Part 2: Autism and Health Issues Unpacked: Exploring the Intersection of Autism and Chronic Fatigue Syndrome

Written by Claire Eliza Sehinson, MS with Dr. Megan Anna Neff, PsyD. Originally posted on Neurodivergent Insights

This is a continuation from Part 1.

Chronic Fatigue Syndrome Overview 

Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (M.E.), is a chronic, multifactorial neurological disease characterized by a spectrum of symptoms impacting various body systems.

Key Diagnostic Characteristics of Chronic Fatigue Syndrome

  • Debilitating Fatigue: A profound level of fatigue that is not relieved by rest and severely impacts daily functioning.

  • Cognitive Difficulties: Often referred to as “brain fog,” this encompasses challenges with memory, concentration, and overall cognitive processing.

  • Sleep Disturbance: Difficulties in both falling asleep and maintaining restful sleep.

  • Post-Exertional Malaise: A significant worsening of symptoms following physical or mental exertion.

It’s important to keep in mind that the experience of ME/CFS varies among individuals. Not everyone will have the same set of symptoms or follow the same progression of the illness. Furthermore, there are additional symptoms that often present with ME/CFS. 

Additional Recognized Symptoms

The complexity of ME/CFS is further evident in a range of associated symptoms, including but not limited to:

  • Chronic pain

  • Orthostatic Intolerance or POTS (Postural Orthostatic Tachycardia Syndrome)

  • Autonomic Dysfunction

  • Temperature Sensitivity

  • Neuromuscular Symptoms (such as twitching and myoclonic jerks)

  • Flu-like Symptoms and recurrent viral infections

  • Intolerance to alcohol or certain foods

  • Heightened sensory sensitivities

  • Gastrointestinal difficulties

These symptoms are officially recognized in the NICE (National Institute for Health and Care Excellence) guidelines, highlighting the multifaceted nature of ME/CFS and its profound impact on those affected.

Variability and Impact

ME/CFS is marked by its variability in severity and daily fluctuation of symptoms, significantly disrupting all aspects of life, including social interactions, work, and personal relationships. The condition's unpredictability and profound psychological impact make it particularly challenging. A 2008 study by Dancey highlighted that individuals with CFS experience greater disruption to their lives than those with other chronic and severe illnesses, including anxiety disorders, cancer, and multiple sclerosis (M.S.).

Current Understanding and Treatment Approaches

To date, there is no consensus on the underlying disease mechanism of ME/CFS, nor is there a cure. Treatment focuses primarily on managing symptoms. However, ongoing research is shedding light on possible contributing factors, including immune and autonomic nervous system dysfunction, neuro-endocrine disorders, gut microbiome imbalances, genetic predispositions, and metabolic abnormalities, such as mitochondrial dysfunction.

Diagnosis: Adult or Rapid Onset (Not Present Since Birth)

ME/CFS is often underdiagnosed, with an estimated 80% of cases going unrecognized. On average, it takes about five years from the onset of symptoms for a patient to receive a diagnosis. Contributing to this challenge is the variability in clinical definitions and criteria for diagnosing ME/CFS.

Common Comorbid Health Conditions

In addition to its primary symptoms, up to 97% of individuals with ME/CFS also contend with one or more comorbid health conditions, which may include:

  • POTS (Postural Orthostatic Tachycardia Syndrome)

  • Anxiety and Depression

  • IBS (Irritable Bowel Syndrome)

  • Fibromyalgia

  • Hashimoto's Thyroiditis

  • Various Autoimmune Disorders

Reference: Afari et al., 2003; Castro-Marrero et al., 2017; Chu et al., 2019; Daniels et al., 2017 Chu et al., 2019; Daniels et al., 2017

Chronic Fatigue Triggers

One notable distinction between ME/CFS and autism is its development later in life. While genetic predispositions can increase susceptibility to ME/CFS, the condition is often precipitated by specific events. These triggers, if not properly addressed, can perpetuate and exacerbate symptoms throughout the illness. Key triggers include:

  • Viral or Bacterial Infection: Researchers like Hickie et al. (2006) have found that infections can initiate ME/CFS, suggesting a link between the immune response and the onset of symptoms.

  • Autoimmunity: According to Sotzny (2018), autoimmunity plays a role in ME/CFS, indicating that the body's immune response against its own tissues may contribute to the condition.

