Women with fibromyalgia (FM) experience more difficulty integrating their thoughts, feelings and memories, known as dissociative symptoms, than healthy women or those with other rheumatic disorders, a study shows.
Although very few fibromyalgia patients in the study were likely to have a mental dissociative disorder, results suggest that the symptoms connected to the condition are particularly prevalent in these patients and may be linked to the “fibro fog” experienced by many of them.
The study, “Fibromyalgia and dissociative symptoms,” was published in the journal CNS Spectrums.
Many patients with fibromyalgia complain of cognitive difficulties, commonly described as fibro fog or brain fog. This condition can manifest in different ways, but common complaints include difficulty in keeping up with conversations, concentrating, and remembering things.
While the origin of fibro fog is still up for debate, some researchers believe it could be at least partially related to a dissociative disorder (DD) — defined as sense of disconnection among one’s thoughts, feelings, consciousness, and memory.
Common symptoms of DDs include memory loss; a sense of being disconnected from oneself; inability to cope well with stress, depression, anxiety; and suicidal thoughts.
However, scientific evidence supporting a link between DDs and fibromyalgia is contradictory.
While some studies report a high prevalence and an increased risk of dissociative symptoms in patients with fibromyalgia, others found a low prevalence of such symptoms.
To shed light on this matter, researchers conducted an observational study to determine the association between fibromyalgia and dissociative symptoms.
They compared three groups of female participants: 31 healthy individuals used as controls, with a mean age of 58; 33 patients with rheumatic disorders, with a mean age of 57; and 35 patients with fibromyalgia, with a mean age of 56.
The degree of dissociative symptoms was determined across the groups by the Dissociative Experiences Scale (DES), a patient-reported questionnaire, ranging from 0-100. It consists of 28 questions about the person’s experiences on a daily basis, and how often they happen. The DES is not a diagnostic instrument but intended for screening purposes only.
The study showed that, on average, women with fibromyalgia had slightly higher DES scores than the control and rheumatic groups, reflecting a somewhat increased prevalence of dissociative symptoms.
But those patients who were taking antidepressants (duloxetine, brand name Cymbalta) or chronic pain medications (pregabaline, brand name Lyrica) reported fewer of these symptoms than those not on these medications.
Although in general, fibromyalgia patients reported more dissociative symptoms, only two of the 35 had a score higher than 30, which is high enough to suggest the presence of a dissociative disorder.
Early trauma, post-traumatic stress syndrome, and victimization seem to be associated with dissociation, and patients with fibromyalgia have a high rate of lifetime trauma as well.
“Patients with FM had higher scores, which might be related to the association of dissociative experiences, lifetime trauma, and victimization,” the researchers wrote.
“Antidepressants might have some role on dissociative symptoms” they said, adding that these medications “seem to have some effect on the severity of their dissociative symptoms, albeit their primary effect on pain.”
However, psychotherapy interventions, adjusted for the type of symptoms a patient is experiencing, are the treatment indicated for dissociative manifestations, according to them.