Fibromyalgia, personality and early trauma: neuroticism, psychoticism and shared vulnerability in an integrated perspective

Abstract

Fibromyalgia (FM) is a chronic pain syndrome with a multifactorial aetiology, in which agrowing body of scientific literature has documented the modulating role of personality traits.This article offers a critical and up-to-date synthesis of the literature on the relationship be-tween fibromyalgia, personality and early trauma, with particular attention to the dimensionsof neuroticism, extraversion and psychoticism in Eysenck’s model. The neurotic profile isdiscussed, associated with greater emotional vulnerability, use of psychotropic medicationand potential amplification of subjective suffering, together with the role of psychoticism,correlated with greater pain severity but also with peculiar anxiety patterns. Particularattention is devoted to the heterogeneity of the extraversion construct: contrary to what issometimes assumed, it does not appear to be stably reduced in FM, but it exerts a protectiveeffect on symptoms and pharmacological burden within the clinical group. The prevalence ofpersonality disorders is also examined, revealing a complex pattern involving both Cluster Cand, according to recent population-scale data, Cluster B. Finally, the article explores the roleof early trauma as a shared aetiological factor capable of bridging personality vulnerability,chronic pain and psychosis, discussing the hypothesis that fibromyalgia may configure, insome patients, as an early or prodromal manifestation of an evolving psychotic vulnerabil-ity. Clinical implications highlight the need for integrated psychodiagnostic assessment andtrauma-informed approaches. Overall, the article argues that fibromyalgia cannot be fullyunderstood without placing the patient’s personality traits and traumatic history within aunitary biopsychosocial model, with direct repercussions on treatment personalisation and onthe prevention of chronification.