Research Brief
For decades, the medical community has debated whether fibromyalgia always involves psychological disorders. Now, a new study suggests that 2 distinct subsets exist; type I does not involve psychological disorders, while type II does.
Researchers found that a distinct group of fibromyalgia patients, the type IIs, exhibited high emotional distress in multiple areas. Scores were above the cutoff level for diagnosis in 3 areas:
- Somatization
- Obsessive-compulsive behaviors
- Depression
Other areas with scores above average but below diagnostic levels included:
- Interpersonal sensitivity
- Anxiety
- Hostility
- Phobic anxiety
- Paranoid ideation
- Psychoticism
By contrast, type I patients' scores were entirely within normal parameters for psychiatric health.
In type II only, emotional status could predict the level of current pain.
Researchers say several things generally attributed to the entire fibromyalgia population - such as psychological distress and maladaptive emotional responses - may only be accurate of type II.
My Thoughts
First, it's a relief to see that researchers are looking at differences in psychology when it comes to us. This could be the start of convincing many health-care professionals that we're not all depressed. For those who do have overlapping psychological disorders, it could be helpful to have a longer list of possibilities to explore than just the standard assumption of depression and maybe anxiety.
This type of subgrouping could do a lot for helping us find appropriate treatments. Fibromites know this is not a one-treatment-fits-all illness, and doctors need to learn that as well.
One thing I find especially interesting about this study is that I have a close family member who's tentatively diagnosed with fibromyalgia and has been diagnosed with most of the psychological conditions listed above. Meanwhile, I have a fibromyalgia diagnosis but no psychological comorbidities. It would seem we each fit into a different subgroup.
So why would some of us have these overlapping conditions and others wouldn't? It could be that neurotransmitter dysregulation is more severe or widespread in type I, as many of the neurotransmitters linked to fibromyalgia also are tied to psychological disorders.
I'd like to see this line of research continue and look into the backgrounds of type I vs. type II patients. My guess is that those with a history of child abuse, which is a known risk factor for fibromyalgia, are more likely to end up with type I. Also, in type I, I think we need to look at whether certain psychological illnesses are a causal factor -- are they actually leading to type I fibromyalgia?
Knowing the background of the relative I mentioned, I'd put money on her having fibromyalgia as a direct result of 40+ years of obsessive-compulsive disorder, depression, anxiety and phobias. All of these were undiagnosed and untreated until she was nearly bedridden and utterly unable to function.
Meanwhile, I think my lifetime of insomnia was a major contributor to my fibromyalgia. And here's an interesting fact -- serotonin dysregulation is implicated in every one of these problems, which are prevalent in my family. I think I was just fortunate to have it in different areas of the brain, where it favored physiological traits instead of psychological ones.
The Stigma of Psychological Illness
I've said this before, but it bears repeating. I think this is one of the things that our society really needs to understand: when it comes to the brain, the line between physical and mental/emotional is pretty much an arbitrary one.
It's a difficult concept, but it's true. Your thoughts and emotions cause a chemical changes in your brain. Your brain chemistry then influences the thoughts and emotions that follow, which in turn have their own impact on the chemistry.
Things like medications and supplements can cause changes to brain chemistry, which can change the way you think and feel and look at the world. Psychological counseling can have the same effect by taking the reverse approach, because changing the way you think and feel and look at the world changes brain chemistry.
Look at it this way: the same neurotransmitter, dopamine, plays a key role in both Parkinson's disease and schizophrenia. No one would argue that Parkinson's is psychological. Schizophrenia is considered psychiatric because it effects behavior and emotional states, but its roots are physiological.
We need to recognize that mental illness is no more a "fault" or "weakness" than degenerative brain disease, cancer or arthritis. It's simply the result of your genetic makeup combined with environmental factors, and those environmental factors come from everything you experience in life, physically, mentally, emotionally and spiritually.
So yes, some people with fibromyalgia have comorbid psychological disorders. Some of us have other pain conditions or multiple sleep disorders. It's a fact, not a judgement, and not something to be ashamed of. It's simply another illness that needs to be diagnosed and treated.
OK, I'm stepping down from my soapbox now.
Which type of fibromyalgia do you think you have? For those with lots of fibromyalgia in the family, do you have cases of both types in people close to you? Do you think subgrouping like this will help with diagnosis and treatment? Leave your comments below!
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I’m kind of confused about the “type 1″ and “type 2″. I think possibly there might be typos in article? If not could someone explain “My guess is that those with a history of child abuse, which is a known risk factor for fibromyalgia, are more likely to end up with type I. Also, in type I, I think we need to look at whether certain psychological illnesses are a causal factor — are they actually leading to type I fibromyalgia?”
I thought type 1 was no emotional disorders?
