title: Primary attributions in women suffering fibromyalgia emphasize the perception of a disruptive onset for a long-lasting pain problem.
abstract: OBJECTIVE
  Fibromyalgia (FM) is a chronic musculoskeletal pain disorder characterized by widespread pain. This study focuses on patients' attributions of illness and of symptom onset.
  
  
  METHODS
  Semi-structured interviews were conducted with 56 women to elicit patients' views on what triggered their FM. The transcripts of the interviews were analyzed using a classical indexing technique to identify key themes. Content analysis was performed by two independent coders.
  
  
  RESULTS
  Primary causal attributions fell into five categories: psychological problems (28 respondents); somatic concerns (N=12); violence/abuse during childhood (N=7), gynaecological/obstetrical problems (N=6), and fatigue (N=3). Patients' attributions were internal and external in the same proportions, more frequently unstable than stable, and more often described uncontrollable than controllable. Participants expressed decrements in self-esteem and feelings such as self-blame or despair; global perceptions of persistent pain and long-lasting problems, evoking chronicity and hopelessness; and low perceived control over their lives as well as beliefs that nothing can be done, thus increasing a feeling of guilt and vulnerability. Patients' narratives emphasized disruptive circumstances surrounding symptom onset.
  
  
  CONCLUSIONS
  Attributions often referred to the psychological dimension of the events surrounding FM onset, even though some of them also had a clear somatic dimension. Many narratives mentioned successive disruptive events and suggested an increasing loss of control. Addressing these illness representations may contribute to tailor the treatment and to help patients gain self-coherency by providing means to understand pain onset but also to guide future behaviours, particularly in terms of adjustment and help-seeking.
authors: Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland. Christine.Cedraschi@hcuge.ch
authors: Christine
authors: C
authors: Cedraschi
authors: Elodie
authors: E
authors: Girard
authors: Christophe
authors: C
authors: Luthy
authors: Michel
authors: M
authors: Kossovsky
authors: Jules
authors: J
authors: Desmeules
authors: Anne-Françoise
authors: AF
authors: Allaz
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000209:etiology / Q000523:psychology*; D005260:Female; D005356:Fibromyalgia / Q000209:etiology / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007406:Interview, Psychological; D008016:Life Change Events; D008875:Middle Aged; D036301:Qualitative Research