Psychological Aspects of Fibromyalgia

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Role of negative affect in fibromyalgia[edit]

Bartley et al. state that “correlational research suggests negative affect (e.g., depression, anxiety) and deficits in positive affect may contribute to FMS symptomatology.” (Experimental assessment of affective processing in fibromyalgia. Bartley EJ1, Rhudy JL, Williams AE. J Pain. 2009 Nov;10(11):1151-60.)

They studied the presence of affective processing in fibromyalgia using a well-validated picture-viewing paradigm. This was done to provoke emotional responses. They viewed pleasant (erotica), neutral, and unpleasant (attack related) pictures as well as abrupt white noises that were delivered during two-thirds of the pictures. This was done to evoke startle eye blinks.

They accessed appetitive and defensive responding using “subjective (valence/ pleasure and arousal ratings) and physiological (corrugator EMG, heart rate, skin-conductance response, startle-reflex modulation) reactions to pictures.”

Results suggested that in fibromyalgia there is an associated increase in “defensive activation (displeasure, subjective arousal, corrugator EMG) to the unpleasant, threat-related pictures, but not deficits in appetitive activation to erotic pictures.” They concluded that it was likely that people with fibromyalgia “have deficits in affective processing, but this dysregulation may be limited to defensive activation.”

Focal psychological conflict in fibromyalgia[edit]

There are psychological conflicts which aggravate fibromyalgia or which precipitate attacks. Some even seem to be causal based on the fact that chronic widespread muscular pain and deterioration of sleep often occurs after and during emotional upheavals when conflicts are at critical points. The word conflict her is used in the psychoanalytic sense. It covers a broad range of mental disturbances. (For a book that discusses this topic see The Mind in Conflict by Charles Brenner.) There have several case histories of fibromyalgia patients in conflict. Several of Freud’s patients in Studies in Hysteria seem to have had fibromyalgia on top of their hysteria.

The author of this Encyclopedia has had dozens of patients with fibromyalgia in which conflict was a factor. Examples include a young woman with a complex dispute with her boyfriend; a working woman with hostility to her boss; and finally a woman that had been sexually abused by her brothers when she was a child who did not have the slightest doubt that this conflict contributed to her fibromyalgia. Decades after the abuse she was still struggling to find a way to undue the thinking patterns and tension which were set in motion by the original abuse.

For a paper on the role of self and identity conflicts see: Cognitive Factors in Fibromyalgia: The Role of Self-Concept and Identity Related Conflicts. Compañ V, Feixas G, Varlotta-Domínguez N, Torres-Viñals M, Aguilar-Alonso A, Dada G, Angel Saúl L. J Constr Psychol. 2011 Jan;24(1):56-77 available in full online at:

For a case history see: [Fibromyalgia (fibrositis) syndrome--a case report]. [Article in Japanese] Kobayashi S1, Iijima K, Tanaka M, Tamura N, Hashimoto H, Hirose S. Ryumachi. 1991 Apr;31(2):206-11.

Also see: [Psychosomatic aspects in the diagnosis and treatment of fibromyalgia]. [Article in German] Blumenstiel K1, Eich W. Schmerz. 2003 Dec;17(6):399-404.

Building bridges between body and mind: The analysis of an adolescent with paralyzing chronic pain. Shapiro B1. Int J Psychoanal. 2003 Jun;84(Pt 3):547-61. (The abstract does not use the word “fibromyalgia”; but when searching pubmed for “fibromyalgia and psychoanalysis, this paper comes up.)

Mindfulness training for reducing anger, anxiety, and depression in fibromyalgia patients.Amutio A, Franco C, Pérez-Fuentes Mde C, Gázquez JJ, Mercader I. Front Psychol. 2015 Jan 12;5:1572 available in full online at:

A Forgiveness Intervention for Women With Fibromyalgia Who Were Abused in Childhood: A Pilot Study. Lee YR1, Enright RD2. Spritual Clin Pract. 2014 Sep;1(3):203-217 available in full online at:

Sadrediny et al. report the case of man who was married to a woman. He had refractory fibromyalgia “after an 8-year history of generalized chronic pain. He under-went multiple treatment modalities, such as tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and nonpharmacological therapies, with no dramatic success. Psychiatric assessment revealed a homosexual tendency. He and his wife were informed about the problem. A change in sexual behavior caused a significant resolution of symptoms over a 6-month period, and he no longer receives medication for FM. This is the first case report to demonstrate the efficacy of sexual disorder improvement in the treatment of refractory FM.” The authors seemed to be of the opinion that his homosexuality was a strain on him. (Sexual disorder improvement: a target or a way in treatment of fibromyalgia. A case report and brief review. Sadrediny S1, Molaeephard M, Mir-Ahmadi M. Mod Rheumatol. 2010 Feb;20(1):74-6.)