E0 ConsensusModerate confidencePEM unclearReview-NarrativePeer-reviewedMachine draft
Childhood stressors in the development of fatigue syndromes: a review of the past 20 years of research.
Borsini, A, Hepgul, N, Mondelli, V et al. · Psychological medicine · 2014 · DOI
Quick Summary
This review looked at 31 studies to see if stressful experiences during childhood might increase the chance of developing ME/CFS or fibromyalgia later in life. The researchers found that people who experienced childhood stress were 2-3 times more likely to develop these fatigue conditions compared to those without such experiences. They also found that people with these conditions who had experienced childhood stress were more likely to also develop depression, anxiety, and pain.
Why It Matters
Understanding how childhood experiences may contribute to ME/CFS development could help clinicians better identify at-risk individuals and inform treatment approaches that address trauma-related biological changes. This research validates patients' experiences of childhood stress as potentially relevant to disease etiology and may reduce stigma around psychiatric comorbidities in ME/CFS.
Observed Findings
- People exposed to childhood stressors have 2-3 fold higher rates of CFS/FM compared to unexposed individuals
- Individuals with CFS/FM and a history of childhood stressors show increased rates of depression and anxiety compared to those without childhood trauma
- Childhood stressors are consistently associated with increased pain symptoms in CFS/FM populations
- Multiple forms of childhood stressors (various types examined across the 31 studies) show association with fatigue syndrome development
Inferred Conclusions
- Childhood stressors represent an important environmental risk factor contributing to CFS and FM development
- Childhood adversity may act through persistent dysregulation of inflammatory and HPA axis systems to increase vulnerability to these conditions
- Individuals with childhood trauma histories who develop CFS/FM have distinct phenotypes with elevated psychiatric and pain comorbidities
- Mechanistic research is needed to clarify how early-life stress 'programs' biological systems toward later disease
Remaining Questions
- What are the specific biological mechanisms linking childhood stress to persistent immune and endocrine dysfunction in CFS/FM?
- Does early intervention in traumatized children at risk for fatigue syndromes prevent disease development?
What This Study Does Not Prove
This review demonstrates association, not causation—childhood stress may increase susceptibility, but does not definitively prove it causes ME/CFS. The review cannot identify specific biological mechanisms or determine whether childhood stress is a primary cause versus one risk factor among many. Individual studies included may have varied in case definitions, measurement of childhood stressors, and control for confounding variables.
Tags
Symptom:PainFatigue
Biomarker:Cytokines
Phenotype:Pediatric
Method Flag:Weak Case DefinitionExploratory OnlyMixed Cohort
Metadata
- DOI
- 10.1017/S0033291713002468
- PMID
- 24093427
- Review status
- Machine draft
- Evidence level
- Established evidence from major reviews, guidelines, or evidence maps
- Last updated
- 8 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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