The association among childhood maltreatment, somatic symptom intensity, depression, and somatoform dissociative symptoms in patients with fibromyalgia syndrome: a single-center cohort study.

Research demonstrates strong associations between childhood maltreatment and health problems that include dissociative symptoms and fibromyalgia syndrome (FMS). We assessed the associations among childhood maltreatment, somatic symptom severity, depression, and somatoform dissociative symptoms in all consecutive adult FMS patients of a tertiary referral pain medicine center between January 2010 and December 2011. Childhood maltreatment was assessed with the Childhood Trauma Questionnaire, somatoform dissociative symptoms with the Somatoform Dissociation Questionnaire, somatic symptom severity with the Patient Health Questionnaire-15 and depression by the Patient Health Questionnaire-2. A total of 117 patients (84% women) were included in the analysis, of whom 20.5% reported severe emotional abuse, 8.6% severe physical abuse, 12.8% severe sexual abuse, 25.6% severe emotional neglect, and 12.0% severe physical neglect in childhood and adolescence. On average, patients reported high levels of somatoform dissociative symptoms and moderate levels of somatic symptom severity and depression. Somatoform dissociative symptoms and emotional abuse were moderately correlated (r = .32). In hierarchical regression analysis, gender (p = .01) and somatic symptom severity (p < .0001) but not childhood maltreatment and depression were significant predictors of somatoform dissociative symptoms. Reports of somatoform dissociative symptoms by FMS patients might be attributed to their tendency to report multiple somatic symptoms.

Is the association of self-reported childhood maltreatments and adult fibromyalgia syndrome attributable to depression? A case control study.

OBJECTIVES: Systematic reviews of case-control studies demonstrated an association between self-reported childhood sexual and physical abuse and fibromyalgia syndrome (FMS). We tested in a case-control study if the association of self-reported childhood maltreatments in childhood and in adult FMS-patients is attributable to depression. METHODS: All consecutive patients diagnosed with FMS of two clinical centres were included into the study from January to June 2011. Randomly selected age- and sex-matched controls from a representative survey of the general German population were used as controls. Childhood maltreatments were assessed by the German version of the Childhood Trauma Questionnaire CTQ and depression by the two-item depression scale of the German version of the Patient Health Questionnaire PHQ-4. The scores of the five CTQ-subscales were compared between FMS-patients and controls using analysis of covariance adjusting for depressed mood. RESULTS: 153 FMS-patients (87.6% women; mean age 50.3 years) and 153 age- and sex matched participants of the general population were included. The comparison between FMS-patients and population controls, adjusted for depressed mood, demonstrated a significant group difference for emotional (p<0.001), and sexual abuse (p=0.01). Depressed mood fully accounted for group difference in physical abuse (p=0.01) and in emotional neglect (p<0.001). Depressed mood partially accounted for group difference in emotional abuse (p<0.001), but did not account for group difference in sexual abuse (p=0.10). CONCLUSIONS: Reports of FMS-patients some on childhood maltreatments were biased by depressed mood. However, the difference in self-reported childhood sexual abuse between adult FMS-patients and population controls was not attributable to depression.