Fibromyalgia: heterogeneity in personality and psychopathology and its implications

Abstract

The fibromyalgia syndrome (FM) is a chronic widespread pain condition whose etiology remains unknown and no treatment has satisfactory levels of success. A metaanalysis has identified a distinct Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical profile between FM female patients and healthy controls, and differences between FM and other chronic pain condition with clear etiology have also been found. However, heterogeneity in this population has been suggested in several studies. We aim to assess clinical aspects in FM patients, based on personality psychopathology characteristics, in order to explore heterogeneity and the existence of core common aspects. In this cross-sectional study, a relatively homogeneous sample of 56 female FM patients (Mage = 45.95, SDage = 9.39) was assessed through MMPI-2. A K-Means cluster analysis identified two clusters, one (n = 24) with clinically significant levels in Negative Emotionality and Introversion scales. Subsequent MANOVAs identified important features of this cluster on several MMPI-2 dimensions. Moreover, several dimensions are clinically elevated in both clusters. In conclusion, the combination of psychopathological negative emotionality, interpersonal isolation, and low hedonic capacity, in a group of patients, has implications for the daily living and treatment of FM patients, and several core aspects of FM need to be addressed.

Suicidal Ideation Profiles in Patients with Fibromyalgia Using Transdiagnostic Psychological and Fibromyalgia-Associated Variables

“…Studies by Vincent et al [ 49 ] and Follick et al [ 50 ] have identified four subgroups of FM patients: two extreme subgroups with high vs. low scores on all variables and two subgroups with moderate physical symptoms distinguishable from each other by degree of psychological condition (high vs. low). Likewise, studies based on more specific aspects, such as the psychopathological dimensions of personality, found the existence of two subgroups differentiated mainly by the degree (low vs. high) of negative emotionality/neuroticism, aggressiveness, restraint (i.e., the degree to which behavior is limited by consideration of future consequences) and introversion [ 51 ]. In this line, Torres et al [ 52 ] found two subgroups of FM patients: one with a maladaptive personality profile (i.e., high predisposition to social distress, low positive affectivity, tendency to inhibitory behavior, less open to experience, low cooperative behavior, less proactive and with a tendency to maladaptive strategies for managing social conflicts) and another with scores in line with an adapted personality.…”

Perfectionism and Pain Intensity in Women with Fibromyalgia: Its Influence on Activity Avoidance from The Contextual Perspective

“…Nevertheless, among healthy people, maladaptive perfectionism has been associated with avoidance of physical activity [59]. Another finding that should be highlighted is that the direct effect of perfectionism on avoidance is significant, independently of the patient disease severity, therefore, its negative effects could be generalized considering the heterogeneity of the patients [38,55]. In this sense, perfectionism is shown to be a variable with a direct positive effect on activity avoidance when controlling for pain intensity and disease severity.…”

“…For this reason, acceptance and commitment therapy has been used [33,35] to reduce perfectionism and the associated symptoms. Previous studies have shown that there is an association between perfectionism and stress, poor mental health, reductions in functioning, and the frequency/intensity of pain and fatigue [36][37][38]. Particularly, perfectionism is associated with reductions in health functioning in women with fibromyalgia [37], mediated by behavioral disengagement processes, denial, and self-blame [29,30].…”

“…Finally, we expected that the moderating effect of perfectionism on the pain intensity would have a greater influence on avoidance behaviors in the high disease severity group because these patients maintain a high level of pain over time, which favors a greater goal conflict between the avoidance of pain [7,8] and the fulfillment of tasks relevant to them [32,35]. The findings might have important repercussions on the design of programs to improve adherence to physical exercise, attending to the heterogeneity of these patients [38].…”

“…Due to the heterogeneity and the differential profiles of fibromyalgia patients [38,41], the sample was divided into two groups according to pain severity as an indicator of disease severity. As has been pointed out, the use of pain as an indicator of the severity of the disease is supported by its diagnostic role in the criteria most used today [5] and its close correlation with the most current criteria [12].…”