  • Mycotoxin and Mold Illness: Brewer et al. (2013) highlight the impact of environmental factors, specifically mycotoxins and mold, in triggering ME/CFS, showing the condition's sensitivity to external biological agents.

  • Genetic Variants in Biological Pathways: Wang et al. (2017) point to specific genetic variations that affect immune and neurotransmitter systems, which can predispose individuals to ME/CFS.

  • Stress and Occupational Burnout: Recent findings by Springer et al. (2023) demonstrate a correlation between prolonged stress, occupational burnout, and the development of ME/CFS, underscoring the interplay between psychological stressors and physical health.

  • Emotional Trauma: Emotional trauma is also recognized as a potential trigger, reflecting the complex interaction between mental health and physical well-being in ME/CFS.

Correlated with High Adverse Childhood Events (ACES) and PTSD

Psychological factors are integral in the complex web of health challenges associated with ME/CFS. Notably, experiences of childhood trauma, including sexual, physical, and emotional abuse or neglect, as well as conditions like depression and anxiety, significantly increase the risk of developing CFS in later life. This risk is magnified in the presence of PTSD symptoms, as detailed in studies like Heim (2009), which report a six-fold increase in risk.

The persistent stimulation of the biological stress response, specifically the HPA axis (hypothalamic pituitary axis), due to developmental trauma or PTSD, leads to altered sensitivity. This change means the stress response doesn't “switch off” as easily, resulting in symptoms like hyper-vigilance and hyper-reactivity to minor or non-existent threats, or what can be described as a “loss of resilience”.

Correlation with Personality Traits

Further, studies exploring personality traits in ME/CFS have shed light on increased risks associated with certain characteristics. For instance, Buckley (1999) found that individuals with ME/CFS were often more "hard driving". Lievesley et al. (2014) reported higher personal and parental expectations during childhood among this group. Additionally, Magnusson et al. (1996) linked the negative aspects of perfectionism in individuals with ME/CFS to maladaptive coping strategies.

This evidence underscores the profound impact of psychological experiences and traits on the development of ME/CFS, suggesting that both childhood experiences and personality factors can significantly influence the risk and experience of the condition.

Occupational Triggers And Risk Factors 

Clinical observations suggest that certain professions may be more susceptible to developing ME/CFS. This heightened risk is often linked to exposure to environmental toxins, chemicals, or infections, especially in specific geographical areas. These occupational hazards can interact with genetic predispositions, which might be previously undetected, and are often exacerbated by lifestyle factors like inadequate sleep and high stress levels.

Military Service and Gulf War Syndrome

Military personnel exemplify this risk. Soldiers frequently face sleep deprivation, intense physical training, and considerable psychological stress, all while being exposed to diverse microbial, chemical, and biological threats. 

A notable instance is Gulf War Syndrome (GWS), often called "the ME of the military." GWS, affecting about 50% of Gulf War veterans, shares over 30 symptoms with ME/CFS. Although its cause remains medically unexplained, studies such as Chao et al. (2014) have linked it to brain volume shrinkage associated with low-level organophosphate exposure, affecting regions related to emotions, the autonomic nervous system, and sensory processing.

Industrial Work and Heavy Metal Exposure

The industrial sector poses similar risks. Exposure to heavy metals like cadmium, a common environmental and occupational pollutant, has been linked to neurological symptoms similar to those of ME/CFS. Research, including Pacini et al. (2012), indicates that cadmium exposure can adversely affect memory, attention, and energy levels. The highest cadmium exposure risk is seen among industrial workers, residents of heavily industrialized areas, and cigarette smokers.

Recognizing the connection between certain occupations and ME/CFS risk is crucial for preventive measures and providing targeted support and treatment for those impacted by such occupational hazards.

continued in part 3

References

Aaron RV, Fisher EA, de la Vega R, Lumley MA, Palermo TM. Alexithymia in individuals with chronic pain and its relation to pain intensity, physical interference, depression, and anxiety: a systematic review and meta-analysis. Pain. 2019 May;160(5):994-1006. doi: 10.1097/j.pain.0000000000001487. PMID: 31009416; PMCID: PMC6688175.

Afari, N., & Buchwald, D. (2003). Chronic fatigue syndrome: a review. American Journal of Psychiatry, 160(2), 221-236.

