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Am J Psychiatry 1991; 148:1721-1726
Copyright © 1991 by American Psychiatric Association
Psychiatric status of patients with primary fibromyalgia, patients with rheumatoid arthritis, and subjects without pain: a blind comparison of DSM-III diagnoses
TA Ahles, SA Khan, MB Yunus, DA Spiegel and AT Masi
Behavioral Medicine Section, Dartmouth Medical School, Lebanon, NH.
OBJECTIVE: The major purpose of this study was to compare the frequency of
the occurrence of DSM-III diagnoses in patients with primary fibromyalgia
syndrome, patients with rheumatoid arthritis, and subjects without pain.
METHOD: Thirty-five patients with primary fibromyalgia, 33 patients with
rheumatoid arthritis, and 31 nonpatients without pain were blindly assessed
for psychiatric diagnoses with the Psychiatric Diagnostic Interview.
RESULTS: Data from this interview revealed no group differences in terms of
lifetime history of any psychiatric disorders, including major depression,
somatization disorder, or anxiety-based disorders. Analysis of the
auxiliary symptoms of depression on the Psychiatric Diagnostic Interview
revealed that the patients with fibromyalgia did not report a higher
frequency of vegetative signs of depression. However, analysis of the
somatization scale revealed an interaction between medical and psychiatric
diagnoses: patients with primary fibromyalgia syndrome and a psychiatric
history endorsed significantly more somatic symptoms than did patients with
rheumatoid arthritis or subjects without pain, and fibromyalgia patients
without a psychiatric history were no more likely to endorse somatic
symptoms than were arthritis patients or subjects without pain.
CONCLUSIONS: The Psychiatric Diagnostic Interview data failed to
discriminate in any major way between primary fibromyalgia syndrome (a
disorder with no known organic etiology) and rheumatoid arthritis (a
disorder with a known organic etiology). Therefore, these data do not
support a psychopathology model as a primary explanation of the symptoms of
primary fibromyalgia syndrome.
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