian rhythm disturbances, and health problems. One of the significant determinants of sleep deprivation is bedtime procrastination, which is understood as the individual tendency to postpone going to bed in the absence of any external circumstances that force one to do so. Nowadays, this phenomenon is widespread in various social groups, especially among students. Despite the high prevalence of bedtime procrastination, its relationship with personality characteristics has not yet been thoroughly studied. The presented research aimed to identify the possible impact of the basic dispositional personality traits and trait-like personality characteristics on bedtime procrastination and daytime fatigue resulting from a deficiency of sleep at night. The responses from 399 university students who voluntarily took part in an internet survey were analyzed. The severity of bedtime procrastination was assessed using the Bedtime Procrastination Scale. Five basic dispositional personality traits (extraversion, neuroticism, conscientiousness, agreeableness, and openness/intellect) and their components (aspects) were measured using the International Personality Item Pool - Big Five Aspects Scale. Self-esteem and general self-efficacy were assessed using the Rosenberg Self-Esteem Scale and the General Self-Efficacy Scale. Perceived locus of control was measured using the Delta Questionnaire. The direct and indirect relationships between personality variables and daytime fatigue were investigated using linear regression models with bedtime procrastination as a mediator variable. Industriousness and orderliness, both of which are aspects of conscientiousness, were found to be indirectly associated with daytime fatigue as a consequence of their impact on bedtime procrastination. Volatility and withdrawal, both of which are aspects of neuroticism, were found to be directly related to daytime fatigue without the intermediary impact of bedtime procrastination. Self-esteem was shown to be associated with experiencing daytime fatigue, both directly and indirectly through bedtime procrastination. General self-efficacy and external locus of control were associated with daytime fatigue only directly, without the intermediary role of bedtime procrastination. The results of our research indicate that personality factors may not only play an important role in shaping sleep-related health behaviors, but they also affect well-being during the day.

Occupational Fatigue: Relationship With Personality Traits and Decent Work

Psychology of working theory (PWT) and psychology of working framework (PWF) offered a psychological view of decent work. The present study examined the associations among personality traits, decent work and Occupational Fatigue Exhaustion Recovery Scale (OFER). Two hundred and thirty four participants filled out the Big Five Questionnaire, the Italian version of the Decent Work Scale, and the Italian version of the OFER Scale. Hierarchical regressions showed that decent work explained incremental variance beyond personality traits with respect to OFER both considering total score and its three dimensions (chronic fatigue, acute fatigue, persistent fatigue). The present study underlined the value of decent work in relation to occupational fatigue beyond the contributions of personality, in particular in relation to the dimensions of Adequate compensation and Free time and rest for less occupational fatigue (both as total and as dimensions).

Perfectionism, depression and anxiety in chronic fatigue syndrome: A systematic review

OBJECTIVE

High levels of depression and anxiety are experienced alongside Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). Psychological causal and maintenance factors are not well-understood. Perfectionism is a multifactorial, transdiagnostic risk factor for various physical and mental health conditions. This systematic review assesses the association between perfectionism and depression and/or anxiety in people with CFS/ME.

METHOD

Systematic literature searches used a combination of terms for 'perfectionism', 'depression', 'anxiety' and 'CFS/ME'. Peer-reviewed English-language papers reporting quantitative data regarding the relationship between perfectionism and depression and/or anxiety in adults (aged 18-65 years) with a clinical diagnosis of CFS/ME were included. Screening, selection and assessment of risk of bias was completed independently by two authors. Bivariate and multivariate associations between perfectionism and anxiety and depression were extracted. Data were synthesised narratively.

RESULTS

Seven studies, reported in eight papers, were included. Seven examined the relationship between perfectionism and depression. Moderate-strong significant positive associations were found between depression and maladaptive perfectionism (r = 0.42 to .48, p < .01), and its component factors of concern over mistakes (r = 0.40 to .60, p < .01) and doubts about actions (r = 0.51 to .60, p < .01). Methodological limitations included sample size justification and selection, psychometric measures, and control of potential confounders.

