Psychiatric Comorbidities in Fibromyalgia: A Comparison With Chronic Conditions and Healthy Controls

Abstract

Introduction: Fibromyalgia is characterized by chronic widespread pain and psychiatric comorbidities, but robust comparative data remain limited.

Methods: This retrospective cohort study compared psychiatric diagnoses and medication use among matched groups with fibromyalgia, chronic pain, chronic fatigue syndrome, rheumatoid arthritis, and healthy controls (total N=5,040), using data from a large national health care provider.

Results: Psychiatric disorders were most prevalent in fibromyalgia, followed by chronic pain, chronic fatigue syndrome, rheumatoid arthritis, and healthy controls. In fibromyalgia patients, anxiety (55.1%) and depression (48.7%) were predominant, accompanied by extensive medication use. Notably, fibromyalgia showed exceptionally high relative risks for Cluster B personality disorders (RR=34), personality disorders overall (RR=24), and PTSD (RR=22.75).

Conclusions: Fibromyalgia patients experience significantly elevated psychiatric comorbidities compared with other chronic conditions. Comprehensive and integrated multidisciplinary care strategies are necessary to address the distinct psychiatric burden associated with fibromyalgia. This study extends prior work by directly comparing fibromyalgia to other chronic conditions and identifying distinct psychiatric risk patterns in a culturally diverse national cohort.

Keywords: Fibromyalgia; chronic fatigue syndrome; chronic pain; psychiatric comorbidities; rheumatoid arthritis.

FIGURE 1

Comparison of psychiatric disorders by subject population. (A) The prevalence (%) of key psychiatric disorders in each of the five groups—fibromyalgia (FM), chronic pain (CP), chronic fatigue syndrome (CFS), rheumatoid arthritis (RA), and healthy controls. (B) The corresponding relative risks (RR) on a logarithmic scale, with the healthy control group serving as the reference (RR = 1.0). Higher bars (A) reflect a greater proportion of individuals meeting criteria for each disorder, whereas values above 1.0 (B) indicate elevated risk compared with healthy controls.

FIGURE 2

Comparison of psychiatric medication usage by subject population. (A) The prevalence (%) of psychiatric medication use (e.g., antidepressants, anxiolytics, and antipsychotics) in each of the five groups—fibromyalgia (FM), chronic pain (CP), chronic fatigue syndrome (CFS), rheumatoid arthritis (RA), and healthy controls. (B) The relative risks (RR) of medication usage on a logarithmic scale, using healthy controls as the reference group. Bars above 1.0 (B) represent increased likelihood of medication use in that group relative to healthy controls.