Aronica L, Ordovas JM, Volkov A, Lamb JJ, Stone PM, Minich D, Leary M, Class M, Metti D, Larson IA, Contractor N, Eck B, Bland JS. Genetic Biomarkers of Metabolic Detoxification for Personalized Lifestyle Medicine. Nutrients. 2022 Feb 11;14(4):768. doi: 10.3390/nu14040768. PMID: 35215417; PMCID: PMC8876337.

Acheson ED. The clinical syndrome variously called benign myalgic encephalomyelitis, Iceland disease and epidemic neuromyasthenia. Am J Med. 1959 Apr;26(4):569-95. doi: 10.1016/0002-9343(59)90280-3. PMID: 13637100.

Atchison CJ, Davies B, Cooper E, Lound A, Whitaker M, Hampshire A, Azor A, Donnelly CA, Chadeau-Hyam M, Cooke GS, Ward H, Elliott P. Long-term health impacts of COVID-19 among 242,712 adults in England. Nat Commun. 2023 Oct 24;14(1):6588. doi: 10.1038/s41467-023-41879-2. PMID: 37875536; PMCID: PMC10598213.

Bennett JA, Germani T, Haqq AM, Zwaigenbaum L. Autism spectrum disorder in Prader-Willi syndrome: A systematic review. Am J Med Genet A. 2015 Dec;167A(12):2936-44. doi: 10.1002/ajmg.a.37286. Epub 2015 Aug 29. PMID: 26331980.

Bested AC, Marshall LM. Review of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: an evidence-based approach to diagnosis and management by clinicians. Rev Environ Health. 2015;30(4):223-49. doi: 10.1515/reveh-2015-0026. PMID: 26613325.

Booth NE, Myhill S, McLaren-Howard J. Mitochondrial dysfunction and the pathophysiology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Int J Clin Exp Med. 2012;5(3):208-20. Epub 2012 Jun 15. PMID: 22837795; PMCID: PMC3403556.

Bonaz B, Sinniger V, Pellissier S. Anti-inflammatory properties of the vagus nerve: potential therapeutic implications of vagus nerve stimulation. J Physiol. 2016 Oct 15;594(20):5781-5790. doi: 10.1113/JP271539. Epub 2016 May 1. PMID: 27059884; PMCID: PMC5063949.

Bonaz B, Lane RD, Oshinsky ML, Kenny PJ, Sinha R, Mayer EA, Critchley HD. Diseases, Disorders, and Comorbidities of Interoception. Trends Neurosci. 2021 Jan;44(1):39-51. doi: 10.1016/j.tins.2020.09.009. PMID: 33378656.

Bonaz B, Sinniger V, Pellissier S. The Vagus Nerve in the Neuro-Immune Axis: Implications in the Pathology of the Gastrointestinal Tract. Front Immunol. 2017 Nov 2;8:1452. doi: 10.3389/fimmu.2017.01452. PMID: 29163522; PMCID: PMC5673632.

Brewer JH, Thrasher JD, Straus DC, Madison RA, Hooper D. Detection of mycotoxins in patients with chronic fatigue syndrome. Toxins (Basel). 2013 Apr 11;5(4):605-17. doi: 10.3390/toxins5040605. PMID: 23580077; PMCID: PMC3705282.

Buckley L, MacHale SM, Cavanagh JT, Sharpe M, Deary IJ, Lawrie SM. Personality dimensions in chronic fatigue syndrome and depression. J Psychosom Res. 1999 Apr;46(4):395-400. doi: 10.1016/s0022-3999(98)00120-2. PMID: 10340240.

Chao LL, Kriger S, Buckley S, Ng P, Mueller SG. Effects of low-level sarin and cyclosarin exposure on hippocampal subfields in Gulf War Veterans. Neurotoxicology. 2014 Sep;44:263-9. doi: 10.1016/j.neuro.2014.07.003. Epub 2014 Jul 21. PMID: 25058901; PMCID: PMC5464327.

Chu, L., Valencia, I. J., Garvert, D. W., & Montoya, J. G. (2019). Onset patterns and course of myalgic encephalomyelitis/chronic fatigue syndrome. Frontiers in pediatrics, 7, 12.

Crompton, C. J., Sharp, M., Axbey, H., Fletcher-Watson, S., Flynn, E. G., & Ropar, D. (2020). Neurotype-matching, but not being autistic, influences self and observer ratings of interpersonal rapport. Frontiers in Psychology, 11, 2961.

