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Chronic stress, PTSD, and burnout can all manifest as fatigue from mild to the point of a medical diagnosis.

Exertion-related crashes can be delayed, so pacing requires tracking patterns beyond today's energy.

Pacing covers emotional, cognitive, physical, social, and spiritual effort, not only physical activity.

Chronic stress, posttraumatic stress disorder (PTSD), and burnout don't just stay in the head. At some point, the overloaded body systems stop working, and that manifests as fatigue. Eventually, you end up in a state of chronic fatigue.

At the low end of the scale, it's easy to ignore; you wake up tired after a full night's sleep. A bit further down the scale is burnout, or what Sweden calls exhaustion disorder (Eskilsson et al., 2017). Then, at the far end of the scale, you have a medical diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

People with PTSD have significantly raised levels of inflammatory mediators (Passos et al., 2015), and inflammation in itself is linked to fatigue (Cho et al., 2013). Both childhood trauma and PTSD are associated with a greatly increased risk of CFS (Dansie et al., 2012; Heim et al., 2009). ME/CFS is a biological illness rather than a psychological one (Centers for Disease Control and Prevention, n.d.). The systems aren't separate, of course, and a body that's been under chronic stress for years may have very few reserves left to recover.

People with ME/CFS and long COVID will refer to what happens when you do too much as a "crash." The medical term is post-exertional malaise (PEM), and it can occur days later. In one survey of people with ME/CFS, 90 percent reported experiencing PEM following both mental and emotional exertion (Chu et al., 2018). Burnout isn't ME/CFS in another guise, but anyone who's been running on depleted reserves for years will have felt that delayed bill. That's the approach I'm taking, not the diagnosis.

Three Tiers of Sustainability

An Individualized Sustainability Plan (ISP) in the ETI approach is built on three levels of activity:

Enjoyment is the "right now"........

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