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Psychiatric Disorders in Patients With Fibromyalgia

A Multicenter Investigation

Received December 18, 1997; revised March 27, 1998; accepted April 2, 1998. From the Georgetown University Medical Center, Washington, D.C.; the University of California, San Diego; the State University of New York at Stonybrook, Long Island, New York; and the Medical University of South Carolina, Charleston. Address correspondence and reprint requests to Dr. Epstein, Department of Psychiatry, Georgetown University Medical Center, 3800 Reservoir Road, NW, Washington, DC 20007.

The authors conducted an investigation in four tertiary-care centers to determine if psychiatric comorbidity and psychological variables were predictive of functional impairment in patients with fibromyalgia syndrome (FMS). Seventy-three individuals were administered the Structured Clinical Interview for DSM-III-R, the Rand 36-item Health Survey (SF-36), and multiple self-report measures. The patients with FMS were found to have a high lifetime and current prevalence of major depression and panic disorder. The most common disorders were major depression (lifetime [L]=68%, current [C]=22%); dysthymia (10% [C only]); panic disorder (L=16%, C=7%); and simple phobia (L=16%, C=12%). The self-report scales revealed significant elevations in depression, anxiety, neuroticism, and hypochondriasis. Functional impairment on all measures of the SF-36 was severe (e.g., physical functioning=45.5 and role limitations due to physical problems=20.0). Stepwise multiple-regression analysis revealed that current anxiety was the only variable that predicted a significant proportion of the variance (29%) in SF-36 physical functioning. Thus, in this multicenter study, the persons with FMS exhibited marked functional impairment, high levels of some lifetime and current psychiatric disorders, and significant current psychological distress. Current anxiety level appears to be an important correlate of functional impairment in individuals with FMS.

Key Words: Fibromyalgia • Psychiatric Disorders • Comorbidity

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