Coping styles in fibromyalgia: effect of co-morbid posttraumatic stress disorder

To analyze coping styles of Wbromyalgia (FM) patients with speciWc emphasis on diVerences in coping styles between Wbromyalgia patients with and without post traumatic stress disorder (PTSD). Seventy-seven consecu- tive patients (40 women and 37 men) who fulWlled ACR criteria for FM, and 48 healthy controls, completed ques- tionnaires measuring prevalence and severity of PTSD symptoms, including the structured clinical interview for DSM-III-R—non-patient edition (SCID-NP) and the clini- cian administered PTSD scale (CAPS). Subjects were divided into two groups based on the presence or absence of PTSD symptoms. Subsequently, coping styles were mea- sured using the Albert Einstein College of Medicine (AECOM) Coping Style Questionnaire. Student t tests were used to compare the means of quantitative variables, and proportions were compared by Chi square tests. Analysis of variance (ANOVA) was used to compare the scores of the FM patients with and without PTSD, as well as to estimate the eVect of gender on psychiatric variables. FM patients exhibit signiWcantly higher levels of suppression (P < 0.00001), help-seeking (P < 0.007), replacement (P < 0.003), substitution (P < 0.002), and reversal (P < 0.004) compared with healthy controls. FM patients with PTSD and without PTSD diVered signiWcantly only on the suppression subscale (P < 0.02). FM patients that have PTSD presented higher suppression scores compared to FM patients without PTSD. No signiWcant diVerence was noted on scales of minimization, help-seeking, replacement, blame, substitution, mapping, and reversal. Our results have delineated coping patterns of FM patients, identifying suppression, help-seeking, replacement, substitution and replacement as strategies more common among these patients. We further identiWed suppression as the only cop- ing style signiWcantly more common among FM patients with co-morbid PTSD then among FM patients without such a diagnosis. Our results may serve to further character- ize cognitive and behavioral aspects of FM patients and subsequently guide therapeutic interventions.