Participantes:

Participaron 10 pacientes, 9 mujeres, 1 hombre, con fibromialgia según los criterios del Colegio Norteamericano de Reumatología.

Variables cuantitativas:

Estatus físico y severidad del síndrome, personalidad, trastornos de la personalidad, síntomas depresivos y ansiosos.

Foco teórico cualitativo:

Se presentan las experiencias de vida narradas por los pacientes.

Procedimiento:

Todos los pacientes fueron evaluados, en forma individual, al inicio de una intervención cognitivo conductual. Los datos cualitativos se obtuvieron de un registro diario durante al menos tres semanas con un máximo de 12 semanas. Se empleó estadística descriptiva.

Resultados.

Los pacientes presentaron en promedio 16.3 ± 2.5 puntos dolorosos. Los resultados de los instrumentos aplicados indican la severidad de la enfermedad. Los datos cualitativos apoyan la existencia de los síntomas típicos descritos para la histeria.

Conclusión.

De los resultados obtenidos del análisis cuantitativo de este grupo de pacientes con fibromialgia, se puede inferir que padecen un trastorno que les genera gran discapacidad, acompañada de dolor y cansancio. Sin embargo, sus características de personalidad dejan ver en ellas altos niveles de neuroticismo, con presencia de trastornos de la personalidad, y conjuntamente niveles importantes de depresión y ansiedad. En el caso de esta última, predomina la ansiedad como rasgo. Las manifestaciones escritas por las pacientes en su registro diario de los sucesos, emociones y pensamientos asociados al dolor y la fatiga confirman la presencia de la sintomatología clásica que caracterizó el constructo de la histeria. Estas pacientes son vulnerables al entorno, con historia de sufrimiento en la niñez y asumieron el rol de adultos desde muy temprana edad. Los síntomas parecen ser el único mecanismo que en algún momento de su vida les permitió liberarse de las responsabilidades que asumieron desde niñas. Desafortunadamente, al parecer este síntoma fue asociado al entorno de acuerdo a las leyes del aprendizaje. Se concluye que la fibromialgia como entidad nosológica cumple con las características de la histeria, pero como etiología se establece por aprendizaje.

Participants:

Ten patients with fibromyalgia participated in our study, 9 women and 1 man, diagnosed according to the criteria of the American College of Rheumatology, aged 37.9 ± 8.8 and with a medium time of evolution of 3 (2-23) years. Quantitative variables: Physical status and syndrome’s severity were assessed using the Fibromyalgia Impact Questionnaire (FIQ); for personality, disorders were evaluated with the Revised Personality Diagnose Questionnaire (PDQ-R); depression, with Beck’s Inventory, and anxiety with Spielberger’s Trait State Inventory. Qualitative theoretical focus: Life experiences narrated by patients in their daily record of events, emotions and thoughts associated with pain, are presented.

Procedure:

All patients were evaluated individually at the beginning of a cognitive behavioural intervention. Qualitative data was obtained from daily records kept during at least three weeks or a maximum of 12. Texts were transcribed and the words most mentioned were identified, as well as those scarcely reported, thus propitiating descriptive categories.

Results:

The American College of Rheumatology established as one of the diagnose criteria for fibromyalgia, the presence of al least 11 of a total of 18 hypersensitive sites. Patients presented in average 16.3 ± 2.5 painful sites. Incapability was measured by patients in 2.3 ± 2.2 in a scale of 0 to 3 points; they reported to have felt well 1.1 ± 1.2 days per week; they didn’t work 1.0 ± 1.1 days per week. The following measures are reported in scale from 1 to 10 points. Laboural interference was calculated in 7.3 ± 2.3; intensity of pain was 8.1 ± 1.4, day long fatigue, 8.4 ± 1.9, morning fatigue was 8.5 ± 2.3. Rigidity was 7.5 ± 3.0; anxiety perceived, 7.5 ± 2.6 (FIQ), and anxiety state along 12 weeks was 38.5 ± 10.3. Anxiety trait during the same period was 50.9 ± 9.7; perceived depression, 6.9 ± 3.4 (FIQ), and cognitive depression 14.7 ± .5. In the scale of personality it was found that six patients reached punctuations higher than T60 in neuroticism, and two other punctuated below T40 in extroversion. Regarding personality disorders it was found an average for 1.8 ± 1.1 disorders per patient; those more frequent were the following: histrionic (4), borderline (3), passive aggressive (2) and schizoid (2). Qualitative data support the existence of the typical symptoms described for hysteria.

Conclusions:

According to the results obtained from the quantitative analysis of this group of patients with fibromyalgia, we can conclude that they suffer from a disorder that generates major incapability accompanied of pain and fatigue. Nevertheless, their personality characteristics show that they have high levels of neuroticism with presence of personality disorders and at the same time important levels of depression and anxiety, predominating in the former, anxiety as a trait. Manifestations described by patients in their daily record of events, emotions and thoughts associated with pain and fatigue, confirm the presence of the classic symptoms that typified the construct of hysteria. These patients are vulnerable to their surroundings, have a story of childhood sufferings, and assumed an adult role from a very early age. Symptoms appear to be the only mechanism which at a given moment in life allowed them to get rid of the responsibilities that burdened them from childhood. Unfortunately, this symptom was associated to their environment, according to the laws of learning. It is concluded that fibromyalgia, as nosologic entity accomplishes the characteristics of hysteria, although as etiology it is established by learning.