Csecs JLL, Iodice V, Rae CL, Brooke A, Simmons R, Quadt L, Savage GK, Dowell NG, Prowse F, Themelis K, Mathias CJ, Critchley HD, Eccles JA. Joint Hypermobility Links Neurodivergence to Dysautonomia and Pain. Front Psychiatry. 2022 Feb 2;12:786916. doi: 10.3389/fpsyt.2021.786916. PMID: 35185636; PMCID: PMC8847158.

Dancey CP, Friend J. Symptoms, impairment and illness intrusiveness--their relationship with depression in women with CFS/ME. Psychol Health. 2008;23(8):983-99. doi: 10.1080/08870440701619957. PMID: 25160923.

Daniels, J., Brigden, A., & Kacorova, A. (2017). Anxiety and depression in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): examining the incidence of health anxiety in CFS/ME. Psychology and Psychotherapy: Theory, Research and Practice, 90(3), 502-509.

Dargenio VN, Dargenio C, Castellaneta S, De Giacomo A, Laguardia M, Schettini F, Francavilla R, Cristofori F. Intestinal Barrier Dysfunction and Microbiota-Gut-Brain Axis: Possible Implications in the Pathogenesis and Treatment of Autism Spectrum Disorder. Nutrients. 2023 Mar 27;15(7):1620. doi: 10.3390/nu15071620. PMID: 37049461; PMCID: PMC10096948.

de Magistris L, Familiari V, Pascotto A, Sapone A, Frolli A, Iardino P, Carteni M, De Rosa M, Francavilla R, Riegler G, Militerni R, Bravaccio C. Alterations of the intestinal barrier in patients with autism spectrum disorders and in their first-degree relatives. J Pediatr Gastroenterol Nutr. 2010 Oct;51(4):418-24. doi: 10.1097/MPG.0b013e3181dcc4a5. PMID: 20683204.

Dong H, Zhang X, Qian Y. Mast cells and neuroinflammation. Med Sci Monit Basic Res. 2014 Dec 21;20:200-6. doi: 10.12659/MSMBR.893093. PMID: 25529562; PMCID: PMC4282993.

Eisenlohr-Moul T, Divine M, Schmalenberger K, Murphy L, Buchert B, Wagner-Schuman M, Kania A, Raja S, Miller AB, Barone J, Ross J. Prevalence of lifetime self-injurious thoughts and behaviors in a global sample of 599 patients reporting prospectively confirmed diagnosis with premenstrual dysphoric disorder. BMC Psychiatry. 2022 Mar 19;22(1):199. doi: 10.1186/s12888-022-03851-0. PMID: 35303811; PMCID: PMC8933886.

Giloteaux, L., Goodrich, J.K., Walters, W.A. et al. Reduced diversity and altered composition of the gut microbiome in individuals with myalgic encephalomyelitis/chronic fatigue syndrome. Microbiome 4, 30 (2016). 

Gotts ZM, Deary V, Newton J, Van der Dussen D, De Roy P, Ellis JG. Are there sleep-specific phenotypes in patients with chronic fatigue syndrome? A cross-sectional polysomnography analysis. BMJ Open. 2013 Jun 20;3(6):e002999. doi: 10.1136/bmjopen-2013-002999. PMID: 23794547; PMCID: PMC3669720.

Groenman AP, Torenvliet C, Radhoe TA, Agelink van Rentergem JA, Geurts HM. Menstruation and menopause in autistic adults: Periods of importance? Autism. 2022 Aug;26(6):1563-1572. doi: 10.1177/13623613211059721. Epub 2021 Nov 26. PMID: 34825585; PMCID: PMC9344571.

Engineer CT, Hays SA, Kilgard MP. Vagus nerve stimulation as a potential adjuvant to behavioral therapy for autism and other neurodevelopmental disorders. J Neurodev Disord. 2017 Jul 4;9:20. doi: 10.1186/s11689-017-9203-z. PMID: 28690686; PMCID: PMC5496407.

Espinosa P, Urra JM. Decreased Expression of the CD57 Molecule in T Lymphocytes of Patients with Chronic Fatigue Syndrome. Mol Neurobiol. 2019 Sep;56(9):6581-6585. doi: 10.1007/s12035-019-1549-7. Epub 2019 Mar 21. PMID: 30895436.

Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011 Mar 4;144(5):646-74. doi: 10.1016/j.cell.2011.02.013. PMID: 21376230.

Heim C, Wagner D, Maloney E, Papanicolaou DA, Solomon L, Jones JF, Unger ER, Reeves WC. Early adverse experience and risk for chronic fatigue syndrome: results from a population-based study. Arch Gen Psychiatry. 2006 Nov;63(11):1258-66. doi: 10.1001/archpsyc.63.11.1258. PMID: 17088506. 

Heim C, Nater UM, Maloney E, Boneva R, Jones JF, Reeves WC. Childhood trauma and risk for chronic fatigue syndrome: association with neuroendocrine dysfunction. Arch Gen Psychiatry. 2009 Jan;66(1):72-80. doi: 10.1001/archgenpsychiatry.2008.508. PMID: 19124690.

Kojima, M. Alexithymia as a prognostic risk factor for health problems: a brief review of epidemiological studies. BioPsychoSocial Med 6, 21 (2012). https://doi.org/10.1186/1751-0759-6-21

Kong, X., Zhu, J., Tian, R., Liu, S., Sherman, H. T., Zhang, X., ... & Wan, G. (2020). Early screening and risk factors of autism spectrum disorder in a large cohort of Chinese patients with Prader-Willi syndrome. Frontiers in psychiatry, 11, 594934.

Kossewska J, Bierlit K, Trajkovski V. Personality, Anxiety, and Stress in Patients with Small Intestine Bacterial Overgrowth Syndrome. The Polish Preliminary Study. Int J Environ Res Public Health. 2022 Dec 21;20(1):93. doi: 10.3390/ijerph20010093. PMID: 36612414; PMCID: PMC9819554.

Lee M, Krishnamurthy J, Susi A, Sullivan C, Gorman GH, Hisle-Gorman E, Erdie-Lalena CR, Nylund CM. Association of Autism Spectrum Disorders and Inflammatory Bowel Disease. J Autism Dev Disord. 2018 May;48(5):1523-1529. doi: 10.1007/s10803-017-3409-5. PMID: 29170940.

Li Y, Qiu S, Shi J, Guo Y, Li Z, Cheng Y, Liu Y. Association between MTHFR C677T/A1298C and susceptibility to autism spectrum disorders: a meta-analysis. BMC Pediatr. 2020 Sep 24;20(1):449. doi: 10.1186/s12887-020-02330-3. PMID: 32972375; PMCID: PMC7517654.

Liu CH, Yang MH, Zhang GZ, Wang XX, Li B, Li M, Woelfer M, Walter M, Wang L. Neural networks and the anti-inflammatory effect of transcutaneous auricular vagus nerve stimulation in depression. J Neuroinflammation. 2020 Feb 12;17(1):54. doi: 10.1186/s12974-020-01732-5. PMID: 32050990; PMCID: PMC7017619.

Lievesley K, Rimes KA, Chalder T. A review of the predisposing, precipitating and perpetuating factors in Chronic Fatigue Syndrome in children and adolescents. Clin Psychol Rev. 2014 Apr;34(3):233-48. doi: 10.1016/j.cpr.2014.02.002. Epub 2014 Mar 1. PMID: 24632047.

Maes M, Mihaylova I, De Ruyter M. Lower serum zinc in Chronic Fatigue Syndrome (CFS): relationships to immune dysfunctions and relevance for the oxidative stress status in CFS. J Affect Disord. 2006 Feb;90(2-3):141-7. doi: 10.1016/j.jad.2005.11.002. Epub 2005 Dec 9. PMID: 16338007.

Maes M, Mihaylova I, Leunis JC. Increased serum IgA and IgM against LPS of enterobacteria in chronic fatigue syndrome (CFS): indication for the involvement of gram-negative enterobacteria in the etiology of CFS and for the presence of an increased gut-intestinal permeability. J Affect Disord. 2007 Apr;99(1-3):237-40. doi: 10.1016/j.jad.2006.08.021. Epub 2006 Sep 27. PMID: 17007934.

Maes M, Leunis JC. Normalization of leaky gut in chronic fatigue syndrome (CFS) is accompanied by a clinical improvement: effects of age, duration of illness and the translocation of LPS from gram-negative bacteria. Neuro Endocrinol Lett. 2008 Dec;29(6):902-10. PMID: 19112401.

