Emotional patterns along the fibromyalgia continuum: a cross-cultural study

Background. Several studies have reported disturbed emotional functioning in fibromyalgia (FM) (1, 2). Recently, FM has been conceptualized as resulting from a primary or secondary threat-soothing imbalance (3). However, whether and how threat and soothing-related emotional patterns vary along the fibromyalgianess continuum remains underexplored.
Objective. The aims are two-fold: 1. identify the most predominant emotions in each fibromyalgianess category; 2. characterize and compare the emotional patterns along the fibromyalgianess continuum.
Methods. 2871 international participants (n=2603 women) composed of people with self-reported FM (n=2255; 94.5% women) and controls (n=616; 76.6% women) were enrolled. Sociodemographic, clinical, and trait-like affective variables were collected. Descriptive and comparative analyses were conducted.
Results. Participants were categorized into the fibromyalgianess categories proposed by Wolfe (4) – absent (n=269), mild (n=170), moderate (n=177), severe (n=796), and very severe (n=1459). The five most highly rated emotions in each category were: 1) joy, love, pleasure, contentment, and enthusiasm (absent and mild); 2) joy, love, anxiety, pleasure, and contentment (moderate); 3) love, anxiety, joy, sadness, enthusiasm (severe); and 4) anxiety, sadness, upset, irritation, fear (very severe). These results show a greater imbalance between threat and soothing activation scores as FM-like symptoms become more severe, with a progressive reduction in active and safeness-related positive emotions and increased threat-related emotions.
Conclusion. Results support the FITSS model by showing a link between greater threat-soothing imbalance and more severe FM-like symptoms. These findings point to the value of assessing the emotional functioning of individuals along the fibromyalgia spectrum and, when needed, targeting such imbalance through interventions aimed at improving soothing-related outputs.