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Study: DSM-5 could not be properly applied to fibromyalgia patients


Senior Member
SAN DIEGO — Frederick Wolfe, MD, of the National Data Bank for Rheumatic Diseases, Wichita, Kan., presented study results of patients with fibromyalgia, somatoform disorders and the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders at the American College of Rheumatology annual meeting.

Wolfe and colleagues studied whether fibromyalgia should be considered a somatoform disorder or a pain disorder.

“The DSM-5 in patients with rheumatoid arthritis and fibromyalgia lacked face validity and probably should not be used … did not seem valid, and there was no way it could be properly applied,” Wolfe concluded.

For more information:

Wolfe F. #840: Fibromyalgia, Somatic Symptoms, and Mental Illness in View of the 2013 Diagnostic and Statistical Manual of Mental Disorders. Presented at: the 2013 American College of Rheumatology Annual Meeting; Oct. 26-30, San Diego.

Snow Leopard

South Australia
Here is an interview on the topic:

He states that "We don’t believe for a moment that these people have a mental illness. I think what we’ve shown is that there is a limitation about the way that DSM-5 looks at these sorts of conditions. There’s no real benefit to anybody to consider this in the way that DSM is considering it."

But then he also says:

"In fibromyalgia, studies have shown that the symptoms of fibromyalgia exist on a continuum. From a little pain and a little distress: to a lot of pain and a lot of distress. In fact we call the measures that we use to diagnose fibromyalgia measures of polysymptomatic distress.

This is termed by the UK psychiatrist Simon Wesley who first described illnesses such as chronic fatigue syndrome and fibromyalgia being at the end of a continuum of polysymptomatic distress.

What do we mean by polysymptomatic? Many different symptoms. One might have headaches, but not have all of the symptoms of fibromyalgia."

I take issue at this whole idea of "polysymptomatic", because it is necessarily vague and non-specific, such that is it is not at all useful clinically. Because all patients of all illnesses report multiple symptoms if you probe them enough.


Senior Member
A new article by Frederick Wolfe on the same subject

Symptoms, the Nature of Fibromyalgia, and Diagnostic and Statistical Manual 5 (DSM-5) Defined Mental Illness in Patients with Rheumatoid Arthritis and Fibromyalgia
  • Frederick Wolfe,

  • Brian T. Walitt,

  • Robert S. Katz,

  • Winfried Häuser
To describe and evaluate somatic symptoms in patients with rheumatoid arthritis (RA) and fibromyalgia, determine the relation between somatization syndromes and fibromyalgia, and evaluate symptom data in light of the Diagnostic and Statistical Manual-5 (DSM-5) criteria for somatic symptom disorder.

We administered the Patient Health Questionnaire-15 (PHQ-15), a measure of somatic symptom severity to 6,233 persons with fibromyalgia, RA, and osteoarthritis. PHQ-15 scores of 5, 10, and 15 represent low, medium, and high somatic symptom severity cut-points. A likely somatization syndrome was diagnosed when PHQ-15 score was ≥10. The intensity of fibromyalgia diagnostic symptoms was measured by the polysymptomatic distress (PSD) scale.

26.4% of RA patients and 88.9% with fibromyalgia had PHQ-15 scores ≥10 compared with 9.3% in the general population. With each step-wise increase in PHQ-15 category, more abnormal mental and physical health status scores were observed. RA patients satisfying fibromyalgia criteria increased from 1.2% in the PHQ-15 low category to 88.9% in the high category. The sensitivity and specificity of PHQ-15≥10 for fibromyalgia diagnosis was 80.9% and 80.0% (correctly classified = 80.3%) compared with 84.3% and 93.7% (correctly classified = 91.7%) for the PSD scale. 51.4% of fibromyalgia patients and 14.8% with RA had fatigue, sleep or cognitive problems that were severe, continuous, and life-disturbing; and almost all fibromyalgia patients had severe impairments of function and quality of life.

All patients with fibromyalgia will satisfy the DSM-5 “A” criterion for distressing somatic symptoms, and most would seem to satisfy DSM-5 “B” criterion because symptom impact is life-disturbing or associated with substantial impairment of function and quality of life. But the “B” designation requires special knowledge that symptoms are “disproportionate” or “excessive,” something that is uncertain and controversial. The reliability and validity of DSM-5 criteria in this population is likely to be low.