Magnusson AE, Nias DK, White PD. Is perfectionism associated with fatigue? J Psychosom Res. 1996 Oct;41(4):377-83. doi: 10.1016/s0022-3999(96)00189-4. PMID: 8971668.

Maintz L, Novak N. Histamine and histamine intolerance. Am J Clin Nutr. 2007 May;85(5):1185-96. doi: 10.1093/ajcn/85.5.1185. PMID: 17490952.

Makris G, Agorastos A, Chrousos GP, Pervanidou P. Stress System Activation in Children and Adolescents With Autism Spectrum Disorder. Front Neurosci. 2022 Jan 13;15:756628. doi: 10.3389/fnins.2021.756628. PMID: 35095389; PMCID: PMC8793840.

Mallorquí-Bagué N, Garfinkel SN, Engels M, Eccles JA, Pailhez G, Bulbena A, Critchley HD. Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility. Front Psychol. 2014 Oct 14;5:1162. doi: 10.3389/fpsyg.2014.01162. PMID: 25352818; PMCID: PMC4196473

McElhanon BO, McCracken C, Karpen S, Sharp WG. Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis. Pediatrics. 2014 May;133(5):872-83. doi: 10.1542/peds.2013-3995. PMID: 24777214.

McGinnis WR, Audhya T, Walsh WJ, Jackson JA, McLaren-Howard J, Lewis A, Lauda PH, Bibus DM, Jurnak F, Lietha R, Hoffer A. Discerning the Mauve Factor, Part 1. Altern Ther Health Med. 2008 Mar-Apr;14(2):40-50. Erratum in: Altern Ther Health Med. 2008 May-Jun;14(3):15. PMID: 18383989.

McGinnis WR, Audhya T, Walsh WJ, Jackson JA, McLaren-Howard J, Lewis A, Lauda PH, Bibus DM, Jurnak F, Lietha R, Hoffer A. Discerning the Mauve factor, Part 2. Altern Ther Health Med. 2008 May-Jun;14(3):56-62. PMID: 18517107.

Monzio Compagnoni G, Di Fonzo A, Corti S, Comi GP, Bresolin N, Masliah E. The Role of Mitochondria in Neurodegenerative Diseases: the Lesson from Alzheimer's Disease and Parkinson's Disease. Mol Neurobiol. 2020 Jul;57(7):2959-2980. doi: 10.1007/s12035-020-01926-1. Epub 2020 May 22. PMID: 32445085; PMCID: PMC9047992.

Morris G, Berk M, Walder K, Maes M. The Putative Role of Viruses, Bacteria, and Chronic Fungal Biotoxin Exposure in the Genesis of Intractable Fatigue Accompanied by Cognitive and Physical Disability. Mol Neurobiol. 2016 May;53(4):2550-71. doi: 10.1007/s12035-015-9262-7. Epub 2015 Jun 17. PMID: 26081141.

Nakanishi G, Pita-Oliveira M, Bertagnolli LS, Torres-Loureiro S, Scudeler MM, Cirino HS, Chaves ML, Miwa B, Rodrigues-Soares F. Worldwide Systematic Review of GSTM1 and GSTT1 Null Genotypes by Continent, Ethnicity, and Therapeutic Area. OMICS. 2022 Oct;26(10):528-541. doi: 10.1089/omi.2022.0090. Epub 2022 Sep 16. PMID: 36112350.

Peters SL, Yao CK, Philpott H, Yelland GW, Muir JG, Gibson PR. Randomised clinical trial: the efficacy of gut-directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2016 Sep;44(5):447-59. doi: 10.1111/apt.13706. Epub 2016 Jul 11. PMID: 27397586.

Poznyak AV, Ivanova EA, Sobenin IA, Yet SF, Orekhov AN. The Role of Mitochondria in Cardiovascular Diseases. Biology (Basel). 2020 Jun 25;9(6):137. doi: 10.3390/biology9060137. PMID: 32630516; PMCID: PMC7344641.

Rasa S, Nora-Krukle Z, Henning N, Eliassen E, Shikova E, Harrer T, Scheibenbogen C, Murovska M, Prusty BK; European Network on ME/CFS (EUROMENE). Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). J Transl Med. 2018 Oct 1;16(1):268. doi: 10.1186/s12967-018-1644-y. PMID: 30285773; PMCID: PMC6167797.

