Clinical Rheumatology

, Volume 31, Issue 4, pp 677–685

Delineating psychological and biomedical profiles in a heterogeneous fibromyalgia population using cluster analysis

  • Barbara L. Loevinger
  • Elizabeth A. Shirtcliff
  • Daniel Muller
  • Carmen Alonso
  • Christopher L. Coe
Original Article


The heterogeneity of patients meeting American College of Rheumatology (ACR) criteria for a diagnosis of fibromyalgia (FM) challenges our ability to understand the underlying pathogenesis and to optimize treatment of this enigmatic disorder. Our goal was to discern clinically relevant subgroups across multiple psychological and biomedical domains to better characterize the phenomenology of FM. Women meeting 1990 ACR criteria for FM (N = 107) underwent psychological (childhood trauma, mood, anxiety, and stress) and biomedical (neuroendocrine, immune, and metabolic) testing. Cluster analysis identified four distinct subgroups. Subgroups I, II, and III exhibited profiles that included high psychological distress. Subgroup I was further distinguished by a history of childhood maltreatment and hypocortisolism, and these women reported the most pain and disability. Subgroup II evinced more physiological dysregulation and also reported high levels of pain, fatigue, and disability. Subgroup III was characterized by normal biomarkers and reported intermediate pain severity with higher global functioning. Subgroup IV was distinguished by their psychological well-being, reporting less disability and pain. Our findings underscore the heterogeneity of both psychological and physiological features among FM patients presenting with nearly identical tender point counts. This subgroup categorization is compatible with hypothesized pathogenetic mechanisms of early trauma, stress system dysregulation, and pro-inflammatory bias, each prominent in some but not all FM patients. Appreciation of distinct FM subgroup features is invaluable for selecting the most appropriate treatment modalities.


Distress Fibromyalgia Immune Maltreatment Metabolic Neuroendocrine [6 MeSH terms] Pain 


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Copyright information

© Clinical Rheumatology 2011

Authors and Affiliations

  • Barbara L. Loevinger
    • 1
    • 5
  • Elizabeth A. Shirtcliff
    • 3
  • Daniel Muller
    • 1
    • 2
  • Carmen Alonso
    • 1
  • Christopher L. Coe
    • 4
  1. 1.Department of PsychiatryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  3. 3.Department of PsychologyUniversity of New OrleansNew OrleansUSA
  4. 4.Department of PsychologyUniversity of WisconsinMadisonUSA
  5. 5.Harlow Center for Biological PsychologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

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