When Emotions Hurt: Reduced Differentiation Between Physiological and Emotional States in Fibromyalgia

Background People with fibromyalgia often demonstrate hypersensitivity to benign bodily signals and misattribute non-noxious physical sensations as pain, suggesting alterations in body-brain communication and interoception. However, little is known about whether altered body-brain communication may extend to misattribution of emotion as pain. Here, using a cross-sectional design, we aimed to investigate how individuals with fibromyalgia perceive, identify, and interpret emotions and other bodily sensations, including pain, compared to healthy controls. Methods Nineteen people with fibromyalgia and 19 age- and gender-matched pain-free controls completed the emBODY task, which assesses the topography of experienced bodily sensations for 13 different states [seven emotional states, neutral state, three pain-related states (stomach ache, headache, pain today), as well as physical and mental fatigue]. Additionally, participants completed self-report measures of alexithymia, bodily sensation interpretation, and interoception. Results Compared to controls, participants with fibromyalgia coloured larger body areas in all body sensation maps. Linear discriminant analysis, performed to test whether different emotions and states are associated with statistically distinct bodily patterns, indicated that the classification accuracy of body sensation maps was lower in the fibromyalgia group. Moreover, compared with controls, the fibromyalgia group showed higher levels of alexithymia, higher awareness of bodily signals, and more negative interpretation of ambiguous bodily sensations in daily life. Conclusions Our findings provide evidence for an amplified perception of bodily signals coupled with enlarged embodiment of both emotions and non-emotional states in fibromyalgia. Targeting perception, differentiation, and interpretation of bodily sensations might hold therapeutic value, by improving pain symptoms and their impact, including increased engagement in everyday activities.