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Depression and Anxiety in Adolescent CFS, FM and OI

"adolescent girls with CFS showed strengths such as adequate self-esteem and scholastic and social abilities, and weaknesses such as low competence in adolescent-specific tasks and internalizing distress, which may partly be explained by syndrome-specific somatic complaints." ~ van Middendorp et al
Anxiety and depression may be experienced as a result of the disbelief, hurtful comments, loss of socialization time and learning difficulties faced by kids with chronic illnesses such as Chronic Fatigue Syndrome (CFS), Fibromyalgia (FM), and Orthostatic Intolerance (OI). Losing the ability to participate in activities that helped define an adolescent's self-image, seeing friends drift away, being teased by disbelieving peers, and facing the possibility that medical treatments will not help can be very difficult. Adolescents may be frustrated by their inability to push through their symptoms and achieve in the same ways they did when they were healthy. They may be deeply upset by the possibility that they may not recover. There are many issues for them to face and come to terms with prior to and immediately after a diagnosis.  

It is also thought that depression and anxiety may occur as part of the neuroendocrine changes that are part of CFS and FM. For example, anxiety may be triggered by the surges of catecholamines that occur during presyncope and orthostatic tachycardia, common experiences for youth with CFS and forms of orthostatic intolerance such as neurally mediated hypotension (NMH) or postural orthostatic tachycardia syndrome (POTS).

It is often possible to differentiate between CFS, FM, and major depressive disorder. A comparison of adolescents with CFS and adolescents with depression finds higher self-esteem and feelings of self-efficacy in those with CFS. In addition, adolescent CFS subjects have less depressive symptoms and antisocial behavior than do their peers with major depression (Carter, 1995; Carter, 1996). Characteristics such as life changes, cognitive difficulties, negative self-attributions, social relationship disruption, and somatic symptom presentation may also be used to differentiate between idiopathic chronic fatigue (ICF), depression, and controls (Carter, 1996). 

The area of overlap between adolescent CFS and adolescent depression that has received the most attention is the internalization of distress. Three studies of adolescent girls with CFS (Pelcovitz, 1995; Carter, 1999; van Middendorp, 2001) and one study of adolescents with several months of idiopathic chronic fatigue (Carter, 1995) reported high scores on measures of internalizing. The evidence of increased rates of depression in adolescent ICF (Smith, 1991; Carter, 1995b) and CFS (Brace, 2000; E Garralda, 1999), and of anxiety in CFS (E Garralda, 1999), has added to interest in this area. However, researchers continue to report that adolescents with CFS can be differentiated from those with major depression.

Despite the challenges they face, adolescents with CFS have psychological strengths that they draw upon. Normal achievement motivation, no unusual fear of failure, high internal locus of control, and the use of palliative reaction patterns are reported in adolescent CFS (van Middendorp, 2001). Normal adjustment for psychosocial self-esteem and social abilities is is also found in adolescent girls with CFS (van Middendorp, 2001; E Garralda, 1999). Total competence is higher in CFS than in adolescent juvenile rheumatoid arthritis (Brace, 2000). Syndrome-specific somatic complains and the impact of the loss of socialization time may help explain low perceived competence in specific adolescent domains for girls with CFS, such as athletics and romance (van Middendorp, 2001). 

The questions raised by comparing adolescent depression, CFS, and juvenile rheumatoid arthritis are explored in this interview with Bryan Carter, PhD.

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