CONCLUSION

Maladaptive perfectionism is consistently associated with depression in patients with CFS/ME. The relationship between perfectionism and anxiety is under-researched. Corroboration is required from longitudinal, cross-cultural studies. Clinical understanding may be increased through examining the interplay between maladaptive perfectionism, depression and anxiety and the physical and cognitive symptoms of CFS/ME.

Urologic chronic pelvic pain syndrome: insights from the MAPP Research Network

Urologic chronic pelvic pain syndrome (UCPPS), which encompasses interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, is characterized by chronic pain in the pelvic region or genitalia that is often accompanied by urinary frequency and urgency. Despite considerable research, no definite aetiological risk factors or effective treatments have been identified. The Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network uses a novel integrated strategy to characterize UCPPS as a systemic disorder that potentially involves multiple aetiologies. The first phase, MAPP I, included >1,000 participants who completed an intensive baseline assessment followed by a 12-month observational follow-up period. MAPP I studies showed that UCPPS pain and urinary symptoms co-vary, with only moderate correlation, and should be evaluated separately and that symptom flares are common and can differ considerably in intensity, duration and influence on quality of life. Longitudinal clinical changes in UCPPS correlated with structural and functional brain changes, and many patients experienced global multisensory hypersensitivity. Additionally, UCPPS symptom profiles were distinguishable by biological correlates, such as immune factors. These findings indicate that patients with UCPPS have objective phenotypic abnormalities and distinct biological characteristics, providing a new foundation for the study and clinical management of UCPPS.

The association of major life events with chronic fatigue

OBJECTIVE

Major life events have been associated with the onset of unexplained chronic fatigue (CF) and with variability in illness course. The purpose of this study was to characterize the associations of major life events with illness status over time.

METHOD

Sentinel measures of clinical status were collected four times over 18 months in a cohort of 99 persons with CF; participants also were interviewed regarding major life events, which were independently rated by observers.

RESULTS

Over time, more major life events attributed to CF predicted a worse clinical course, suggesting that illness-related major life events rather than stressful life events in general are associated with worse clinical status for persons with CF.

CONCLUSION

This study adds to the literature regarding specific types of life events' relationship to illness course, which has implications for the management of CF.

Fatigue symptoms in relation to neuroticism, anxiety-depression, and musculoskeletal pain. A longitudinal twin study

BACKGROUND

The nature of the relationship between fatigue and its risk factors is poorly understood. In the present study the genetic and environmental association between anxiety-depression, musculoskeletal (MS) pain and fatigue was examined, and the role of neuroticism as a shared risk factor that may possibly explain the co-occurrence between these phenotypes was investigated in a combined cross-sectional and longitudinal twin design.

METHODS

The sample consisted of 746 monozygotic (MZ) and 770 dizygotic (DZ) twins in the age group of 50-65 (mean = 57.11 years, SD = 4.5). Continuous measures of fatigue symptoms and the other phenotypes were employed. Using Cholesky modeling, genetic and environmental influences on the phenotypes, and the associations among them, were determined. Analyses were performed using measures of neuroticism obtained concurrently and 13-19 years earlier.

RESULTS

Results from multiple regression analyses showed that neuroticism, anxiety-depression symptoms, and MS pain were all significantly associated with fatigue, controlling for sex, education, and general health indices. The best-fitting biometric models included additive genetic and individual-specific environmental effects. Heritabilities in the 0.40-0.53 range were demonstrated. Furthermore, while there was a considerable overlap in genetic risk factors between the four phenotypes, a substantial proportion of the genetic risk shared between anxiety-depression and fatigue, and between MS pain and fatigue, was independent of neuroticism.

CONCLUSION

Evidence for a common underlying susceptibility to report fatigue symptoms, genetically linked to neuroticism, anxiety-depression, and MS pain, was found. Both unique and pleiotropic effects appear to be involved in the genetic architecture of the phenotypes.

