Emotional Self-awareness Problem Negatively Impacts Fibromyalgia Coping Strategies, Researchers Say

Emotional Self-awareness Problem Negatively Impacts Fibromyalgia Coping Strategies, Researchers Say

A study of psychological factors in fibromyalgia patients found an association between alexithymia — a self-awareness personality disposition — and coping strategies that coincide with patients’ perceived social support.

The researchers argue for a need to assess and deal with alexithymia as part of a treatment strategy for fibromyalgia patients.

The study, “Coping strategies and perceived social support in fibromyalgia syndrome: Relationship with alexithymia,” was published in the Scandinavian Journal of Psychology.

Alexithymia is defined as a self-awareness problem that makes it difficult for some people to recognize their own emotions and feelings. These individuals have a hard time understanding their own self-experience or the nuances of how others feel. They also tend to pay too much attention to other events.

In the study, researchers used the Toronto Alexithymia Scale, a questionnaire that measures three aspects of alexithymia: difficulty identifying feelings (DIF); difficulty describing feelings (DDF); and externally-oriented thinking (EOT) — the tendency to focus on outside events and not on their inner emotional experience.

A battery of tests assessing coping strategies, perceived social support, alexithymia, psychological distress, and pain intensity was completed by 153 fibromyalgia patients.

High levels of psychological distress (mainly anxiety and depression) and alexithymia were observed in the fibromyalgia patients who participated in the study.

The Coping Orientations to Problems Experienced scale (Brief COPE), a questionnaire that assesses coping techniques in a variety of stressful situations, was used to measure coping strategies.

Fibromyalgia patients scored higher on problem-focused coping, which includes active coping, instrumental support, and planning. They scored lower on two other coping strategies: emotion-focused coping, which includes acceptance, emotional support, humor, positive reframing, and religion; and dysfunctional coping, which involves behavioral disengagement, denial, self-distraction, self-blame, substance use, and venting.

The higher the alexithymia score (total and EOT), the lower the problem-focused coping score, and vice versa.

Likewise, those scoring high on the alexithymia assessment (total, DDF, and EOT) had lower emotion-focused coping scores, and vice versa. Total and DIF scores were also associated with dysfunctional coping.

All the scores (total, DIF, DDF and EOT) coincided with psychological distress scores — mainly anxiety and depression.

The Multidimensional Scale of Perceived Social Support (MSPSS), a self-report measure of social support, showed that lower scores on perceived social support were associated with higher alexithymia scores (total, DIF and DDF).

The researchers noted that each of the three different aspects of the dysfunction had specific effects on coping strategies and social support in the patients studied, making it important to take all three aspects into account when treating patients.

“Psychological interventions should take into account the specific dimensions of alexithymia which appear to be more compromised in each FM [fibromyalgia] patient,” the researchers wrote. The results showed a specific relationship between factors in the emotional dysfunction “and the coping strategies or the perceived social support,” they added.

“A psychological intervention focusing on the specific alexithymic features should thus be considered a key clinical aspect in the treatment of [fibromyalgia], in order to improve both their coping strategies and the levels of social support,” the authors said.


  1. Lisa B says:

    “difficult for some people to recognize their own emotions and feelings”
    If the average person were to wake up one morning debilitated by pain, go from doctor to doctor for help only to be told there is nothing wrong with them, a refrain echoed by family, friends, and colleagues, the average person would develop difficulty in recognizing their own emotions and feelings. There is no surprise here. FM patients deal with this every day. I have tremendous difficulty even assigning a number to pain; decades of “it can’t be that bad” when it is that bad takes its toll.

  2. Rachel says:

    Very astute research! Great idea to explore this angle!!!
    Yes, I notice this all the time. That mind-body connection is a wreck in Fibro. Normally, where thoughts create a physical “gut feeling” is part of the process of “knowing what am I feeling,” but in Fibro emotions hit the body unidirectionally as just intensified pain. It’s automatic, like how intense emotions cause a narcoleptic to fall asleep. Plus there’s this constant body-wide tension feeling that creates a feeling in the skin like being covered in tar or wool….I can barely feel my child’s soft skin or gauge how roughly I touch him. Much less, I can’t use my bodily experiences to “feel” any subtleties in my emotions or the mirror the nuances of someone else’s. Venting IS my main stress valve. And I’m a huge planner to avoid stress. And I’m more nimble, emotionally and physically, when hard painkillers eliminate the deafening pain signals.

  3. nancy anderson says:

    This article could use some serious “for examples” to clarify the exact nature of the dysfunctions relative to lack of emotional awareness and fibromyalgia. For information to be useful to a patient suffering from such a difficult collection of symptoms, it needs to include easily relatable examples coupled with a clearly defined “what next”. Information for information’s sake has it’s place, but victims of fibro need hard answers.

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