The concept of affective spectrum disorder: relationship to fibromyalgia and other syndromes of chronic fatigue and chronic muscle pain

Abstract

Fibromyalgia syndrome is characterized primarily by diffuse musculoskeletal pain. However, the musculoskeletal pain does not present in isolation, but rather as a part of a broader syndrome, with prominent associated symptoms of fatigue, sleep disturbance, depression, anxiety, headache and functional bowel disturbance (Yunus et al, 1981; Wolfe et al, 1990). Indeed, fibromyalgia syndrome is associated not only with these specific symptoms, but very often with well-defined, full-scale syndromes of chronic fatigue, mood and anxiety disorders, migraine and irritable bowel. What is the nature of the relationship between musculoskeletal pain and the other symptoms associated with fibromyalgia syndrome? And what is the nature of the relationship between the fibromyalgia syndrome and the other syndromes which are so frequently comorbid with it? We have proposed that fibromyalgia and these frequently comorbid syndromes (listed in Table 1) may all be members of a family of related disorders, which we have termed 'affective spectrum disorder' (Hudson and Pope, 1989, 1990). In this chapter, we shall describe the coficept of affective spectrum disorder, and the evidence that fibromyalgia and other syndromes of chronic fatigue and pain may be part of the affective spectrum disorder family.