Adult attachment styles in American and Spanish patients with fibromyalgia and rheumatoid arthritisa cross-sectional study /

Résumé

Introduction and aims. Fibromyalgia is defined by criteria related on symptomatic range and severity. In the American College of Rheumatology 1990 criteria, musculoskeletal pain is the cardinal symptom evaluated, while in the updated 2010 criteria, only one of the five criteria items directly concerns musculoskeletal pain. The etiology is yet unclear, although there is a frequent established association with psychosocial stressors. Adult attachment style is an internal representation of self and others, yielding from early childhood experiences of relationships with primary caregivers. Attachment style determines how individuals relate to each other and is associated to strategies for managing threatening situations, with precedents of distinctive traits within Spanish population. Given that attachment is a relatively stable, trait-like characteristic, it served as framework for this research. In this study, the main aim was to obtain more detailed clinical, attachment, and psychosocial information through a comparison between fibromyalgia and another rheumatic condition of a mainly organic, autoimmune, etiology: rheumatoid arthritis. Also, a cross-cultural report was added to examine the Spanish attachment particularities. Material and methods. The study consisted of a cross-sectional design with a fibromyalgia group and a rheumatoid arthritis comparison group, both in Barcelona (67 and 70 patients, respectively) and New York (16 and 15 patients). All subjects submitted demographic and clinical information, as well as complied psychological questionnaires on attachment, depression, functional status, pain-related dimensions, quality of life, and anxiety. Results. Fibromyalgia patients showed higher levels of depression, anxiety, pain intensity and interference, somatic symptoms, and worse functional status than the rheumatoid arthritis sample. Insecure attachment was prominent in both conditions, albeit it yielded significant differences only in the cross-cultural comparison. In general, the hostile fearful style reported the worse health status. Most significant differences remained when comparing both medical conditions across nationalities. Attachment was found to predict pain-related outcomes in fibromyalgia; as well as rheumatoid arthritis quality of life, pain-related variables, functional status, and somatic symptoms. In fibromyalgia, changes in quality of life and pain interference were explained by anxiety and depression; whereas pain intensity, functional status, and somatic symptoms were predicted only by anxiety. In rheumatoid arthritis, most variables were also predicted by both anxiety and depression; while the physical component of quality of life and pain intensity were predicted only by depression. Conclusions. The findings highlight the importance of overall adult attachment and mood disorders contributing to the burden of fibromyalgia and rheumatoid arthritis, despite the latter being an inflammatory disease associated to severe disability and premature mortality. Investigation in the direction of adapting psychological interventions stressing these components will help, striving for an improvement in quality of life and function of these medication conditions that still require palliative treatment and hold no definitive cure.