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Women Developing and Maintaining Fibromyalgia: Qualitatively and Quantitatively Appearing Dissociative and Self-Loading Psychological Patterns

Chapter in book
Authors Kerstin Wentz
Annika Dahlgren Sandberg
Published in In F. Hu (Ed). Pain Research Progress:Migraine, Fibromyalgia and related pain
Pages 71-111
Publisher Nova Publishers
Place of publication New York
Publication year 2008
Published at Department of Psychology
Pages 71-111
Language en
Keywords fibromyalgia, psychosomatic, qualitative data, psychometric instruments, dissociation, repression, activity, self-loading, self-regulation
Subject categories Applied Psychology

Abstract

Aims: The overall aim of this study was to describe psychological functioning in women developing and maintaining fibromyalgia. A further aim was to test if women with fibromyalgia and women with organically explained long-lasting pain differed on selected psychometrical instruments. In this study creation, selection and use of inventories were based on theoretical formulations from in depth interviews with 21 women diagnosed with fibromyalgia. These formulations included difficulties handling affects and stimulation in adult life before onset of fibromyalgia. Psychological vulnerability was compensated for through pronounced helpfulness and dissociation/repression including intense activity. The state of fibromyalgia meant continued high levels of mental load such as difficulties due to the self-structure, impaired cognitive functioning and somatic symptoms. Methods: From previously naturalistically generated theory the I Myself Scale (IMS) was constructed to mirror self-regulation in adult life prior to onset of fibromyalgia symptoms. The IMS was complemented with an instrument on current self-regulation: Structural Analysis of Social Behaviour (SASB). The result of the psychometrical testing was elucidated by a determination of sample characteristics regarding physical functioning, bodily pain and other dimensions of health related quality of life. A standardized instrument, SF-36 was employed. The groups were compared using analysis of variance, principal components analysis paired with discriminant analysis and profile analysis. Results: Psychometrical testing confirmed qualitative data patterns of self-regulation connected to development and maintenance of fibromyalgia. Prior to onset of symptoms women with fibromyalgia showed contrasting self-regulatory measures as a pattern of impaired self-reference/understanding of health needs. Strategies of dissociation or repression including intense activity and self-loading were used to avoid mental pain. Others were urgent objects of help and assistance but were not asked for help and advice. SF-36 indicated that the two groups experienced similar quality of life in the physical dimension but less psychological well being on behalf of the fibromyalgia group. The result from SASB showed that women with fibromyalgia experienced a higher level of mental “load” than the other pain group. Conclusion: Qualitative data indicated that life prior to onset of fibromyalgia and current fibromyalgia held qualities of impaired self-regulation in relation to mental load. Quantitative data patterns confirmed qualitative results on impaired self-protection before onset of fibromyalgia and a specifically high level of mental load during the state of fibromyalgia. Based on the result, relationships between self-regulation, development and maintenance of mental overload and generalized pain are discussed. Aspects of psychological and psychosomatic disregulation are discussed and hypothesized to cause but also later in the process to parallel alterations in somatic homeostatic functions. Consequences for treatment are suggested.

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