Comorbidity of Fibromyalgia and Psychiatric Disorders

Lesley M. Arnold, M.D; James I. Hudson, M.D., Sc.D.; Paul E. Keck, Jr., M.D.; Megan B. Auchenbach, B.A.; Kristin N. Javaras, D.Phil.; and Evelyn V. Hess, M.D.

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 disorders.

(J Clin Psychiatry 2006;67:1219-1225)

Received July 13, 2005; accepted Feb. 8, 2006. From the Women's Health Research Program, the Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr. Arnold and Ms. Auchenbach); Biological Psychiatry Laboratory, McLean Hospital, Belmont, and the Department of Psychiatry, Harvard Medical School, Boston, Mass. (Drs. Hudson and Javaras); Psychopharmacology Research Program, the Department of Psychiatry, University of Cincinnati College of Medicine and Mental Health Care Line and General Clinical Research Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio (Dr. Keck); the Department of Biostatistics, Harvard School of Public Health, Boston, Mass. (Dr. Javaras); and the Division of Immunology, the Department of Internal Medicine, the University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr. Hess).

This research was supported by National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases grant R01-AR-46054 (Dr. Arnold).

The data were presented, in part, at the 68th annual meeting of the American College of Rheumatology; October 16-21, 2004; San Antonio, Tex.

Dr. Keck is a consultant to or member of the scientific advisory boards of Abbott Laboratories, AstraZeneca Pharmaceuticals, Bristol-Myers Squibb, GlaxoSmithKline, Janssen Pharmaceutica, Eli Lilly, Ortho-McNeil, Pfizer, and Shire; and is a principal or co-investigator on research studies sponsored by Abbott Laboratories, the American Diabetes Association, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Elan, Eli Lilly, Janssen Pharmaceutica, Merck, National Institute of Mental Health (NIMH), National Institute of Drug Abuse (NIDA), Organon, Ortho-McNeil, Pfizer, the Stanley Medical Research Institute (SMRI), and UCB Pharma. Drs. Arnold, Hudson, Javaras, and Hess and Ms. Auchenbach report no additional financial or other relationships relevant to the subject matter of this article.

Corresponding author and reprints: Lesley M. Arnold, M.D., University of Cincinnati, Medical Arts Building, 222 Piedmont Ave., Suite 8200, Cincinnati, OH 45219 (e-mail: Lesley.Arnold@uc.edu).