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

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Abstract
Background: 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. Objectives: 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. Design: 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. Methods: 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 χ 2 or Kruskal–Wallis tests, and associations were examined using univariable and multivariable linear regression models (α = 0.05). Results: 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. Conclusion: 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.

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