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The five personality patterns of fatigue

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According to therapist and founder of The Optimum Health Clinic (OHC) Alex Howard, who beat his myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) with an integrative approach and has worked with over 10,000 patients, identifying your energy-depleting personality patterns could be the key to unlocking your fatigue.

Over the years at the OHC, we’ve discovered five key personality patterns that we believe significantly increase the likelihood of developing fatigue. And when I talk about fatigue, I mean when your levels of exertion are normal, and yet you still experience fatigue, whether mild or severe. 

These patterns, which we call ‘energy-depleting psychologies,’ are ways of living life that are inherently draining and will affect the very terrain in which our cells live. Identifying and addressing these patterns is a crucial part of my 12-step plan for recovering from fatigue.  

It’s not a definitive list, but these are by far the most common personality patterns. You can have one or all of them, and different patterns may have different prominence in different chapters of your life. 

1: Achiever  

Achievers define their self-worth by what they do and achieve in the world. The achiever pattern is probably why, in the 1980s, chronic fatigue syndrome was labeled ‘yuppie flu.’ There seemed to be a disproportionate number of highly pressured executives who were becoming ill.  

This pattern is only one small part of a much more complex picture, but the reality still stands—when the body is placed under relentless pressure, at some point it starts to show signs of this.  

However, not everyone with an achiever pattern is driven to excel in their career or to gain material status in the world. There are many atypical achiever patterns—from being driven to live sustainably and help tackle global issues like climate change to being the best parent.  

There are as many ways to push through the body’s feedback in pursuit of accomplishing things as there are people affected by fatigue.Whether we’re driving ourselves toward our career, trying to make the world a better place, striving to become a good parent, or pursuing our own healing path, if the demands of the tasks ahead of us are consistently placed above our body’s communications for rest or care, we’re living in a way that’s unsustainable, and an achiever pattern is at play.  

2: Perfectionist  

The perfectionist is a close comrade of the achiever. Perfectionists define their self-worth and create a sense of safety in the world by getting things perfectly right. 

They tend to have a somewhat black-and-white view of the world and a sense that there is a right and wrong way of doing things and being on the correct side of this is important. Perfectionists hold themselves and others to impossibly high standards and often suffer from harsh and unfair internal self-judgment, which they may also project onto others.  

Living in the mind and body of a perfectionist can feel utterly exhausting because however much the body may beg for rest and care, the drive to get things right is more important. The difference between achievers and perfectionists is that achievers tend to be more focused on the image of success, whereas perfectionists are more focused on getting things right along the way. 

Achievers are addicted to the very act of doing and being busy, while perfectionists are addicted to handling all the details. And, of course, we can have both forces at play.  

3: Helper

Helpers define their self-worth by what they give to and do for others. They’re the classic givers—when it comes to being there for people, nothing is too much trouble for them. 

As with the achiever, there are many different iterations and variations of the helper pattern. For some, it may be in the classic sense of being in a helper role, such as a teacher, medic or therapist. For others, it may be the constant inner pressure to be there for family and friends. 

And it can be less obvious, too—it may just be the unreasonable demands we place on ourselves to support people in our team at work. I’m not suggesting that to sustain good health we need to live in a world where everyone selfishly looks after their own needs at the expense of everyone else. The issue I’m pointing to is when we consistently ignore our own physical and emotional needs so we can be there for others—not only for an acute period of time, such as supporting a loved one who’s going through a crisis, but as a core habit in the way we approach our lives.  

Ultimately, if we reject and ignore our own needs to be there for others, we’re living our lives in an unsustainable, unhealthy way. 

There is a particular challenge that goes with being a helper—because of our natural tendency to want to help others, we find ourselves in a lot of situations with people who want or need our help. 

Be it full-on codependent relationships or just naturally finding ourselves giving rather than receiving support, the impact is eventually the same—we consistently put more into our relationships than we get back, and this is inherently energy-depleting. 

This dynamic isn’t always the fault of the other person, either—we also teach people how to treat us. Even with those people who aren’t naturally energy-draining, we’ll find that we’re the one who’s always giving to and taking responsibility for others.   

