Anybody else have AvPD & chronic fatigue?

This summer was great. I was unemployed, listened to a lot of records, smoked a lot of pot, made mixtapes. Even had a girlfriend. Our thing was to go on hikes, find a secluded spot in the woods by a stream or waterfall, roll a spliff and share it.

Best of all I had my health back after some serious bouts of fatigue and diffuse body aches, and my social anxiety was under control after getting back on SSRI's (which I had stopped taking because the fatigue and body aches got worse shortly after first going on them). I was enjoying life while realizing the party would be over soon. It was back to college in the fall for me, and I had decided to quit smoking pot while in school.

Before classes started, I had broken it off with my girlfriend, because she wasn't communicative, would kind of push me away, and wasn't willing to hear me out on how that bothered me. I think she was afraid of rejection in her own way.

About halfway through fall term, a good friend of mine died. I decided to fly back home so I could participate in the funeral. Throughout it all, I was so intent on not falling behind in my classes that I didn't fully allow myself to grieve. I started panicking about how much of a failure I would be if I didn't get good grades in my classes, especially because I already had a bachelor's degree, and was hoping to apply to a masters program in a new field.

Shortly after the funeral my health deteriorated again. I began missing classes. I had to withdraw from a dance class because I couldn't keep up. I got A's in the other courses, but in retrospect I'm not sure it was worth the mental and physical anguish.

Now I'm trying to do the job search thing with very limited energy. I need about 12 hours of sleep each night and some days I need lots of rest. It's tough figuring out my next move. Do I go for something part time? Do I mention these health issues during an interview? Should I opt for freelance projects? This is a gig economy, or so they say. Maybe I should just apply for disability.

One thing I have plenty of is time, which has its plusses. You need time to listen to records, and watch movies, and read books, and keep up on the news. You also need time to grieve, and to get a little perspective on life.

Recently, I got the idea to write Dr Gabor Maté and ask him if he has any insights into chronic fatigue syndrome, as I suspect that's what I have. He had once responded to an email I sent about a friend's health issues. I was first made aware of Maté by an episode of Democracy Now! where he spoke about the connections between certain personality styles and illnesses. I later read his, "When the Body Says No: Understanding the Stress-Disease Connection", which I found fascinating.

As Maté pointed out on DN!, the immune system has been called the "floating brain" because "[i]t has memory, it has reactive capacity, and it has learning capacity." It seems plausible that a system this complex; which, as Maté claims, western science shows "incontrovertibly and in great detail" to be "physiologically connected" to the brain; could be affected by a personality disorder. "[I]n short," Maté says, "we have one system. The science that studies it is called psychoneuroimmunology. And scientifically, it’s not even controversial, but it’s completely lacking from medical practice."

In trying to imagine what his response to my email would be (thinking like the Maté), I came up with the following theory: My chronic fatigue syndrome is my immune system acting on behalf of an inner sense that danger lurks around every corner. It must stay on alert, even to the point of causing suffering. Chronic, low-grade inflammation becomes necessary collateral damage in the never ending mission to subdue the threat, destroy the invaders. It is the psychoneuroimmunological consequence of my personality disorder.

Maybe for me, fighting inflammation is as much about lessening my fear of rejection as it is about eating the right foods. Maybe feeling energetic again is as much about not diverting energy into worry thoughts as it is about finding the right level of physical activity. In fact, I have run across a published study that concluded there is indeed evidence of a meaningful correlation between certain personality disorders (including AvPD) and CFS.

I can certainly see a kind of comorbidity between my fatigue symptoms and avoidant tendencies. I want to have friendships, but worry that I won't have the energy necessary to foster them, which only undermines them anyway. I want a good job, and a girlfriend, but I constantly worry that my health (among other things) will screw it all up for me, which only worsens my health. Down I spiral.

Maybe unlearning my worries could literally cure my ills.

Does this story sound familiar to anyone or am I just a big, anxious weirdo? I wonder if there is anybody else on this forum who deals with CFS or CFS-like symptoms and knows how challenging that is. I have had little help from doctors, who tend to assume the fatigue and aches are just part of depression. But I'm convinced it's much more than that, based on the severity of my symptoms, and the fact that they don't seem to correspond to my depression at all.

You are only ever going to get annecdotal evidence from a forum So treat it all with a grain of salt.

Having said that, I would tend to agree with you. I am not so much AvPD, but have social and generalised anxiety issues. About 10 years ago my psychologist said to me, all that worry takes a lot of energy. I was young, around 20 at that time, and I had so much energy in abundance I didn't realise.

It is only now that I am 35 or so, that I am beginning to struggle with energy/fatigue issues and it is becoming apparent to me that it is due to excessive anxiety.

ObblesO wrote:It is only now that I am 35 or so, that I am beginning to struggle with energy/fatigue issues and it is becoming apparent to me that it is due to excessive anxiety.