And of course, research like this concerns me. I can see where type 2 will be considered “garbage can” along with all other mental health disorders and type 1 will be considered an actual disease eventually.
I was thinking the sam
Sorry my computer went crazy, I was sexually and emotionaly abused as
I agree. As I’ve stated before in these discussions, we need to be careful when blaming illnesses on psychology and abuse. Considering 1 in 3 women have been abused (this stat can vary depending on type of abuse) and that these illnesses mostly affect women, it’s not going to be unusual that women with these illnesses have experienced abuse but it does not mean it’s the cause of these illnesses. I could say that because the majority of women drive a certain color car and so many of them have been abused we can conclude… THAT’S JUST RIDICULOUS. There’s correlation and then there’s proof. 2 very different things.
I agree, Kathy. Some typos, some confusion, also in the segment “…No one would argue that Parkinson’s is psychological. Schizophrenia is considered psychiatric because it effects (affects?) behavior and emotional states, but its roots are physiological.” I guess I’m the one that would argue that Parkinson’s is physiological rather than psychological. I agree that schizophrenia is psychiatric, as it is physiologically based (via imbalances in neurotransmitters) and thus presents with emotional/behavioral (psychological) symptoms. As Adrienne points out, “your thoughts and emotions cause chemical changes in your brain. Your brain chemistry then influences the thoughts and emotions that follow, which in turn have their own impact on the [brain] chemistry.” It is often difficult to discern which comes first.
I read it 3 tiimes as I usally have to, there’s only 1 typo and you can guess what she ment.
I believe you have come across a good point. I’m would bet I’m a type 2, I deal with emotional pain as bad as the body pain. Childhood abuse and neglect caused a few years of unhealthy living. Learning the name of my problem in 97 along with a Doctor who was as passionate to learn about it as I was is wonderful thing. I really didn’t want to see a psychologist at the time, so Doc and I talked, increased meds when life took me down and decreased when needed. I kept track of my moods and let him read them.
I have family members who are fibromites also. We are all different in our disease. A really good understanding Doctor and understanding family makes a world of difference.
Oh, this reminds me of a study I wrote about just over a year ago from the University of Washington Department of Anesthesiology and Pain Medicine, lead by Dennis Tuck, PhD.
They created 3 fibromyalgia subgroups: dysfunctional, adaptive and interpersonal. It sounds like their interpersonal group is much like your study’s group type II. Although I’m not sure how the other two groups compare to your study’s group type I.
Subgroups of fibromyalgia are one of those topics that really excite me – I can’t wait to see where research takes us.
I do beleive there are sub types. I hear of thosee who can barely get out of pain and hardly function. I feel so bad for these people as I have fibro amoung other issues yet work. I too was abused as a child and unfortunatly have a lot of family stress. I do have support from hubby. I know I couldnt make it without my meds.. I see to many variations in degrees with fibro. I do believe bad emotions is a part of fibro 2. As being stated. There are just to many testimonies.
The limit to doing any good research on “fibromyalgia” is that it is such a broad term, like “chest pain”. Chest pain can be caused by heart disease but also by acid reflux and anxiety. Thus, any research on “chest pain” is going to show different results based on the different causes. High cholesterol only relates to chest pain due to heart blockage. Researchers MUST start unraveling the many causes of fibromyalgia, for example, those with a thyroid dysfunction may have more anxiety, whereas those with an infectious cause may have chemical sensitivities. Most of the research is meaningless until we break down a more accurate group of causes. It is imperative that more funding be given to researching this illness.
I’ve had FM and CFS for many years. If you’d mentioned those subsets a couple of years ago, I would have said that I fit into the physical only group. At the moment I feel more like the other group. I really think that if you have FM long enough you will go through many changes and probably go in and out of the different groups.
Just what I was trying to figure out how to express mindy! I cooked my first Thanksgiving dinner in years yesterday and my fibro fog is working overtime! I think you hit it just right. I could see myself in both types at different times in my life and don’t think it’s a matter of either / or !
I am very excited to see this as well. I am definitely a Type II. I’ve always suffered from depression, anxiety…you name it, if it an emotional trait, I have it. I have been diagnosed with fibro, CFS, severe depression, anxiety and GERD. I also have sleep issues and have all my life. I have always felt there were levels of fibro because I don’t have flares, I always hurt. But I know others who have it and they still work, they talk about having a flare and they can take aleve or ultram and that’s all they need while here I am on major medicines, muscle relaxers, anxiety reducers, antidepressants. And I still hurt. It doesn’t make it stop, it just makes it so that I can stand it enough to accomplish minor things. But, most of the time, I’m not far from my bed. I won’t travel anymore because it’s so hard on my body, I get overwhelmed if I have to go somewhere because I have to make myself have the energy to get up and go. I fall all the time and have fallen down stairs so I have a cane if I need it. And I also have a wheelchair now at least so that I can be pushed around when possible. I find that a lot of the people that have it mildly are not understanding or compassionate to those of us like me and then there are still so many doctors, judges, and people who still don’t even believe it at all. I kinda think that is why it is used as a wastebasket diagnosis because every case is different.