Diagnostic Concordance Between Categorical and Dimensional Instruments to Assess Personality Disorder in Chronic Fatigue Syndrome

Abstract. The study examines the relationship between a categorical and a dimensional personality assessment instrument in patients with Chronic Fatigue Syndrome (CFS). A total of 162 CFS patients were included in the study (91.4% women; mean age 47.5 years). All subjects completed the Spanish versions of the Personality Diagnostic Questionnaire-4+ (PDQ-4+) and the Temperament and Character Inventory-Revised (TCI-R). Results: 78 (48.1%) of the patients presented a Personality Disorder (PD), the most frequent being Cluster C, specifically Obsessive-compulsive disorder, followed by Avoidant disorder. PDs showed a specific pattern of correlation with temperament scales. All PD clusters correlated positively with Harm Avoidance and Self-Transcendence, and negatively with Reward Dependence, Self-Directedness, and Cooperativeness. In a logistic regression analysis, Self-Directedness and Cooperativeness predicted PD presence. The findings are consistent with previous studies in non-CFS samples and suggest that the combination of the Temperament and Character dimensions (low Self-Directedness and Cooperativeness and high Harm Avoidance and Self-Transcendence) correlates with PD severity, and that Self-Directedness and Cooperativeness are associated with PD presence in CFS patients. The integration of these two perspectives expands the current comprehension of personality pathology in CFS patients.

Efficacy of rintatolimod in the treatment of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)

Chronic fatigue syndrome/ Myalgic encephalomyelitis (CFS/ME) is a poorly understood seriously debilitating disorder in which disabling fatigue is an universal symptom in combination with a variety of variable symptoms. The only drug in advanced clinical development is rintatolimod, a mismatched double stranded polymer of RNA (dsRNA). Rintatolimod is a restricted Toll-Like Receptor 3 (TLR3) agonist lacking activation of other primary cellular inducers of innate immunity (e.g.- cytosolic helicases). Rintatolimod also activates interferon induced proteins that require dsRNA for activity (e.g.- 2ʹ-5ʹ adenylate synthetase, protein kinase R). Rintatolimod has achieved statistically significant improvements in primary endpoints in Phase II and Phase III double-blind, randomized, placebo-controlled clinical trials with a generally well tolerated safety profile and supported by open-label trials in the United States and Europe. The chemistry, mechanism of action, clinical trial data, and current regulatory status of rintatolimod for CFS/ME including current evidence for etiology of the syndrome are reviewed.

Emotional Variability Predicts Tiredness in Daily Life

Abstract. Intraindividual variability, along with the more frequently studied between-person variability, has been argued to be one of the basic building blocks of emotional experience. The aim of the current study is to examine whether intraindividual variability in affect predicts tiredness in daily life. Intraindividual variability in affect was studied with the experience sampling method in a group of 110 participants (aged between 19 and 84 years) during 14 consecutive days on seven randomly determined occasions per day. The results suggest that affect variability is a stable construct over time and situations. Our findings also demonstrate that intraindividual variability in affect has a unique role in predicting increased levels of tiredness at the momentary level as well at the level of individuals.

Widespread Psychosocial Difficulties in Men and Women With Urologic Chronic Pelvic Pain Syndromes: Case-control Findings From the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network

OBJECTIVE

To determine the extent, severity, and sex differences of psychosocial deficits in men and women with urologic chronic pelvic pain syndromes (UCPPS), which in the past have been considered separate bladder (interstitial cystitis-painful bladder syndrome) and prostate (chronic prostatitis-chronic pelvic pain syndrome) disorders. Evaluations of men and women separately suggest UCPPS is associated with increased anxiety and depression. However, studies directly testing deficits in broader psychosocial domains such as cognitive processes, intimate relationships, and trauma history, or tests of sex differences in the pattern of difficulties associated with UCPPS have not been performed.

METHODS

A total of 233 female and 191 male UCPPS patients and 235 female and 182 male healthy controls (HCs) were recruited from 6 academic medical centers in the United States and evaluated with a comprehensive battery of symptom, psychosocial, and illness impact measures. Primary comparisons of interest were between UCPPS patients and HCs and between men and women with UCPPS.

