Comorbidity of Fibromyalgia and Psychiatric Disorders
J Clin Psychiatry 2006;67(8):1219-1225
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Objective: To assess the co-occurrence of
fibromyalgia with psychiatric disorders in participants of a
fibromyalgia family study.
Method: Patients (probands) with fibromyalgia,
control probands with rheumatoid arthritis, and first-degree
relatives of both groups completed a structured clinical
interview and tender point examination. The co-occurrence odds
ratio (OR) (the odds of a lifetime comorbid DSM-IV disorder in an
individual with fibromyalgia divided by the odds of a lifetime
comorbid disorder in an individual without fibromyalgia, adjusted
for age and sex) was calculated; observations were weighted by
the inverse probability of selection, based on the fibromyalgia
status of the proband; and standard errors were adjusted for the
correlation of observations within families. The study was
conducted from September 1999 to April 2002.
Results: We evaluated 78 fibromyalgia probands
and 146 of their relatives, and 40 rheumatoid arthritis probands
and 72 of their relatives. Among the relatives of both proband
groups, we identified 30 cases of fibromyalgia, bringing the
total number of individuals with fibromyalgia to 108, compared
with 228 without fibromyalgia. The co-occurrence ORs for specific
disorders in individuals with versus those without fibromyalgia
were as follows: bipolar disorder: 153 (95% CI = 26 to 902,
p < .001); major depressive disorder: 2.7 (95% CI = 1.2 to 6.0,
p = .013); any anxiety disorder: 6.7 (95% CI = 2.3 to 20, p < .001);
any eating disorder: 2.4 (95% CI = 0.36 to 17, p = .36); and any
substance use disorder: 3.3 (95% CI = 1.1 to 10, p = .040).
Conclusions: There is substantial lifetime
psychiatric comorbidity in individuals with fibromyalgia. These
results have important clinical and theoretical implications,
including the possibility that fibromyalgia might share
underlying pathophysiologic links with some psychiatric