Debra, yes I agree totally! Your description could be written by me. I think I was born with insomnia and depression as I can’t remember when I didn’t have those and more. I also had 5 c-sections by the time I was 21, a total hysterectomy by the time I was 30 & was in a car accident. Those are just some of the things in my history that I’ve read are stressors that can cause FM. I also have one son and one daughter I’m sure have FM, one Type I & the other Type II.
I’ve noticed it seems like I get worse by the year even though it’s thought Fm isn’t progressive I think it will be found that’s incorrect at least in some cases.
I’m sorry your suffering so much and know how hopeless, isolated and useless you may feel some times. I do understand what you live with on a daily basis and you deserve a lot of respect and credit for having the strength and courage to wake up and try to have a life each and every day!
Gentle Hugs!
I am 60 yrs old and have had insomnia, anxiety, depression and chronic pain (migraines, growing pains etc) since I was a small child,some of these since birth. After a car accident when I was 20 everything got worse. I was finally diagnosed with fibro in 1996, until then the focus was always on my emotional problems. So….I am happy to see this research as I am sure many people with anxiety and depression are misdiagnosed and the Fibro is missed. It really helped me to know that I wasn’t “crazy”.
Wow you have written about me. I have pain all the time nothing seems to ease it, have had depression for years so looks like I’m type 2 well just diagnosed with type 2 diabetes so lets just keep names the same.
Ahh it sort of like the chicken or the egg theory,how many symptoms came before or after the fibro.
I think the missing link to what causes FMS might be found in researching the MEN who have it!!!! Logically, there MUST be a reason why 95% of Fibromites are women…so researchers must start with those RARE MEN diagnosed with this disorder. What do they have in their makeup that most of the women have? Look for clues in their neurotransmitters and medical symptoms. Why do most men NOT get FMS, yet they have OCD and need seretonin?
True that many women have been abused as children; I read that 1 in 4 of us have been abused in some way…so maybe child abuse ISN’T even a possible cause of FMS. Being abused does make the nervous system overly sensitive and we can feel all stimulus more. Are the MEN diagnosed with FMS are overly sensitive?
That’s a good point Annette. My thought on that is that most women are attempting to think and do several things at any given time. Men don’t seem to be the same. Maybe we overwork our brains and nervous systems.
Actually there has to be a genetic link also or most women would have FM.
I’ve also read that men don’t feel pain as strongly as women do. Maybe more men have FM than we realize but don’t have quite the same symptoms as we do. Just a thought.
Seems to me that men tend to under-report both physical and psychological distress, probably due to social stigma, that fear that they may be judged as ineffectual or weak.
I think type 1 and type 2 make total sense. It could be that the extreme emotional issues and the pain cause the most decrease in quality of life. I notice when my pain and fatigue get really bad, I then have a major depressive episode that lasts a very long time. The extreme hopelessness due to both depression and pain also causes suicidal feelings.
I think I’ll remain guarded regarding this research. I can see where it could be easily abused by some doctors, family, friends, the public — as a way to take away the legitimacy of having FMS with the one subset with psych issues. You said it yourself — there is a stigma associated with pysch conditions. And I fear that might weigh more heavily against those put into that subset with them — as a blockage to proper treatment for pain and other non-psych symptoms.
I suffered from depression, anxiety, PTSD, and agoraphobia after I was diagnosed with FMS — but amazing thing — it all cleared up when I FINALLY received proper pain management.
I also question then what does this say about those who did not have any psych issues before FMS — had depression and anxiety for a time after – but recovered from those ailments — what subset would they fall under?
Adrienne,
I could hug you for this article! Not because of the sub-grouping (I know you didn’t come up with that) but because of the way you explained “The Stigma of Psychological Illness”! I loved the way you compared schizophrenia and parkinson’s. Thank you for continuing to write about relevant topics for us! You are a godsend!
Interesting.. I’d love to learn what’s behing the Fibro in group I patients! I always thought there must be an emotional element to this illness. I myself recovered from CFS using mind-body healing techniques and am completely well now.
I’m confused, if someone suffered child abuse, I would think they would be in the Type II group.
I have been emotionally, sexual
i am a lot like what lauren wrote about. agoraphobia started about 34 yrs ago, fms started about 17 years ago. and just for fun, i mixed in ocd, major depression, suicidal thoughts, panic attacts, etc etc. i, too, am concerned about being singled out by docs cuz of ‘head’ issues. i’ve suffered enough grief at the hands of doctors.
