The mediator role of alexithymia between childhood traumas and fibromyalgia impact level of patients with fibromyalgia

Abstract

Objective: Fibromyalgia is a disease that is associated with childhood traumas. The person’s alexithymic features, such as avoidance of intensely experienced negative emotions or the inability to express their emotions, may cause physical symptoms, particularly fibromyalgia. This study aimed to examine the relationship between fibromyalgia and childhood traumas and alexithymia. Methods: Sample selection was made using the convenience sampling method. A total of 185 patients, 128 females (69.2%) and 57 males (30.8%), diagnosed with fibromyalgia participated in the study. The average age of the participants was 38.6, ranging from 18 to 65 years. The study was designed with relational screening and convenience sampling method. Fibromyalgia Impact Questionnaire (FIQ), Perth Alexithymia Questionnaire (PAQ), Childhood Trauma Questionnaire (CTQ), and socio-demographic data form were applied to the participants. The SPSS 25 program was used to examine the acquired data. Independent samples t-test, Pearson correlation analysis, and one way ANOVA were used. Results: Results showed that childhood traumas and alexithymia predicted the effect level of fibromyalgia (49%), and alexithymia played a partial mediator role (8%) between childhood traumas and fibromyalgia impact level. It has been observed that emotional abuse (p<.001) and emotional neglect (p=.002) affect the effect level of fibromyalgia. It was discovered that the participants’ degrees of fibromyalgia impact and alexithymia, and childhood traumas varied significantly by education and perceived income levels (p<0.05). Conclusion: In addition to physiotherapy interventions in the treatment of fibromyalgia patients, focusing on the patients’ traumatic childhood memories and helping them to recognize, express, and make sense of their emotions during the psychotherapy process will help alleviate the patients’ pain intensity.

Keywords

• Fibromyalgia
• childhood traumas
• emotional deafness
• alexithymia

References

1. Boussi-Gross R, Catalogna M, Lang E, Shamai Z, Ablin JN, Aloush V, et al. Hyperbaric oxygen therapy vs. pharmacological intervention in adults with fibromyalgia related to childhood sexual abuse: prospective, randomized clinical trial. Sci Rep. 2024;14(1):11599. https://doi.org/10.1038/s41598-024-62161-5
2. Heidari F, Afshari M, Moosazadeh M. Prevalence of fibromyalgia in general population and patients, a systematic review and meta-analysis. Rheumatol Int. 2017;37:1527-39. https://doi.org/10.1007/s00296-017-3725-2
3. Husak AJ, Bair MJ. Chronic pain and sleep disturbances: a pragmatic review of their relationships, comorbidities, and treatments. Pain Medicine. 2020;21(6):1142-52. https://doi.org/10.1093/pm/pnz343
4. Sandoval NB, Solà JF, Mateo AG, Durán MPN, Urrea LAM, Belmonte ST, et al. Design and validation of a predictive model for determining the risk of developing fibromyalgia. Clin Exp Rheumatol. 2023;1:1238-47.
5. Combas M, Ozturk E, Derin G. Childhood trauma and dissociation in female patients with fibromyalgia. Medicine. 2022;11(4):1635-40. https://doi.org/10.5455/ medscience.2022.09.211
6. Romeo A, Tesio V, Ghiggia A, Di Tella M, Geminiani GC, Farina B, et al. Traumatic experiences and somatoform dissociation in women with fibromyalgia. Psychol Trauma. 2022;14(1):116-23. https://doi.org/10.1037/tra0000907.
7. Shafiei M, Rezaei F, Sadeghi M. The role of childhood traumas, interpersonal problems, and contrast avoidance model in development of the generalized anxiety disorder: A structural equation modeling. Psychol Trauma. 2022;14(3):377–85. https://doi.org/10.1037/tra0001117
8. Gul H, Torun YT, Cakmak FH, Gul A. Facial emotion recognition in adolescent depression: The role of childhood traumas, emotion regulation difficulties, alexithymia and empathy. Indian J Psychiatry. 2023; 5(4):443-52. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_284_22

