Tender points or tender patients? The value of the psychiatric in-depth interview for assessing and understanding psychopathological aspects of fibromyalgia

Abstract

Although the aetiology of fibromyalgia is still unexplained, evidence favouring the role of psychopathology is accumulating, at least in a subgroup of patients; however, the exact aetiological significance of psychopathology in this syndrome is difficult to assess. Various assessment strategies have both strengths and weaknesses. Two case reports are presented which illustrate the value of the psychiatric in-depth interview (including psychodynamic-biographical history taking) for assessing and understanding psychological/psychiatric aspects of fibromyalgia.

Daily Hassles Reported by Chronic Fatigue Syndrome and Fibromyalgia Patients in Tertiary Care: A Controlled Quantitative and Qualitative Study

“…CFS/FM patients’ preoccupations may, notably, reflect deep disappointment and frustration about their failed strivings for physical or mental achievement, as well as approval from others. Such strivings – which have been described as a central theme in the illness narratives of CFS/FM patients [37]– may be psychodynamically linked to personality factors, such as a vulnerable self-esteem [38, 39, 40], narcissistic or perfectionistic tendencies [41, 42]and, not uncommonly, early victimisation experiences [14, 15]. …”

Are childhood adversities relevant in patients with chronic low back pain?

“…Although the relevance of biographical data was underlined (Van Houdenhove et al ., 1994), the most telling criticism of retrospective studies on childhood adversities, and thus to the present as well as to Schofferman's study, is that recollection is biased. This was examined in some studies on patients with a depressive disorder assuming a possible confounding effect of present mood on memories of the past (Lewinson et al ., 1980; Parker, 1981; Robins et al ., 1985; Kendler et al ., 1991; Bemporad and Romano, 1993; Van Houdenhove et al ., 1994). These studies demonstrate a tendency for more false‐negative than false‐positive results regarding childhood adversities.…”

Untitled

“…I am of the opinion that the European Journal of Pain should give space to these authors and, moreover, encourage interdisciplinary communication and collaboration between empirical/experimental (e.g. neurobiological or behavioural) investigators and those trained to analyse 'meaningful connections' in the patients' narratives (Slavney and McHugh, 1984;Van Houdenhove et al, 1994). Evidently, studies of the latter should meet classical standards of validity and reliability.…”