Rauch SAM, King A, Kim HM, Powell C, Rajaram N, Venners M, Simon NM, Hamner M, Liberzon I. Cortisol awakening response in PTSD treatment: Predictor or mechanism of change. Psychoneuroendocrinology. 2020 Aug;118:104714. doi: 10.1016/j.psyneuen.2020.104714. Epub 2020 May 15. PMID: 32446108; PMCID: PMC7984524.

Reynolds, A. M., Soke, G. N., Sabourin, K. R., Hepburn, S., Katz, T., Wiggins, L. D., Schieve, L. A., & Levy, S. E. (2019). Sleep Problems in 2- to 5-Year-Olds With Autism Spectrum Disorder and Other Developmental Delays. Pediatrics, 143(3), e20180492. https://doi.org/10.1542/peds.2018-0492

Sandin S, Lichtenstein P, Kuja-Halkola R, Hultman C, Larsson H, Reichenberg A. The Heritability of Autism Spectrum Disorder. JAMA. 2017 Sep 26;318(12):1182-1184. doi: 10.1001/jama.2017.12141. PMID: 28973605; PMCID: PMC5818813.

Sharp HEC, Critchley HD, Eccles JA. Connecting brain and body: Transdiagnostic relevance of connective tissue variants to neuropsychiatric symptom expression. World J Psychiatry. 2021 Oct 19;11(10):805-820. doi: 10.5498/wjp.v11.i10.805. PMID: 34733643; PMCID: PMC8546774.

Schmidt R, Hiemisch A, Kiess W, von Klitzing K, Schlensog-Schuster F, Hilbert A. Macro- and Micronutrient Intake in Children with Avoidant/Restrictive Food Intake Disorder. Nutrients. 2021 Jan 27;13(2):400. doi: 10.3390/nu13020400. PMID: 33513954; PMCID: PMC7911718.

Shoemaker RC, House D, Ryan JC. Structural brain abnormalities in patients with inflammatory illness acquired following exposure to water-damaged buildings: a volumetric MRI study using NeuroQuant®. Neurotoxicol Teratol. 2014 Sep-Oct;45:18-26. doi: 10.1016/j.ntt.2014.06.004. Epub 2014 Jun 17. PMID: 24946038.

Sotzny F, Blanco J, Capelli E, Castro-Marrero J, Steiner S, Murovska M, Scheibenbogen C; European Network on ME/CFS (EUROMENE). Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - Evidence for an autoimmune disease. Autoimmun Rev. 2018 Jun;17(6):601-609. doi: 10.1016/ j.autrev.2018.01.009. Epub 2018 Apr 7. PMID: 29635081. 

Springer A, Oleksa-Marewska K, Basińska-Zych A, Werner I, Białowąs S. Occupational burnout and chronic fatigue in the work of academic teachers-moderating role of selected health behaviours. PLoS One. 2023 Jan 26;18(1):e0280080. doi: 10.1371/journal.pone.0280080. PMID: 36701360; PMCID: PMC9879519. 

Szyf M. The epigenetics of early life adversity and trauma inheritance: an interview with Moshe Szyf. Epigenomics. 2022 Mar;14(6):309-314. doi: 10.2217/epi-2021-0483. Epub 2021 Dec 8. PMID: 34877868.

Theoharides TC, Kavalioti M, Tsilioni I. Mast Cells, Stress, Fear and Autism Spectrum Disorder. Int J Mol Sci. 2019 Jul 24;20(15):3611. doi: 10.3390/ijms20153611. PMID: 31344805; PMCID: PMC6696098.

Tomas C, Newton J, Watson S. A review of hypothalamic-pituitary-adrenal axis function in chronic fatigue syndrome. ISRN Neurosci. 2013 Sep 30;2013:784520. doi: 10.1155/2013/784520. PMID: 24959566; PMCID: PMC4045534.

Traianos E, Dibnah B, Lendrem D, et alAB0051 THE EFFECTS OF NON-INVASIVE VAGUS NERVE STIMULATION ON IMMUNOLOGICAL RESPONSES AND PATIENT REPORTED OUTCOME MEASURES OF FATIGUE IN PATIENTS WITH CHRONIC FATIGUE SYNDROME, FIBROMYALGIA, AND RHEUMATOID ARTHRITISAnnals of the Rheumatic Diseases 2021;80:1057-1058.