4: Anxiety  

Anxiety types have a constant feeling of being on edge and a sense that the world isn’t a safe place. There tends to be a lot of mental busyness and living more in the mind than the body. The primary strategy is to try and think one’s way to a feeling of safety. If we can think of all the possible scenarios around what might happen—how, where, when, why, etc.—and then all of the solutions, we might be able to have a temporary feeling of safety.  

It takes a lot of mental energy to fuel this strategy, which means we become less connected to our body and the needs it’s trying to communicate to us. This is a fundamentally draining place from which to meet ourselves and the world.  

The core problem with anxiety is that it becomes what I call a ‘safety loop’ (right). We feel a sense of being unsafe in the world, and so our mind speeds up to protect us; as our mind speeds up, we disconnect from our body; by disconnecting from our body we feel more unsafe, and so our mind speeds up further, creating a vicious cycle.  

Because our nervous system doesn’t distinguish  between something that’s real and something that’s vividly imagined, the more anxiety patterns we run, the more draining it becomes to our body and nervous system. In a sense, there is an almost addictive nature to anxiety—we get so used to experiencing it that we almost can’t imagine a world without it.   

Of course, during a particularly stressful chapter in life, such as suffering with fatigue, any anxiety patterns we have will become worse. But those with this underlying pattern will be able to trace back their sense that the world isn’t quite safe to a time before they experienced fatigue.  

For some people anxiety is primarily a mental experience, while others will be more aware of the feeling of anxiety in their body. However, when anxiety is felt in the mind it changes what’s happening in the body; and equally, when the body is in a state of anxiety it affects the mind.  

5: Controller

The controller is closely related to the anxiety type. The controller’s strategy is to manage the inner sense of not feeling safe in the world by controlling themselves and their environment—be it controlling their emotions, controlling others in a team, or even controlling things such as the temperature in the room or the direction of a conversation.

As with the other personality patterns, sustaining the controller takes an enormous amount of ongoing energy. And because we can’t truly control ourselves or the world around us, we’re still left with an underlying sense of anxiety. Ultimately, the strategy never truly works. 

One of the consequences of the controller pattern is that we tend to push away the people around us who could offer us genuine emotional holding and support. To feel truly supported, we need to be vulnerable enough to let others into our emotional space, and the controller pattern gets in the way of this. 

The controller pattern also has a sort of self-perpetuating quality to it—the harder we work to control ourselves and the world around us, the more we generate the illusion that we have some kind of control. This means that the more we do it, the harder it can feel to stop.  

Retraining the brain

You do not need to become the thought police of every thought you might ever have or learn to “control your mind.” Indeed, neither of those things will ultimately work. However, it’s important to learn to catch such patterns and come to gradually retrain your mental habits. 

Learning to change these patterns can be a significant focus in itself—it’s a key part of my online coaching program, the RESET Program (see—but here are some simple tips and techniques you can try straight away. 

Cultivating self-awareness

One of the tools I use with patients and in my online coaching programs is a thought and behavior diary that helps catch personality patterns as they’re happening. The better we get at identifying these behaviors, the easier it becomes to start to change them. It’s a simple yet powerful exercise.  

  1. Every evening, think about the five personality patterns and then write down examples of each one you followed that day. These can be big things, such as pushing through your fatigue symptoms all day with an achiever pattern, or subtler ones, such as spending more time than you needed to trying to refine an email with a perfectionist pattern. 
  2. As you reflect on how these patterns are playing out, that knowledge becomes power. Your next challenge is to get better at catching and stopping those patterns as they’re happening.

The four types of tiredness  

While helping patients at the OHC, my friend and colleague Anna Duschinsky noticed that not all tiredness is the same. She identified four different types of tiredness, each with its own causes and with different strategies effective in helping resolve it. 


Adapted from Decode Your Fatigue, A Clinically Proven 12-Step Plan to Increase Your Energy, Heal Your Body and Transform Your Life, by Alex Howard (Hay House, 2021). 

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