Restricted emotional processing and somatic attribution in fibromyalgia

Objective: Medically unexplained symptoms or syndromes, such as fibromyalgi a (FM), might be partly caused or sustained by a mechanism involving restri cted emotional processing (REP) and the subsequent attribution of emotional arousal to somatic or syndrome-consistent causes. In this study, it was hy pothesized that FM patients, compared to healthy individuals, would be high er on trait measures of REP (defensiveness and alexithymia), and would show affective-autonomic response dissociation, that is, higher standardized sc ores of heart rate responses than affective responses, during negative emot ional stimulation. Additionally, FM patients were expected to attribute the ir bodily symptoms more to somatic than to psychological causes. Method: Em otional movie excerpts were shown to 16 female FM patients and 17 healthy w omen. Affective response and heart rate were monitored continuously, while symptoms and their causal attributions were measured before and after the e xcerpts. Repressor coping style and alexithymia. were measured, along with negative affectivity and habitual attributions of somatic complaints. Resul ts: FM patients nearly all showed the relatively uncommon combination of hi gh defensiveness and high anxiousness. Compared with healthy women FM patie nts were more alexithymic, showed a higher level of affective-autonomic res ponse dissociation, and lower within-subject emotional variability. The gro ups showed opposite attributional patterns, with FM patients attributing sy mptoms less to psychological causes and more to somatic causes. There was n o evidence of a shift in these attributions caused by the emotional stimuli . Conclusions: The results provide preliminary support for the hypotheses. Both at trait and at state level, FM showed restricted emotional processing on most of the parameters measured, and a high ratio of somatic to psychol ogical symptom attribution, coupled with high negative affectivity.