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Contested credibility of fibromyalgia within medical, legal, and insurance contexts Le Page, Judy Ann

Abstract

Fibromyalgia (FM) is a controversial diagnosis that has been associated with considerable personal and occupational disability. The difficulty in determining the credibility of reported pain and disability in FM has perplexed the various disciplines involved in this process. The purpose of this dissertation was to take a multidisciplinary approach and examine the complexities of FM as faced by patients, the medical and legal system, and the insurance industry. Two independent, yet related, studies comprise this dissertation, each examining aspects of the various perspectives involved in disability claims for FM. Study 1 was more exploratory in nature and involved a systematic review of every trial-by-judge litigated FM claim in Canada (N=194) up to 2003. The cases were examined in relation to demographic, insurance, and credibility factors. The demographic factors revealed a gender disparity of women (84%) plaintiffs, and a disproportionate number of FM cases litigated in British Columbia (61%). Insurance related factors indicated that although surveillance information played a role in disability determinations for FM, the credibility of that information was central to the amount of award granted. Plaintiff credibility played a similar role, indicating that plaintiffs perceived as more credible were typically granted greater awards. An examination of medical expert credibility revealed that judges appear to perceive experts as more credible overall than plaintiffs, regardless of the expert's familiarity level with the plaintiff. The purpose of Study 2 was to examine the phenomenology of exaggeration and the deliberate portrayal of excessive disability in patients with FM. Fifty-four patients with FM completed a variety of psychological, physical, functional, and symptom validity measures twice. In one session, patients were instructed to complete the tests and measures in a manner that was "normal" for them, while patients were instructed to "exaggerate" pain and disability associated with FM in the other session. There were medium to large differences associated with exaggeration on some of the self-report measures of physical, functional, and psychological status. The subjects did not, however, exaggerate on the symptom validity tests. Although multiple cutoff scores exceeded single test scores in the identification of exaggerators in most cases, the false negative rate remained moderate to high. These findings suggest that patients with FM can exaggerate their disability on self-report measures in a plausible manner.

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