Many sufferers of PTSD/complex PTSD feel constantly exhausted and, in this article, I want to examine the reasons why:
Causes of exhaustion in the PTSD/complex PTSD sufferer:
At my most ill, I was having to retire to bed at 3 p.m. and would not re-emerge until about 15 hours later (i.e. 6 a.m. the next day). The sleep itself was very low quality, extremely broken, and unrefreshing; I would wake up literally dozens of times and the sleep I did get was full of hideous, terrifying nightmares.
Indeed, badly disrupted sleep is very common in individuals who suffer from PTSD. The person may have frequent and intense nightmares, suffer broken sleep, take a long time to fall asleep, and wake up undesirably early in the morning, unable to get back to sleep despite feeling exhausted (indeed, this is also one of the hallmarks of major depression).
PTSD/complex PTSD sufferers who experience such symptoms of insomnia wake up feeling both mentally and physically unrefreshed and, as a consequence, find both their physical and mental abilities are impaired.
Also, as a result of not sleeping properly, they often find their ability to cope with everyday life is greatly diminished and their vulnerability to the adverse effects of stress is greatly increased.
2) Psychological strain.
People with PTSD are constantly tormented by, and attempting to fight, extremely painful memories and distressing intrusive thoughts. This, too, is exhausting.
3) Effort of ‘putting up a front’ and of hiding behind a false self.
Many sufferers of PTSD/complex PTSD do not want others (such as acquaintances and work associates) to know about their illness so feel they need to ‘wear a social mask’ and pretend that ‘everything’s fine’. Keeping up such a pretense is mentally taxing and extremely tiring.
4) Effects on diet.
People with PTSD may lose their appetites and consequently under-eat, leading to malnutrition and deprivation of important minerals and vitamins which may cause increased fatigue.
One way some PTSD/complex PTSD sufferers try to cope with their disturbing thoughts and feelings is to immerse themselves in work in order to divert their minds, working each day for excessive hours ( up to 20 hours a day, in the most extreme cases).
Consequences of extreme tiredness and exhaustion in the PTSD/complex PTSD sufferer:
The consequences of the great fatigue the PTSD sufferer may experience include:
1) Lacking in mental and physical energy.
2) Poor concentration.
3) Poor decision-making and poor judgment.
4) Irritable mood.
5) Extreme tiredness can lead to the development of depression (on the other hand, depression can also lead to constant tiredness).
7) Impaired work performance and more days absent from work.
8) Impaired social life.
9) Increased risk to physical health.
We have seen from other articles that I have published on this site that significant and protracted childhood trauma can physically damage the developing brain and, in particular, the development of a brain region known as the AMYGDALA.
One of the functions of the amygdala is to regulate our emotions, including fear and anxiety, and, as a result of this damage, it can become dysfunctional.
This dysfunction may result in the amygdala becoming ‘stuck in overdrive’ leading us to feel constantly highly anxious and fearful – in other words, locked into a perpetual state of ‘fight or flight’.
When we are in a state of ‘fight or flight’, our bodies undergo certain physical effects; these include :
– increased heart rate.
– increased blood pressure.
– an increase in the production of the stress hormone known as cortisol.
– an increase in the stress hormone known as adrenalin.
According to Adrenal Fatigue theory, when we are subjected to chronic, intense stress, such as that described above, the adrenal gland becomes dysfunctional resulting in symptoms such as those listed below:
– constant, extreme tiredness.
– an impaired ability to concentrate.
– difficulty in getting out of bed in the morning.
However, it is important to note that, at the time of writing, there exists insufficient evidence to establish Adrenal Fatigue Syndrome as a formally recognized disorder in the world of mainstream medicine.
If ‘adrenalin fatigue syndrome’ is not, in fact, a real condition, being diagnosed with it by an alternative therapist might detract from the real issue which could be, for example, depression, chronic fatigue syndrome, heart failure, diabetes, poor diet, poor quality sleep or anemia, all of which conditions may produce symptoms of extreme and chronic fatigue.
Overcoming Fatigue: The Importance Of Considering The Role Of Psychological Factors In Its Causation.
As referred to above, some individuals who experience chronic, extreme fatigue are diagnosed with chronic fatigue syndrome (although there is a debate about how exactly the condition should be defined and what causes it; it is sometimes also referred to as myalgic encephalopathy or M.E.). Theories that seek to explain its origin consider, variously, biological, genetic, environmental, and psychological factors, although, as already alluded to, no one theory enjoys universal acceptance. In this article, however, I want to consider possible psychological factors.
Research Demonstrating How Psychological Factors Relate To An Individual’s Energy Levels :
A study conducted by Beedie (University of Aberystwyth, Wales, U.K.) involved elite cyclists being given a pill that they were told would improve their performance (in fact, this was not true – the pill was simply a ‘dummy’ pill, otherwise known as a placebo).
The results of this study found that although the pill the athletes took was merely a ‘dummy’ pill, their performance improved by approximately 2-3%.
From this finding, we may infer that the athletes who took the ‘dummy’ pill derived from doing so a BELIEF that they would be able to improve their performance and, indeed, it was this BELIEF that allowed them to do so, as opposed to any direct action of the ‘dummy’ pill.
Effects Of The Patients’ Beliefs About Their Condition :
There is also research that suggests that the attitude a person holds about their fatigued condition has an effect on how it progresses. More specifically, it has been found that sufferers of chronic fatigue syndrome who HOLD THE BELIEF THAT THE CAUSE OF THEIR CONDITION IS BIOLOGICAL AND OUT OF THEIR CONTROL ARE SIGNIFICANTLY LESS LIKELY TO RECOVER THAN THOSE WHO HOLD A MORE OPEN-MINDED ATTITUDE.
Cognitive Behavioral Therapy :
Based on the idea that what an individual believes about how their condition will develop in and of itself affects such development, it is interesting to look at the effects of cognitive-behavioral therapy (a therapy that helps people to beneficially alter how they think about things) when it is applied to the treatment of chronic fatigue syndrome.
White et al., 2011, did just this: the researchers carried out a study involving 641 patients who had been diagnosed with chronic fatigue syndrome. These patients were split into 3 groups :
GROUP 1: These patients were given routine medical care only.
GROUP 2: These patients were given routine medical care AND a therapy called G.E.T. (this stands for ‘graded exercise therapy’ and is a kind of extremely light interval training intended to reduce the patient’s fear, very gradually, of undertaking physically exerting tasks).
GROUP 3: These patients were given routine medical care AND cognitive behavioral therapy.
GROUP 4: These patients were given routine medical care AND ‘adaptive pacing therapy’ (A.P.T.).
Results Of The Study :
The results of the study showed that 22% of the participants in GROUPS 2 and GROUP 3 recovered from their chronic fatigue syndrome after one year compared to 7-8% in the other two groups.
This finding adds further weight to the theory that how the person thinks about their condition affects how it develops, or, to put it more simply, thinking more positively in relation to one’s experience of extreme fatigue makes it more likely that the condition will abate.
David Hosier BSc Hons; MSc; PGDE(FAHE).