Tsai SY, Chen HJ, Lio CF, Kuo CF, Kao AC, Wang WS, Yao WC, Chen C, Yang TY. Increased risk of chronic fatigue syndrome in patients with inflammatory bowel disease: a population-based retrospective cohort study. J Transl Med. 2019 Feb 22;17(1):55. doi: 10.1186/s12967-019-1797-3. PMID: 30795765; PMCID: PMC6387539.

Tsilioni I, Patel AB, Pantazopoulos H, Berretta S, Conti P, Leeman SE, Theoharides TC. IL-37 is increased in brains of children with autism spectrum disorder and inhibits human microglia stimulated by neurotensin. Proc Natl Acad Sci U S A. 2019 Oct 22;116(43):21659-21665. doi: 10.1073/pnas.1906817116. Epub 2019 Oct 7. PMID: 31591201; PMCID: PMC6815178.

van Rensburg R, Meyer HP, Hitchcock SA, Schuler CE. Screening for Adult ADHD in Patients with Fibromyalgia Syndrome. Pain Med. 2018 Sep 1;19(9):1825-1831. doi: 10.1093/pm/pnx275. PMID: 29099955.

Wang SX, Wu WC. Effects of psychological stress on small intestinal motility and bacteria and mucosa in mice. World J Gastroenterol. 2005 Apr 7;11(13):2016-21. doi: 10.3748/wjg.v11.i13.2016. PMID: 15800998; PMCID: PMC4305729.

Wang T, Yin J, Miller AH, Xiao C. A systematic review of the association between fatigue and genetic polymorphisms. Brain Behav Immun. 2017 May;62:230-244. doi: 10.1016/j.bbi.2017.01.007. Epub 2017 Jan 12. PMID: 28089639; PMCID: PMC5947855.

Weiss RB, Stange JP, Boland EM, Black SK, LaBelle DR, Abramson LY, Alloy LB. Kindling of life stress in bipolar disorder: comparison of sensitization and autonomy models. J Abnorm Psychol. 2015 Feb;124(1):4-16. doi: 10.1037/abn0000014. PMID: 25688428; PMCID: PMC4332547.

Wojcik DP, Godfrey ME, Christie D, Haley BE. Mercury toxicity presenting as chronic fatigue, memory impairment and depression: diagnosis, treatment, susceptibility, and outcomes in a New Zealand general practice setting (1994-2006). Neuro Endocrinol Lett. 2006 Aug;27(4):415-23. PMID: 16891999.

Yang EV, Webster Marketon JI, Chen M, Lo KW, Kim SJ, Glaser R. Glucocorticoids activate Epstein Barr virus lytic replication through the upregulation of immediate early BZLF1 gene expression. Brain Behav Immun. 2010 Oct;24(7):1089-96. doi: 10.1016/j.bbi.2010.04.013. Epub 2010 May 11. PMID: 20466055; PMCID: PMC2939213.

Yap CX, Henders AK, Alvares GA, Wood DLA, Krause L, Tyson GW, Restuadi R, Wallace L, McLaren T, Hansell NK, Cleary D, Grove R, Hafekost C, Harun A, Holdsworth H, Jellett R, Khan F, Lawson LP, Leslie J, Frenk ML, Masi A, Mathew NE, Muniandy M, Nothard M, Miller JL, Nunn L, Holtmann G, Strike LT, de Zubicaray GI, Thompson PM, McMahon KL, Wright MJ, Visscher PM, Dawson PA, Dissanayake C, Eapen V, Heussler HS, McRae AF, Whitehouse AJO, Wray NR, Gratten J. Autism-related dietary preferences mediate autism-gut microbiome associations. Cell. 2021 Nov 24;184(24):5916-5931.e17. doi: 10.1016/j.cell.2021.10.015. Epub 2021 Nov 11. PMID: 34767757.

Yuzefovych LV, Pastukh VM, Ruchko MV, Simmons JD, Richards WO, Rachek LI. Plasma mitochondrial DNA is elevated in obese type 2 diabetes mellitus patients and correlates positively with insulin resistance. PLoS One. 2019 Oct 10;14(10):e0222278. doi: 10.1371/journal.pone.0222278. PMID: 31600210; PMCID: PMC6786592.

Autism, Chronic healthKiley Hanish