Mapping emotional function in fibromyalgia: integrating alexithymia, pain catastrophizing, and self-compassion

Key Findings

Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread musculoskeletal pain, fatigue, sleep disturbance, and cognitive dysfunction. Alexithymia-difficulty identifying and describing emotions-has been reported in up to 48% of FM patients and is associated with increased psychological distress and pain intensity, yet its specific contribution to FM remains unclear. This study aimed to assess the interplay among alexithymia, self-compassion, pain catastrophizing, and hope to inform future integrated and emotion-focused treatment strategies for FM. We conducted a cross-sectional investigation, consecutively recruiting 112 Caucasian women meeting the 2016 American College of Rheumatology criteria for FM between October 2023 and June 2024. Socio-demographic, clinical, and psychometric data were collected at baseline. Disease burden was evaluated using the Widespread Pain Index, Symptom Severity Scale (SSS), Polysymptomatic Distress Scale, modified Fibromyalgia Assessment Scale, and revised Fibromyalgia Impact Questionnaire (FIQ-R). Psychological constructs were assessed using the Toronto Alexithymia Scale (TAS-20), Adult Hope Scale, Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), and Self-Compassion Scale (SCS). Participants were stratified into non-alexithymic, borderline, and alexithymic groups according to TAS-20 thresholds. Group differences were analyzed through χ2 or Kruskal-Wallis tests, and associations were examined using univariable and multivariable linear regression models (α = 0.05). Alexithymic traits were identified in 51.8% of patients. Individuals with alexithymia exhibited significantly higher anxiety, depression, and total HADS scores (all p < 0.01), greater pain catastrophizing (p = 0.003), and lower levels of hope (p < 0.05). Two self-compassion components, self-judgment and overidentification, were also significantly impaired (p = 0.012). Univariable analyses showed that alexithymia was positively associated with FM severity indices (SSS, FIQ-R) and psychological distress and negatively associated with hope and several self-compassion domains (all p < 0.001). In multivariable models, SSS (p < 0.001), PCS-Helplessness (p = 0.005), and SCS-Overidentification (p = 0.020) emerged as significant independent associated variables. Alexithymia represents a prominent marker of emotional vulnerability in FM, closely linked to symptom severity, maladaptive pain coping, and reduced hope and self-compassion. Integrating these constructs into FM assessment and management may support more comprehensive, emotion-focused therapeutic approaches. Understanding how emotional difficulties, negative thinking about pain, and low self-compassion shape the experience of fibromyalgia in women, to support better clinical assessment and more integrated treatment strategies Fibromyalgia (FM) is a long-lasting condition that causes widespread pain, fatigue, sleep problems, and other symptoms that strongly affect daily life. Many people with FM also struggle to recognize, understand, or express their emotions. This difficulty, known as alexithymia, may make it harder to cope with pain and stress, but its specific impact in FM is still not fully understood. In this study, we evaluated 112 Caucasian women diagnosed with FM to explore how alexithymia relates to disease burden and key psychological factors: hope, self-compassion, and pain catastrophizing (a pattern of negative thoughts about pain). All participants completed questionnaires measuring symptom severity and emotional well-being. Over half of the women in the study showed signs of alexithymia. Compared to those without alexithymia, these patients reported higher levels of anxiety and depression, more catastrophic thinking about pain, and lower levels of hope and self-compassion. They also tended to experience more severe fibromyalgia symptoms, particularly fatigue, sleep problems, and overall distress. When we analysed the data in detail, three factors were strongly linked to higher levels of alexithymia: 1. Greater symptom severity, 2. A stronger sense of helplessness toward pain, and 3. A tendency to become overwhelmed by negative experiences, reflected by low scores in the self-compassion domain of overidentification. These findings suggest that emotional difficulties are deeply intertwined with the experience of fibromyalgia. Addressing alexithymia and related psychological factors may help clinicians better understand patient needs and deliver more personalized care. Treatments that support emotional awareness, coping strategies, and self-compassion—such as mindfulness-based approaches—may be particularly helpful for individuals who struggle with these aspects. Overall, our results highlight that managing FM effectively requires attention not only to physical symptoms.

Why This Matters for Body-Mind Practice

[Draft — editorial context needed]

Source

• Mapping emotional function in fibromyalgia: integrating alexithymia, pain catastrophizing, and self-compassion. — Therapeutic advances in musculoskeletal disease