Somatization Syndrome, Childhood Trauma Identified as Fibromyalgia Predictors

A recent study reported that patients with fibromyalgia had significantly more traumatic events, psychosomatic syndromes, anxiety, depression, and pain compared to patients with rheumatoid arthritis (RA).1 However, the analysis only identified somatization syndromes and childhood trauma as predictors of fibromyalgia.

“… our results confirmed that [fibromyalgia] patients are primarily characterized by marked somatization and a high prevalence of early stressful life events compared with a similar chronic condition in which pain is primarily nociceptive in origin, such as RA,” wrote investigators, led by Ada Ghiggia, from the department of life sciences at University of Trieste in Italy.

Chronic pain in fibromyalgia often links to sleep disturbances, fatigue, cognitive dysfunction, affective disorders, hyperalgesia, and allodynia. Genes and stress exposure likely predispose individuals to fibromyalgia, although the etiology and pathophysiology of this pain disease remain unknown. According to the Mayo Clinic, people are at a greater risk of developing fibromyalgia if they are female, have a parent or sibling with it, and have osteoarthritis, RA, lupus, or obesity.2

Nociplastic pain, the term created to validate pain complaints without clear evidence of nociceptive or neuropathic involvement, describes pain from altered function of sensory pathways in the periphery and central nervous system.1 This type of pain occurs in fibromyalgia; patients with nociplastic pain often report a history of psychosocial trauma and stressful life events. Moreover, RA is a primary nociceptive pain disorder.

Investigators aimed to evaluate the influence of traumatic experiences and psychosomatic factors as potential predictors of chronic pain, with or without fibromyalgia. They compared stressful life events (Traumatic Experiences Checklist), psychosomatic syndromes (Toronto Alexithymia Scale and Diagnostic Criteria for Psychosomatic Research), pain, and psychological distress (Black Depression Inventory-II and State-Trait Anxiety Inventory) in 104 patients with fibromyalgia vs. 104 patients with RA.

Patients with fibromyalgia reported significantly more traumatic events, psychosomatic syndromes, pain, anxiety, and depression compared to patients with RA (P < .01). A hierarchical binary logistic regression showed that somatization syndromes (odds ratio [OR], 3.67), pain (OR, 1.56), and child trauma (OR, 1.11) were statistically significant predictors of group belonging. This finding explained 67% of the diagnosis variance (P < .001).

“Although the majority of studies agree that traumatic life events may be a predictor of the onset and development of FM, the debate about the nature and timing of trauma remains controversial and leads to conflicting results,” investigators wrote.

In this study, they found emotional neglect and emotional abuse among patients with chronic pain were common in childhood and adolescence (0 – 18 years). Though emotional neglect and emotional abuse were significantly more common in RA than in fibromyalgia.

The study also found patients with fibromyalgia reported ≥ 1 of the 12 psychosomatic syndromes assessed with the DCRP, yet about a fifth of patients with RA did not have any psychosomatic syndrome.

Investigators also compared abnormal illness in patients with fibromyalgia vs RA and found that only thanatophobia was more significantly common in patients with fibromyalgia. Irritability was frequently reported in both patients with fibromyalgia (50%) and RA (20%), with a significantly greater prevalence in fibromyalgia. Additionally, more than half of the patients with fibromyalgia experienced demoralization.

Patients with fibromyalgia also had a high prevalence of psychosocial stress, with 80% affected by persistent somatization, 50% by conversion symptoms, and 45% by anniversary reactions—all greater than in those with RA.

The study discovered that, alongside pain, only somatization syndromes and childhood trauma served as significant predictors of an individual receiving a fibromyalgia diagnosis over an RA one.

“Taken together, neither the differences in psychological distress nor the differences in the other types of psychosomatic syndromes contribute significantly to explaining the differences between the groups,” investigators concluded. “From a clinical perspective, the fact that psychological factors other than psychological distress, such as somatization, play a more central role in FM underlines the importance of assessing these aspects in order to implement appropriate and effective psychological interventions.”

References

1. Ghiggia A, Tesio V, Colonna F, Fusaro E, Geminiani GC, Castelli L. Stressful Life Events and Psychosomatic Symptoms in Fibromyalgia Syndrome and Rheumatoid Arthritis. Int J Environ Res Public Health. 2025 Mar 2;22(3):366. doi: 10.3390/ijerph22030366. PMID: 40238382; PMCID: PMC11941855.

2. Fibromyalgia. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780. Accessed April 28, 2025.