Presentation: Fibromyalgia Symptom Reporting and Application for Disability Insurance: Is it Possible to Fake Fibromyalgia Symptoms for Financial Benefit? (2007)

1539 Fibromyalgia Symptom Reporting and Application for Disability Insurance: Is it Possible to Fake Fibromyalgia Symptoms for Financial Benefit?

PURPOSE: To determine whether symptoms of fibromyalgia (FM) patients who are applying for or receiving disability insurance differ from those of FM patients who have never applied for disability insurance, and whether healthy individuals can fake FM symptoms for financial benefit.
METHODS: Seventeen FM patients applying for or receiving disability insurance, 17 FM patients who had never applied for disability insurance, and 17 healthy asymptomatic individuals were recruited by advertisement. The healthy individuals were provided a detailed written description of FM and requested to simulate the disorder first without an incentive, and a second time with the financial incentive of applying for disability insurance. All subjects were examined for tender points and completed the following standard questionnaires: a Pain Assessment Questionnaire, the Sleep Assessment Questionnaire (SAQ), the Yoshitake Fatigue Questionnaire, the Beck Depression Inventory (BDI), the SCL-90-R, and the Wahler Physical Symptoms Inventory. Wilcoxon rank sums were used to compare group differences in tender point counts and questionnaire scores. Multivariate logistic regression was conducted using application for disability insurance as the dependent variable, and tender point counts and scores from the questionnaires as the predictor variables.
RESULTS: The two groups of FM patients and healthy simulators had similar demographics. FM patients applying for or receiving disability insurance described more symptoms of depression on the BDI (p=.0064), psychological distress on the SCL-90-R (p=.014), and sleep disturbance on the SAQ (p=.0052) than FM patients who had never applied for disability insurance. On multiple logistic regression, non-restorative sleep factor score on the SAQ (p=.027) and total score on the BDI (p=.024) were significant, independent predictors of disability insurance application in FM patients. Healthy simulators without incentive for disability insurance overestimated symptoms of depression on the BDI (p=.001), and psychological distress on the SCL-90-R (p=.0006) compared to FM patients who had never applied for disability insurance. Healthy simulators given the financial incentive of applying for disability insurance underestimated symptoms of non-restorative sleep on the SAQ (p=.0057) compared to FM patients applying for or receiving disability insurance.
CONCLUSIONS: Symptoms of non-restorative sleep and depression are strongly associated with disability insurance application in FM patients. Healthy individuals are able to fake FM symptoms of pain and fatigue but find it difficult to fake symptoms of depression and non-restorative sleep. The results suggest that non-pain symptoms are important to assess in FM disability insurance claims.

 N. Natarajan, None; H. Moldofsky, None.