Self-Critical Perfectionism Predicts Lower Cortisol Response to Experimental Stress in Patients With Chronic Fatigue Syndrome

Objective: Previous studies have suggested that self-critical perfectionism (SCP) may play a role in the development and maintenance of Chronic Fatigue Syndrome (CFS). In this study we investigated whether SCP is related to a hypofunction of the hypothalamic-pituitary-adrenal (HPA) axis, which has been shown to be a key factor in the pathophysiology of CFS. Method: We conducted a quasi-experimental study to examine the association between SCP (as measured with the Depressive Experiences Questionnaire) and stress reactivity in a sample of 41 female CFS patients. Participants were exposed to the Trier Social Stress Test (TSST). Both subjective stress and salivary cortisol levels were measured until 90 min after the TSST. We also examined the relationship between stress reactivity and illness characteristics (i.e., duration and severity of symptoms). Results: The results showed that SCP was associated with increased subjective stress reactivity, but with decreased HPA-axis reactivity as indicated by a blunted cortisol response to the TSST. Furthermore, we found an inverse relationship between cortisol reactivity and symptom severity. There was no relationship between cortisol reactivity and illness duration. Conclusion: Our findings suggest that SCP is associated with loss of resilience of the neurobiological stress response system in CFS.