CO:09:2 | Mapping Emotional Function in Fibromyalgia: Integrating Alexithymia, Pain Catastrophizing and Self-Compassion

Francesca Trunfio¹, Damiano Currado^1|2, Rosa Bruni³, Barbara Biticchi¹, Francesca Saracino¹, Erika Corberi¹, Ludovica Lamberti¹, Annalisa Marino^1|2, Lyubomyra Kun¹, Leonardo Frasca'¹, Sebastiano Lorusso¹, Marta Vomero², Onorina Berardicurti^1|2, Roberto Giacomelli^1|2, Luca Navarini^1|2 | ¹Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Biomedico, School of Medicine, Rome, Italy; ²Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Campus Biomedico, Rome, Italy; ³Psychiatrist, Psychotherapist, certified Teacher Mindful Self-Compassion Program, contract Professor at University Campu Rome, Italy

Background. Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread musculoskeletal pain, fatigue, sleep disturbance, and cognitive dysfunction. Alexithymia (i.e.: 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 role in FM remains unclear. This study therefore sought to (1) explore the prevalence of alexithymic traits in a FM cohort and (2) examine the relationships among alexithymia, self-compassion, pain catastrophizing, and hope, with the aim of guiding integrated, emotion-focused interventions.

Materials and Methods. This was a cross-sectional study including 112 consecutive Caucasian women meeting the 2016 ACR criteria for FM, recruited from October 2023 to June 2024. At baseline, participants completed socio-demographic, clinical, and psychometric assessments. Disease burden was assessed via the Widespread Pain Index (WPI), Symptom Severity Scale (SSS), Polysymptomatic Distress Scale (PDS), modified Fibromyalgia Assessment Scale (FASmod) and revised Fibromyalgia Impact Questionnaire (FIQR). Psychological variables were measured using the Toronto Alexithymia Scale (TAS-20), Adult Hope Scale (AHS), Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), and Self-Compassion Scale (SCS). Participants were stratified by TAS-20 score into non-alexithymic (<= 51), borderline (52–60), and alexithymic (>= 61). Group differences were evaluated using ² or Kruskal–Wallis tests, as appropriate, and relationships among variables were explored via univariable and multivariable linear regression models (= 0.05).

Results. The cohort’s median age was 51 years (IQR 46.3–59.3). Distribution by alexithymia status was: non-alexithymic n=26 (24.2%), borderline n=28 (25.0%), and alexithymic n=58 (51.8%). No significant between-group differences emerged for age, BMI, WPI, or SSS. Compared with non-alexithymic patients, those with TAS-20 >= 61 exhibited significantly higher HADS anxiety and depression scores, greater catastrophizing across all PCS subscales (p < 0.01), lower hope (AHS; p < 0.05), and reduced self-compassion, particularly in the self-kindness domain (p < 0.01) (Table I). In univariable analyses, TAS-20 correlated positively with SSS, PDS, FASmod, FIQR, HADS, and PCS (all p < 0.001), and inversely with AHS and SCS total scores (p < 0.001) (Table II). Multivariable linear regression identified SSS ( p < 0.001), PCS–Helplessness (p= 0.005), and SCS–Overidentification ( p= 0.020) as independent predictors of elevated alexithymia (Table III).

Conclusions. These findings reinforce the biopsychosocial conceptualization of FM, positioning alexithymia as a key marker of emotional vulnerability. Its strong associations with symptom severity, catastrophizing, and diminished hope and self-compassion highlight the need to incorporate emotional awareness and regulation into FM management frameworks. Prospective and interventional studies are warranted to determine whether targeting alexithymic traits can yield sustainable benefits in patient-centered outcomes.