I'm in my 30's too. The fatigue seemed to get worse then, though I've dealt with it since childhood. But the body aches didn't start becoming a frequent issue until right after I started taking SSRI's in my mid 20's. It feels awful. It's like having the flu without the fever, and sometimes I even get a sore throat. I have other symptoms known to be associated with CFS, like joint pain and gastrointestinal issues.

Basically I'm just tired of doctors treating me like it's "all in my head". I know AvPD is thought to be associated with hypochondriasis, and I wonder if they see the diagnosis in my chart and just tend to shrug off my symptoms because of that. But at a certain point, you know your body and what it's trying to tell you, and you just know something's not all in your head after years of battling with it. I've certainly done my due diligence in trying to treat the anxiety and depression, which have gone into remission at times. Alleviation of the physical symptoms almost never seemed to follow. If they did clear up, it seemed more related to getting off SSRI's, which have been helpful in treating social anxiety.

My theory is that the SSRI's are hard on my stomach and modulate my immune response. Stomach issues are a common side effect. It's also known that a part of the immune system called mast cells communicates using serotonin, which becomes more available when taking antidepressants. There was one study where CFS patients were given immunosuppressants and many of them went into remission, so it would make sense that SSRI's could contribute to CFS in people with already jumpy immune systems. These things may be coming together with my personality style to create the problem.

Firstly I think it is interesting that AvPD is being associated with hypochondria.

My stepdad is a pretty bad hypochondriac, going to doctor's frequently, thinking everything is cancer.

I am a bit of one, but not so much. I do have that tendency, but mostly with mental things. It take a lot of self-control for me NOT to think that I have pretty much every mental illness and to try to filter out the things that really don't apply.

Chronic fatigue is something that I try to be careful about. I certainly have lower energy levels than peers, but I don't know if I really qualify for chronic fatigue.

I think dopamine may be important as well as serotonin.

As we speak, I am trying something called Sulbutiamine for more energy and hopefully to reduce social inhibition. http://en.wikipedia.org/wiki/Sulbutiamine Downed probably about 400mg or so (maybe less), some was left over in the cup from 600mg that I was trying to take. It tasted so horrible, and a few small clumps didn't get swallowed (It didn't really dissolve well in OJ, mostly just floating/swirling in it...)

It has been about 2 hours since I took it. I went for a walk with my family, and I didn't get muscle tiredness, but that normally doesn't happen anyway. I think I feel a bit less fatigued, but it is hard to say, and it could easily be placebo. I feel a bit better in muscles, and maybe a bit stimulated mentally, but not too much.

I will mess with the dosage some, and I will post back if I have any significant effects.

When two things coincide like this, it is neat to find a med that effects both at the same time, because it means that maybe your underlying problem is whatever that one med fixes.

Hey brainslug,

Thanks for the info on sulbutiamine. Looks like it has some effect on social anxiety. Let us know if it helps you out!

Hello I did a little research on Sulbutaimine after reading this, and seems to me it should be used as a supplement of which effects would not be apparent short term. However...of my hour or so of research it looks like a lot of reports on the Internet are of people using it as a memory/concentration aid for studying like one would use caffeine. That conflicts with the supplement thoughts, so I'm a little confused

fuliginCloak wrote:Hey brainslug,

Thanks for the info on sulbutiamine. Looks like it has some effect on social anxiety. Let us know if it helps you out!

I am still experimenting with it, but so far, there is nothing significant.

ObblesO wrote:Hello I did a little research on Sulbutaimine after reading this, and seems to me it should be used as a supplement of which effects would not be apparent short term. However...of my hour or so of research it looks like a lot of reports on the Internet are of people using it as a memory/concentration aid for studying like one would use caffeine. That conflicts with the supplement thoughts, so I'm a little confused

Yeah, there seems to be a lot of conflicting information on it.

It looks like it inhibits DRD1 activation somehow, and it confuses me, but from what I am reading some places, DRD1 inhibits DRD2 or opposes it or something, and DRD2 is the receptor that is sometimes talked about in social anxiety.

So, by that logic, you reduce dopamine activity in D1 receptors, and that increases it in D2 receptors. That just seems strange, though.

Still, amphetamines do the LEAST on DRD2, so I don't see how.

What I am not understanding is what exactly it does with the dopamine to decrease the "activity". Different people say different things.

I am going to try high doses, and I am going to try to take it normal for a few weeks and see what happens.

So far, the theory that it inhibits DRD1, and thus increases the others doesn't seem to apply to me unless I just need a lot (over a gram). Still, I am a bit hesitant to take a lot of this one. 2g is as high as I am going to go.

The other theory is that it sensitizes the DRD1 from the lack of activity, and that is what helps.

I wouldn't put too much stock into this drug. It looked promising, but I am kinda disappointed so far.

Also. It may be worth noting that if you get it on your hands a lot, the smell seems to never come off. You have to wash your hands a lot to get it off.

I think my fatigue is mostly a 2ndary effect to my avoidance. I think that being more social is how I can cure it.