To this day I have never ever believed in any phycological studies in this condition and this is only all part of their plan to push the illness towards mental categories and that is there goal for 2013 which will never happen! People do not go from being in complete controls of their lives to come down with some type of flu like illness and be changed for life…Anytime whether that be a virus or other type of infection or possible something gone wrong in the endocrine system of a hormonal imbalance this would disrupt the central nervous system and put everything out of whack…These researchers are looking at a damaged motor vehicle scene of an accident and to this day no-one has been able to identify and cause and everyone just assumes…these are all just myths and next week or next month someone else will have a different theory as to a link or causal factor…If all these theories proved anything then people would be recovered or leading productive lives…Also anyone who i have spoken to about the illness have all agreed anti-anxiety drugs or anti-depressants make people worse and a high majority of bed ridden individuals are definitely over medicated with these useless dangerous medicines…I have tried these routes at lowest doses in the past and never ever again will I ever venture them as cannot tolerate then whatsoever…The only relief I have had is steroid medicines and/or antibiotics…I am grateful to be followed by a good team of endocrinologists and as mentioned my cortisol was at I believe 437 months back and this past wednesday I underwent another a.c.t.h. injection and await those further results and more pituatary testing to see if I am to go back on steroids again or continue without them and once i know these latest measurements I will post them here…
i dont belive fibro is cause by depression,stress its the other way around,because how it effects the body that were u get the depression and stress,ive had it over 25 years did alot of research like i mean alot,and the doc and the sienceist both say that,i find the ones that say that or put a paper out on it,are those kind of doctors ,that treat depression,so they get patients going back to them,and i have been to them,and the last one told me that my and if iwas depress because of my fibro and the pain it brings with its burdens,,
Very interesting post! My mother (RIP) had childhood abuse, etc, suffered from bipolar, depression,etc all her life, as well as years of unexplained pain, and a very bad marriage to boot. When she was in the final stages of emphysema, one new Doc felt she had Fibro, in reference to her body pain. I knew that for a long time, as I was diagnosed with Fibro in 1994, and was well aware of all the symptoms. My mother would never consider that Fibro was a real disease or diagnosis. This post interests me because I have also suffered from childhood emotional abuse (father), and most of my 4 sibs suffer from either bipolar or depression or anxiety. Very complicated stuff! I am currently on no meds, sleep ok, etc, but did retire 3 yrs ago, sleep is better when you don’t have to get up to an alarm. But I do suffer from anxiety, etc, and just came off 7 yrs on Celexa. Doing ok for the most part, manage pain with yoga, relaxation, lots of walks.
Thanks for this post, will stay tuned!
What an awesome article. I was reading this during one of my typical bouts of insomnia!
It really affirmed for me, the impact of stress on the body, perpetual stress plays havoc on the central nervous system and the body and continually being on high emotional alert takes it’s toll. I had PTSD and anxiety prior but always had high energy and managed my life well. After I got married had two babies 9months apart whilst dealing with a husband who is an unstable emotionally immature addict… Well one day I went to bed really tired and couldn’t get up for months! I felt like I was drunk every morning I woke up, dizzy weak unable to sleep, suddenly allergic to things I’d eaten all my life, crippling pain, weakness in my arms and legs dizziness beyond belief… I got better after about a year and manage more now, but this illness can be terrifying and debilitating!! If the body doesn’t get to recover from stress or have appropriate rest how should we expect to feel and day in and day out of days where your confined to bed would drive anyone crazy! Avoid stress people’s be kind to yourself I’m feeling you <3
The way I’ve best come to understand things stems from something my psychologist said:
“You hurt, and you’re tired all the time. Who wouldn’t be depressed?”
To me, that’s just common sense. Doctors need to focus on helping and leave any “blame” out of it. Sometimes slapping a label on something ends up restricting patients from accessing treatments that might reduce symptoms which will also reduce psychological reactions to symptoms!!!! I left one of my docs behind when he stopped offering me treatments that were geared toward helping me sleep or reducing pain… Instead he started only offering anti-anxiety medication and anti-depressants. He withdrew the offer to let me try Lyrica or to switch to a different muscle relaxant.
I understand that anti-depressant medications can have beneficial effects… but they should not be chosen exclusively!
Darnit, un-treated pain and fatigue would make anybody feel emotionally distraught. Where’s the common sense?
And, why is fibro different? You’ve got stuff like cancer and heart attacks, and they’re treated as “biological illnesses” but yet, a lot of people with cancer or heart issues become depressed as a result of living with their illness.
You picked a great topic. I feel very strongly about it, and someone who hasn’t lived with these illnesses can be downright ignorant to the challenges of living with a chronic disease.