Ablin Jacob N, Cohen Hagit, Neumann Lily, Kaplan Zeev, Buskila Dan
Institute of Rheumatology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman St., Tel-Aviv 64239, Israel.
Rheumatol Int. 2008 May;28(7):649-56. doi: 10.1007/s00296-007-0496-1. Epub 2007 Dec 6.
To analyze coping styles of fibromyalgia (FM) patients with specific emphasis on differences in coping styles between fibromyalgia patients with and without post traumatic stress disorder (PTSD). Seventy-seven consecutive patients (40 women and 37 men) who fulfilled ACR criteria for FM, and 48 healthy controls, completed questionnaires measuring prevalence and severity of PTSD symptoms, including the structured clinical interview for DSM-III-R-non-patient edition (SCID-NP) and the clinician administered PTSD scale (CAPS). Subjects were divided into two groups based on the presence or absence of PTSD symptoms. Subsequently, coping styles were measured 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 effect of gender on psychiatric variables. FM patients exhibit significantly 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 differed significantly only on the suppression subscale (P<0.02). FM patients that have PTSD presented higher suppression scores compared to FM patients without PTSD. No significant difference 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 identified suppression as the only coping style significantly more common among FM patients with co-morbid PTSD then among FM patients without such a diagnosis. Our results may serve to further characterize cognitive and behavioral aspects of FM patients and subsequently guide therapeutic interventions.
分析纤维肌痛（FM）患者的应对方式，特别关注有无创伤后应激障碍（PTSD）的纤维肌痛患者在应对方式上的差异。77例符合美国风湿病学会（ACR）纤维肌痛标准的连续患者（40名女性和37名男性）以及48名健康对照者完成了测量PTSD症状患病率和严重程度的问卷，包括DSM-III-R非患者版结构化临床访谈（SCID-NP）和临床医生实施的PTSD量表（CAPS）。根据是否存在PTSD症状将受试者分为两组。随后，使用阿尔伯特爱因斯坦医学院（AECOM）应对方式问卷测量应对方式。采用学生t检验比较定量变量的均值，采用卡方检验比较比例。方差分析（ANOVA）用于比较有和无PTSD的FM患者的得分，以及评估性别对精神变量的影响。与健康对照相比，FM患者在压抑（P<0.00001）、寻求帮助（P<0.007）、替代（P<0.003）、置换（P<0.002）和反向（P<0.004）方面表现出显著更高的水平。有PTSD和无PTSD的FM患者仅在压抑子量表上有显著差异（P<0.02）。与无PTSD的FM患者相比，有PTSD的FM患者表现出更高的压抑得分。在最小化、寻求帮助、替代、责备、置换、映射和反向量表上未发现显著差异。我们的结果描绘了FM患者的应对模式，确定压抑、寻求帮助、替代、置换和替代是这些患者中更常见的策略。我们进一步确定，压抑是合并PTSD的FM患者中比无此诊断的FM患者显著更常见的唯一应对方式。我们的结果可能有助于进一步描述FM患者的认知和行为方面，进而指导治疗干预。
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