Study Finds Higher Rates of Decreased Emotional Awareness in FM Patients

Study Finds Higher Rates of Decreased Emotional Awareness in FM Patients

People with fibromyalgia are more likely to have difficulty describing their emotions; this is linked to increased psychological stress but not necessarily to pain, a recent study suggests.

The study, “Alexithymia and Psychological Distress in Patients With Fibromyalgia and Rheumatic Disease,” was published in the journal Frontiers in Psychology.

Alexithymia is a condition where a person has trouble identifying and expressing feelings — the word literally means “lack of words to describe emotions.” It’s pretty well-established that psychological disorders such as anxiety and depression are more common among people living with fibromyalgia and other conditions that cause chronic pain, but what about alexithymia?

To find out, researchers recruited 48 fibromyalgia patients (one male, 47 female, average age 52.94 years) and 38 control subjects (14 male, 24 female, average age 47.92 years). For further comparisons, the researchers also recruited 41 people (10 male, 31 female, average age 54.74 years) who had a chronic pain-causing rheumatic disease (RD) other than fibromyalgia.

All subjects were evaluated for alexithymia via the Toronto Alexithymia Scale (TAS), with a score of 61 or more indicating alexithymia. Additionally, patients’ pain was assessed with the Visual Analog Scale for Pain (VAS) and the McGill Pain Questionnaire (MPQ); psychological distress was measured with the Hospital Anxiety and Depression Scale.

Rates of alexithymia were significantly higher among fibromyalgia (47.9%) and RD (41.5%) patients than among the controls (2.6%). Rates of depression and anxiety were also higher in fibromyalgia (66.7% and 58.3%, respectively) and RD (51.2% and 48.8%) patients than healthy controls (13.2% and 5.3%).

“These results may highlight the presence of a greater difficulty in identifying and expressing emotions and an external-oriented cognitive style in patients with chronic pain conditions compared to general population,” the researchers stated, adding, “No significant differences were found between the [fibromyalgia] and RD groups, suggesting that both chronic pain conditions may have similar impairment in awareness and emotional regulation.”

Among fibromyalgia patients, there was no significant association between pain and alexithymia scores. However, there was a significant association between having trouble identifying feelings (a subsection of the TAS) and higher anxiety scores — and anxiety and depression scores were themselves significantly associated with pain.

Additionally, difficulty identifying feelings, as well as difficulty describing them (another TAS subsection), were both significantly associated with fewer years of formal education among the fibromyalgia patients.

The researchers then combined the fibromyalgia and RD patients and divided them into those with alexithymia (40/89 patients) and without (34/89), excluding those who were borderline (15/89). Those in the alexithymia group had significantly higher anxiety and depression scores, as well as higher VAS and MPQ scores. Further statistical analysis revealed that difficulty identifying and describing emotions was significantly correlated with anxiety and depression, but again, there wasn’t a significant association between alexithymia and pain scores.

“This result suggests that lower emotional awareness does not play a primary role in pain perception,” the researchers said, though they noted that “pain experience and psychological distress had a significant relationship” among fibromyalgia patients.

“In the light of these findings, we could hypothesize that in patients with FMS, anxiety and depression affect both pain experience and emotional awareness and therefore they should be identified and taken into account in the treatment,” the researchers said, although this study was not designed to identify cause-and-effect relationships, only associations. As such, more research, with larger sample sizes, will be needed to clarify these relationships.