RESULTS

In addition to greater negative effect, male and female UCPPS patients show higher levels of current and lifetime stress, poorer illness coping, increased self-report of cognitive deficits, and more widespread pain symptoms compared with sex- and education-matched HCs. Similar problems were found in male and female UCPPS patients although female UCPPS patients showed increased self-report of childhood adversity and more widespread symptoms of pain and discomfort.

CONCLUSION

Given the significance of psychosocial variables in prognosis and treatment of chronic pain conditions, the results add substantially to our understanding of the breath of difficulties associated with UCPPS and point to important areas for clinical assessment.

A two-year follow-up case of chronic fatigue syndrome: substantial improvement in personality following a yoga-based lifestyle intervention

BACKGROUND AND OBJECTIVE

Chronic Fatigue Syndrome (CFS) is characterized by excessive fatigue after minimal physical or mental exertion, muscle and joint pain, poor concentration, dizziness, and sleep disturbances. We report here the effect of a yoga-based lifestyle intervention in a 30-year old male patient with a documented diagnosis of CFS with compromised quality of life (QoL) and altered personality.

METHODS

The patient initially attended a short-term yoga-based lifestyle intervention program that consisted of yoga-postures, breathing exercises (pranayama), meditation, group discussions, and individualized advice on stress management, diet and physical activity besides group support. Thereafter, patient attended 5 more such programs.

RESULTS

There was a notable and consistent improvement in his clinical profile, positive aspects of personality and subjective well-being, and reduction in anxiety following this yoga-based lifestyle intervention.

CONCLUSION

Overall, the results suggest that lifestyle intervention may improve clinical condition and personality in patients with CFS.

Clinical and evoked pain, personality traits, and emotional states: can familial confounding explain the associations?

OBJECTIVES

Pain is a complex phenomenon influenced by context and person-specific factors. Affective dimensions of pain involve both enduring personality traits and fleeting emotional states. We examined how personality traits and emotional states are linked with clinical and evoked pain in a twin sample.

METHODS

99 female twin pairs were evaluated for clinical and evoked pain using the McGill Pain Questionnaire (MPQ) and dolorimetry, and completed the 120-item International Personality Item Pool (IPIP), the Positive and Negative Affect Scale (PANAS), and ratings of stress and mood. Using a co-twin control design we examined a) the relationship of personality traits and emotional states with clinical and evoked pain and b) whether genetics and common environment (i.e. familial factors) may account for the associations.

RESULTS

Neuroticism was associated with the sensory component of the MPQ; this relationship was not confounded by familial factors. None of the emotional state measures was associated with the MPQ. PANAS negative affect was associated with lower evoked pressure pain threshold and tolerance; these associations were confounded by familial factors. There were no associations between IPIP traits and evoked pain.

CONCLUSIONS

A relationship exists between neuroticism and clinical pain that is not confounded by familial factors. There is no similar relationship between negative emotional states and clinical pain. In contrast, the relationship between negative emotional states and evoked pain is strong while the relationship with enduring personality traits is weak. The relationship between negative emotional states and evoked pain appears to be non-causal and due to familial factors.

Chronic fatigue syndrome and personality: a case-control study using the Alternative Five Factor Model

Neuroticism is the personality dimension most frequently associated with chronic fatigue syndrome (CFS). Most studies have also shown that CFS patients are less extraverted than non-CFS patients, but results have been inconsistent, possibly because the facets of the extraversion dimension have not been separately analyzed. This study has the following aims: to assess the personality profile of adults with CFS using the Alternative Five-Factor Model (AFFM), which considers Activity and Sociability as two separate factors of Extraversion, and to test the discriminant validity of a measure of the AFFM, the Zuckerman-Kuhlman Personality Questionnaire, in differentiating CFS subjects from normal-range matched controls. The CFS sample consisted of 132 consecutive patients referred for persistent fatigue or pain to the Department of Medicine of a university hospital. These were compared with 132 matched normal population controls. Significantly lower levels of Activity and significantly higher levels of Neuroticism-Anxiety best discriminated CFS patients from controls. The results are consistent with existing data on the relationship between Neuroticism and CFS, and clarify the relationship between Extraversion and CFS by providing new data on the relationship of Activity to CFS.