Handbook of Psychology

Mental Health Issues 519

Fibromyalgia

Fibromyalgia is characterized by a widespread pain syn-
drome and decreased pain threshold. Women represent
80% to 90% of patients with this disease (Belilos & Carsons,
1998), and approximately 2% of American women have the
disease (Hawley & Wolfe, 2000). Symptoms include diffuse
aches and pains, sleep disturbance, fatigue, headaches, irrita-
ble bowel syndrome, and psychological distress. Patients
with this disorder often have dif“culty pinpointing the loca-
tion of their pain. Diagnosis can be dif“cult since no single
test is available to determine the presence of the disease.
Therefore, diagnosis often is made after testing for other dis-
orders reveals negative “ndings, or after patients are mis-
diagnosed because symptoms are similar to another disorder
such as chronic fatigue syndrome. In addition to improving
underlying sleep disorders, the treatment of “bromyalgia
has focused on the use of antidepressants, muscle relaxants,
and exercise programs. Treatment efforts have been largely
unsuccessful because the use of antidepressants, exercise
programs, and cognitive behavioral therapy has shown only
short-term improvement or mild effectiveness (see Hawley &
Wolfe, 2000, for a review).
The diagnosis and treatment of “bromyalgia have been
controversial because some researchers and health care
providers believe the disorder is primarily psychological as
opposed to physical. However, not all patients with “-
bromyalgia have comorbid psychiatric symptomatology or
disorders. Furthermore, because the diagnosis of “bromyal-
gia is based solely on self-reported complaints of pain,
women with this disorder may experience minimization or
trivialization of their symptoms by health care providers. An
interdisciplinary team approach is recommended to address
the multiple problems and offer treatment options. Further re-
search is warranted into ethnic-racial differences, etiology,
diagnosis, and treatment of this disease. Health psychologists
can assist in screening for mental health disorders in this pop-
ulation, as well as in teaching women to recognize the rela-
tionship between physical and psychological symptoms, use
relaxation techniques in response to pain, and manage stres-
sors and psychosocial dif“culties related to their symptoms.

Osteoporosis

Osteoporosis is a debilitating disease characterized by the
loss of bone mass, which often leads to bone fractures.
The most common fractures occur in the hip, spine, or
wrist and can cause severe disability or death. The disease
occurs in older women four times more often than in men of
comparable age (Wisocki, 1998). According to the National

Osteoporosis Foundation (2001), 28 million Americans age

50 and older have osteoporosis or are at risk of developing

the disease, which accounts for more than 1.5 million frac-

tures annually. Additional research is needed to clarify rates

according to ethnic-racial status.

The risk factors for osteoporosis include being female,

having a small frame, older age, and family history. Research

also indicates that caffeine intake, alcohol intake, cigarette

smoking, and lack of exercise can be associated with lower

bone mass resulting in higher risk of fracture (Kaplan-

Machlis & Bors, 2000). Prevention and treatment efforts

often focus on decreasing the risk of fracture, but prevention

efforts educating women about the importance of calcium in-

take in the prevention of osteoporosis may be the most pro-

ductive in decreasing women•s mortality. To be effective,

prevention needs to begin at an early age for girls. Health

psychologists may be able to assist with osteoporosis preven-

tion through the development of effective national awareness

programs for women and children.

MENTAL HEALTH ISSUES

This section presents a brief overview of issues related to

prevalence, gender differences, and risk factors for the cate-

gories of mental disorders most prevalent among women„

depressive disorders, anxiety disorders, and eating disorders.

Given the fact that women with substance use disorders are

more likely to experience severe physical and mental health

effects, we also present relevant data on nicotine and alcohol

use. Further research addressing gender differences, the etiol-

ogy of these disorders, and prevention strategies for these

mental health problems in women is needed.

Depressive Disorders

Depression is a serious health problem for women; in fact,

it has been reported as the leading cause of disability for

women worldwide (C. Murray & Lopez, 1996). Major

epidemiological studies such as the Epidemiological Catch-

ment Area (ECA) Study and the National Comorbidity

Survey (NCS) indicate that women are twice as likely to be

affected by major depressive disorder and dysthymia than

are men (Kessler et al., 1994; Robins, Locke, & Regier,

1991). According to the NCS, lifetime prevalence rates for a

major depressive episode are 21.3% for women and 12.7%

for men. Lifetime prevalence rates for dysthymia are 8.0%

for women and 4.8% for men. Although gender differences

begin to emerge with the onset of puberty, the average age

of onset of major depression is approximately 25 years, with