Personality disorders in patients with fibromyalgia

Fibromyalgia (FM) frequently co-occurs with mental disorders, but population-scale estimates for personality disorders (PDs) and cluster-specific patterns over extended horizons are limited. We quantified cross-sectional prevalence and 20-year cumulative incidence of recorded PD diagnoses in FM versus matched controls, and assessed the impact of diagnostic opportunity.

We performed a retrospective matched-cohort study within a nationwide Israeli health system. Adults with FM (N = 15,869) were matched 1:5 to controls (N = 79,345) on sex, age, and enrollment year. Outcomes were ICD-10 PD codes (F60-F61; ancillary F63-F69). Cross-sectional prevalence at baseline and end-of-follow-up was compared using conditional logistic regression (odds ratios [ORs], 95% CIs) with false-discovery-rate. Among participants PD-free at baseline, 20-year cumulative incidence ("risk") was estimated with risk differences (RD, percentage points) and risk ratios (RR) using Wilson and log-Wald intervals. A surveillance-calibrated sensitivity analysis scaled RRs by the FM:control psychiatry-visit ratio to approximate adjusted RRs (aRRs).

At baseline, any PD was more prevalent in FM than controls (1.84% vs 0.49%; OR 3.79, 95% CI 3.26-4.42; q < 0.001), with pronounced elevations in Cluster B-especially borderline PD (F60.31)-and smaller signals in Cluster C (avoidant, F60.6). At the end of follow-up, contrasts persisted or strengthened (any PD 2.85% vs 0.57%; OR 5.11, 4.48-5.82; q < 0.001). Among those PD-free at baseline, 20-year risk remained higher in FM (any PD 1.03% vs 0.08%; RD 0.95 pp., 0.78-1.14; RR 12.87, 9.62-17.22), driven by Cluster B (borderline 0.20% vs 0.02%; RD 0.19 pp.; RR 12.34, 6.48-23.51). Surveillance calibration attenuated but did not eliminate Cluster-B excess (e.g., borderline aRR ≈ 3.07).

FM is associated with a selective, durable enrichment of Cluster-B PDs-most notably borderline-observable cross-sectionally and as long-term cumulative risk, only partly explained by diagnostic opportunity. Findings support routine PD screening within FM care and motivate mechanistic work on immuno-neuroendocrine and frontolimbic pathways.