9. Martínez MP, Sánchez AI, Miró E, Lami MJ, Prados G, Morales A. Relationships between physical symptoms, emotional distress, and pain appraisal in fibromyalgia: The moderator effect of alexithymia. J Psychol.2015;149(2):115-40. https://doi.org/10.1080/00223980.2013.844673
10. Asgarabad HM, Yegaei PS, Jafari F, Azami-Aghdash S, Lumley MA. The Relationship of Alexithymia to Pain and Other Symptoms in Fibromyalgia: A Systematic Review and Meta-analysis. Eur J Pain. 2022;27(3):1-17 https://doi.org/10.1002/ejp.2064
11. Trucharte A, Leon L, Castillo-Parra G, Magán I, Freites D, Redondo M. Emotional regulation processes: influence on pain and disability in fibromyalgia patients. Clin Exp Rheumatol. 2020;38(123):40-46. 12. Fonagy P, Bateman AW. Adversity, attachment, and mentalizing. Compr Psychiatry. 2016;64:59-66. https://doi.org/10.1016/j.comppsych.2015.11.006
12. Fonagy P, Bateman AW. Adversity, attachment, and mentalizing. Compr Psychiatry. 2016;64:59-66. https://doi.org/10.1016/j.comppsych.2015.11.006
13. Eilers H, aan het Rot M, Jeronimus BF. Childhood trauma and adult somatic symptoms. Psychosom Med. 2023; 85(5):408-16. https://doi.org/10.1097/PSY.0000000000001208
14. Güleç MY, Altintaş M, İnanç L, Bezgin ÇH, Koca, EK, Güleç H. Effects of childhood trauma on somatization in majör depressive disorder: The role of alexithymia. J Affect Disord. 2013;146(1):137-41. https://doi.org/10.1016/j.jad.2012.06.033
15. Pei JH, Wang X, Ma T, Du Y, Dou X. Alexithymia in a Chinese patient with chronic pain and associated factors: A cross-sectional study. Pain Manag Nurs. 2023;24(4):1-6. https://doi.org/10.1016/j.pmn.2023.01.003
16. Burckhardt CS, Clark SR, Bennett RM. The Fibromyalgia Impact Questionnaire: Development and validation. J Rheumatol Suppl. 1991;5:728-33.
17. Sarmer S, Ergin S. The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire. Rheumatol Int. 2000;20:9-12. https://doi.org/10.1007/s002960000077
18. Preece D, Becerra R, Robinson K, Dandy J, Allan A. The psychometric assessment of alexithymia: Development and validation of the Perth Alexithymia Questionnaire. Res Autism Spectr Disord. 2018;132:32-44. https://doi.org/10.1016/j.paid.2018.05.011
19. Gross JJ. Emotion regulation: Current status and future prospects. Psychol Inq. 2015;26(1):1-26. https://doi.org/10.1080/1047840X.2014.940781
20. Bilge Y. The measurement of attention-appraisal modal of alexithymia: psychometric properties of the Perth Alexithymia Questionnaire in Turkish. Anadolu Psikiyatri Derg. 2020;21(2):71-9. https://doi.org/10.5455/apd.133183
21. Bernstein DP, Fink L, Handelsman L, Foote J, Lovejoy M, Wenzel K, et al. Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry. 1994;151(8):1132-6. https://doi.org/10.1176/ajp.151.8.1132
22. Şar V, Öztürk E, İkikardeş E. Validity and reliability of the Turkish Version of the Childhood Trauma Questionnaire (CTQ). Turkiye Klinikleri Journal of Medical Sciences. 2012;32(4):1054-63.
23. Şar V, Necef I, Mutluer T, Fatih P, Türk-Kurtça T. A revised and expanded version of the Turkish Childhood Trauma Questionnaire (CTQ-33): Overprotection-overcontrol as additional factor. J Trauma Dissociation. 2021 22(1):35-51. https://doi.org/10.1080/15299732.2020.1760171
24. Tabachnick BG, Fidell LS. Using Multivariate Statistics. Pearson. 2013.
25. Emir BS, Yıldız S, Sehlikoğlu Ş, Çakmak E, Gözel N. An Investigation of Alexithymia, Type D Personality Traits, and Childhood Traumas in Patients with Fibromyalgia. SAS J. Med. 2023;8:873-9. https://doi.org/10.36347/sasjm.2023.v09i08.013
26. Ditzer J, Wong EY, Modi RN, Behnke M, Gross JJ, Talmon A. Child maltreatment and alexithymia: A meta-analytic review. Psychol Bull. 2023;149(5-6):311. https://doi.org/10.1037/bul0000391
27. Adamowicz JL, Sirotiak Z, Thomas EBK. Childhood maltreatment and somatic symptoms: Examining the role of specific types of childhood maltreatment and alexithymia. Psychol Trauma. 2022; Advance online publication. https://doi.org/10.1037/tra0001315
28. Brown S, Fite PJ, Stone K, Richey A, Bortolato M. Associations between emotional abuse and neglect and dimensions of alexithymia: The moderating role of sex. Psychol Trauma. 2018;10(3):300-8.
29. Schimmenti A. The developmental roots of dissociation: A multiple mediation analysis. Psychoanalytic Psychology. 2017;34:96-105.
30. Khan AN, Jaffee SR. Alexithymia in individuals maltreated as children and adolescents: a meta-analysis. J Child Psychol Psychiatry. 2022;63(9):963-72. https://doi.org/10.1111/jcpp.13616
