2005, Number 6
Fibromyalgia: A functional somatic symptom or a new way to conceptualize hysteria?
Barrera VMI, Cortés SJF, Guerrero MH, Aguirre GA
Full text
Language: Spanish
References: 34
Page: 41-50
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ABSTRACT
During the decade of 1880, Paul Briquet made a well detailed description of a syndrome named after him, characterized by a series of unexplainable medical symptoms that appeared in a hideous way, with clinical curse and without the paroxysmal seizures mentioned by Charcot in his description of hysteria. Nevertheless, all the patients that showed these symptoms were diagnosed as hysteric. Nowadays, the clinical scenery is substituting the term of hysteria in favour of its components and giving it different names such as dissociative disorder, conversive disorder, and disorder caused by somatic symptoms of somatoform. Other terms such as “functional somatic syndrome” or “medically unexplainable symptoms” have been added to the list. In spite of these denominations no explanation has been given to the etiology of hysteria.Each medical specialty has to contend with some functional somatic syndrome: gastroenterology presents irritable colon; cardiology, precordial pain; neurology, tensional cephalalgia; stomatology presents tempomandibular dysfunction, and ginecology, chronic pelvic pain. Lumbar pain is present in orthopedia, chronic fatigue in cases of infectiousness, and finally, in rheumatology, there is fibromyalgia. In spite of their differences, these symptoms have some likenesses: they are associated to depression and anxiety, and have a high co-morbidity with personality disorders; patients show major emotional distress, they share stories of either psychological, physical or sexual abuse during childhool, and suffer from some type of chronic pain. Although having visited several specialists in their search for explanations and treatment, results have been poor and patients have been labelled, in a pejorative way, as hysteric or hypochondriac. When diagnosed with any of these syndromes, patients’ stress is reduced while having to face the invisible, uncontrollable and unpredictable fact implied by suffering from the symptoms that are typical. In particular, fibromyalgia assembles all the characteristics mentioned above. Turk and Cathébras proposed that establishment and exacerbation of the main symptoms of fibromyalgia (pain and fatigue) still constitute and model of respondent conditioning and that repeated exposure to certain stimulus generalizes learning. Also, they affirm that the same symptoms create later a cycle that perpetuates fibromyalgia. Once that symptom have been installed and strengthened, patients avoid all kind of activities, they get involved in legal procedures to obtain leave or else, they look for labour prerogatives. Besides, patients with fibromyalgia show the classic behaviour described for hysteria: “belle indifference”, secondary advantages, dramatizing, blaming for their sufferings events which are out of their daily routine, and scarce tolerance. The purpose of this study is to present quantitatively, in patients diagnosed with fibromyalgia, the following agents: symptoms severity, prevalent personality, co-morbidity with personality disorders, and degree of severity of depression and anxiety. Qualitatively, we wish to demonstrate the presence of the cycle that sustains the given symptoms.
Participants: Ten patients with fibromyalgia participated in our study, 9 women and 1 man, diagnosed according to the criteria of the American College of Rheumatology, aged 37.9 ± 8.8 and with a medium time of evolution of 3 (2-23) years. Quantitative variables: Physical status and syndrome’s severity were assessed using the Fibromyalgia Impact Questionnaire (FIQ); for personality, disorders were evaluated with the Revised Personality Diagnose Questionnaire (PDQ-R); depression, with Beck’s Inventory, and anxiety with Spielberger’s Trait State Inventory.
Qualitative theoretical focus: Life experiences narrated by patients in their daily record of events, emotions and thoughts associated with pain, are presented.
Procedure: All patients were evaluated individually at the beginning of a cognitive behavioural intervention. Qualitative data was obtained from daily records kept during at least three weeks or a maximum of 12. Texts were transcribed and the words most mentioned were identified, as well as those scarcely reported, thus propitiating descriptive categories.
Results: The American College of Rheumatology established as one of the diagnose criteria for fibromyalgia, the presence of al least 11 of a total of 18 hypersensitive sites. Patients presented in average 16.3 ± 2.5 painful sites. Incapability was measured by patients in 2.3 ± 2.2 in a scale of 0 to 3 points; they reported to have felt well 1.1 ± 1.2 days per week; they didn’t work 1.0 ± 1.1 days per week. The following measures are reported in scale from 1 to 10 points. Laboural interference was calculated in 7.3 ± 2.3; intensity of pain was 8.1 ± 1.4, day long fatigue, 8.4 ± 1.9, morning fatigue was 8.5 ± 2.3. Rigidity was 7.5 ± 3.0; anxiety perceived, 7.5 ± 2.6 (FIQ), and anxiety state along 12 weeks was 38.5 ± 10.3. Anxiety trait during the same period was 50.9 ± 9.7; perceived depression, 6.9 ± 3.4 (FIQ), and cognitive depression 14.7 ± .5. In the scale of personality it was found that six patients reached punctuations higher than T60 in neuroticism, and two other punctuated below T40 in extroversion. Regarding personality disorders it was found an average for 1.8 ± 1.1 disorders per patient; those more frequent were the following: histrionic (4), borderline (3), passive aggressive (2) and schizoid (2). Qualitative data support the existence of the typical symptoms described for hysteria.
Conclusions: According to the results obtained from the quantitative analysis of this group of patients with fibromyalgia, we can conclude that they suffer from a disorder that generates major incapability accompanied of pain and fatigue. Nevertheless, their personality characteristics show that they have high levels of neuroticism with presence of personality disorders and at the same time important levels of depression and anxiety, predominating in the former, anxiety as a trait. Manifestations described by patients in their daily record of events, emotions and thoughts associated with pain and fatigue, confirm the presence of the classic symptoms that typified the construct of hysteria. These patients are vulnerable to their surroundings, have a story of childhood sufferings, and assumed an adult role from a very early age. Symptoms appear to be the only mechanism which at a given moment in life allowed them to get rid of the responsibilities that burdened them from childhood. Unfortunately, this symptom was associated to their environment, according to the laws of learning. It is concluded that fibromyalgia, as nosologic entity accomplishes the characteristics of hysteria, although as etiology it is established by learning.
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