International Journal of Behavioral Medicine

, Volume 24, Issue 2, pp 230–238 | Cite as

Classifying Fibromyalgia Syndrome as a Mental Disorder?—An Ambulatory Assessment Study

  • Kristina Klaus
  • Susanne Fischer
  • Johanna M. Doerr
  • Urs M. Nater
  • Ricarda Mewes



Fibromyalgia syndrome (FMS) is associated with psychological distress. The recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) raises the question of whether FMS is classifiable as “somatic symptom disorder” (SSD) and consequently as a mental disorder. To address this, the present ambulatory assessment study focuses on the everyday life occurrence of SSD symptoms in FMS and their predictive value concerning severity indicators of widespread pain.


Ambulatory data were assessed six times daily on 14 consecutive days via iPod. Twenty-eight women suffering from FMS indicated symptoms associated with SSD (somatic illness beliefs, health anxiety, time/energy devoted to pain, or health concerns) and momentary pain levels. Questionnaires regarding potential covariates (such as somatization, depression, health status) were completed at two additional sessions in the research laboratory.


On average, SSD symptoms occurred three to four times daily and were mild to moderate in severity. Furthermore, these symptoms were both concurrently and prospectively associated with momentary pain intensity and subjective impairment by pain. Twenty percent of the variance in pain intensity and 28 % of the variance in subjective impairment were explained by momentary variables (SSD symptoms and intake of pain medication). Eighty-two percent of persons with FMS fulfilled the psychological SSD criterion when considering everyday occurring symptoms with at least mild severity.


FMS might be diagnosed as a mental disorder according to DSM-5 in many cases. SSD symptoms proved to have predictive value for FMS severity and may thus have clinical relevance for diagnostic, prognostic, and intervention purposes.


Ambulatory assessment Fibromyalgia syndrome Health anxiety Somatic illness beliefs Somatic symptom disorder 


Compliance with Ethical Standards

Ethical Approval

The study protocol was approved by the local institutional review board (Department of Psychology, University of Marburg, Germany). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


The authors acknowledge funding by the Volkswagen Foundation and the Swiss National Science Foundation. Participant reimbursements were funded by the Philipps-Universität Marburg.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© International Society of Behavioral Medicine 2016

Authors and Affiliations

  • Kristina Klaus
    • 1
  • Susanne Fischer
    • 2
  • Johanna M. Doerr
    • 2
  • Urs M. Nater
    • 2
  • Ricarda Mewes
    • 1
  1. 1.Clinical Psychology and Psychotherapy, Department of PsychologyUniversity of MarburgMarburgGermany
  2. 2.Clinical Biopsychology, Department of PsychologyUniversity of MarburgMarburgGermany

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