31. Kick L, Schleicher D, Ecker A, Kandsperger S, Brunner R, Jarvers I. Alexithymia as a mediator between adverse childhood events and the development of psychopathology: a meta-analysis. Front Psychiatry. 2024;15:1412229. https://doi.org/10.3389/fpsyt.2024.1412229
32. Chen P, Sun X, Zhang Q, Yang C, Ye X, Wang Y, et al. Alexithymia and depressive symptoms mediated the relationship between childhood trauma and suicidal risk in Chinese male prisoners. Curr Psychol. 2022;42: 29023-34. https://doi.org/10.1007/s12144-022-03975-2
33. Krvavac S, Jansson B. The role of emotion dysregulation and alexithymia in the link between types of child abuse and neglect and psychopathology: A moderated mediation model. European Journal of Trauma & Dissociation. 2021;(3):100213. https://doi.org/10.1016/j.ejtd.2021.100213
34. Romeo A, Di Tella M, Ghiggia A, Tesio V, Fusaro E, Geminiani GC, Castelli L. Attachment style and parental bonding: Relationships with fibromyalgia and alexithymia. PloS One. 2020;15(4):e0231674. https://doi.org/10.1371/journal.pone.0231674
35. Aaron RV, Fisher EA, De La Vega R, Lumley MA, Palermo TM. Alexithymia in individuals with chronic pain and its relation to pain intensity, physical interference, depression, and anxiety: A systematic review and meta-analysis. Pain. 2019;160(5):994-1006. https://doi.org/10.1097/j.pain.0000000000001487
36. Marchi L, Marzetti F, Scotto J, Cesari V, Baroni M, Miccoli M, et al. Alexithymia, negative affective states and pain in patients with fibromyalgia: An experımental study. MJCP. 2019;7(2):93-4.
37. Di Tella M, Castelli L. Alexithymia in chronic pain disorders. Curr Rheumatol Rep. 2016;18:1-9. https://doi.org/10.1007/s11926-016-0592-x
38. Obeid S, Akel M, Haddad C, Fares K, Sacre H, Salameh P, Hallit S. Factors associated with alexithymia among the Lebanese population: Results of a cross-sectional study. BMC Psychol. 2019;7(80):1-10. https://doi.org/10.1186/s40359-019-0353-5
39. Han D, Lu Y, Huang R, Yang Z, Peng G, Qiao Y, et al. Acupuncture for fibromyalgia: A review based on multidimensional evidence. Am J Chin Med. 2023;51(2):1-29. https://doi.org/10.1142/S0192415X23500143
40. Bozbulut R, Soysal Acar AŞ, Döğer E, Orhun Çamurdan M, Bideci A. The relationship between alexithymia, health literacy, and diet quality in obese adolescents. J Pediatr Endocrinol Metab. 2023;36(2):137-46. https://doi.org/10.1515/jpem-2022-0405
41. Estrela M, Semedo G, Roque F, Ferreira PL, Herdeiro MT. Sociodemographic determinants of digital health literacy: A systematic review and meta-analysis. International Journal of Medical Informatics. 2023;177:105124. https://doi.org/10.1016/j.ijmedinf.2023.105124
42. Atzeni F, Alciati A, Bazzichi L, Govoni M, Biasi G, Di Franco M, et al. Sociodemographic factors in fibromyalgia: Results from the Italian Fibromyalgia Registry. Clin Exp Rheumatol. 2022;40(6):1183-8. https://dx.doi.org/10.55563/clinexprheumatol/64963d
43. Fitzcharles MA, Rampakakis E, Ste-Marie PA, Sampalis JS, Shir Y. The association of socioeconomic status and symptom severity in persons with fibromyalgia. J Rheumatol Suppl.. 2014;41(7):1398-1404. https://doi.org/10.3899/jrheum.131515
44. Benebo FO, Lukic M, Jakobsen MD, Braaten TB. The role of lifestyle factors in the association between education and self-reported fibromyalgia: a mediation analysis. BMC Womens Health. 2024;24(244):1-12. https://doi.org/10.1186/s12905-024-03060-9
45. Cantürk M, Faraji H. Tezcan AE. The relatıonshıp between chıldhood trauma and crıme ın male prısoners, Alpha Psychiatry. 2021;22(1):56-60. https://doi.org/10.5455/apd.111825
46. Bauer A, Fairchild G, Hammerton G, Murray J, Santos IS, Rodrigues LT, et al. Associations between childhood trauma and childhood psychiatric disorders in Brazil: A population-based, prospective birth cohort study. Lancet Psychiatry. 2022;9(12):969-77. https://doi.org/10.1016/S2215-0366(22)00337-6
47. Mathkhor AJ, Atwan AH. Fibromyalgia syndrome and its allied clinical features are associated with low socioeconomic status. Int J Clin Rheumtol. 2022;17(11):155-60.
48. Metwally RS, Abdullah AA, AlAmmar WA, Sebastian T. Are dietary pattern associated with alexithymia in Saudi adults? Nutr Health. 2024;30(2):291-300. https://doi.org/10.1177/02601060221115508
49. Cooksey R, Choy E. Exploring gender differences, medical history, and treatments used in patients with fibromyalgia in the UK using primary-care data: A retrospective, population-based, cohort study. Lancet Rheumatol. 2022;4:20. https://doi.org/10.1016/S2665-9913(22)00296-X