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To view this content, JavaScript must be enabled, and you need the latest version of the Adobe Flash Player. Furthermore, poor psychosocial functioning and unsatisfactory relationships might contribute to the genesis and maintenance of chronic pain [ 96 ], intensifying the symptomatology in individuals with FM. From a neurological standpoint, the brain networks relevant for pain and emotional processing partially overlap.

The amygdala plays a crucial role in sharing emotional experiences and in recognising emotions in oneself and others [ 34 , 36 ]. In particular, this structure is involved in the decoding of emotional expressions, and modulates the activity of the fusiform gyrus, which constitutes the most prominent face-selective area of the brain.

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Neuroimaging studies have indeed shown sensitivity of the amygdala to the kind and valence of facially expressed emotions [ 97 — 98 ]. The insular cortex may also be relevant in this context. It has been reported, for instance, that impaired disgust recognition is associated with reduced insula activity [ 99 ]. In addition to their prominent role in emotional functioning, the amygdala and the insula are integral parts of the neural network underlying pain.

Specifically, both structures are involved in transmitting the affective dimension of pain perception [ ] and are altered in patients with FM [ 69 , ]. The hyperactivity of the pain network due to central nervous system sensitisation, may lead to an increased demand on structures such as the amygdala and insula, reducing the available resources for other functions such as emotional processing.

As far as the second goal of this study is concerned, we investigated whether EF measures in the FM group were related to the different social cognition tasks that were used.

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In addition, we also analysed the possible relationships between demographic, clinical and psychological variables, and measures of social cognition. Concerning EF tasks, no correlations were found between social cognition tasks and each of the four subcomponents of the EF domain that were analysed.

The only exception was represented by a low positive correlation between the Ekman total score and the DS B. Regarding the demographic, clinical and psychological variables, correlation analyses showed no relationship between Ekman total score, anger and disgust, RME experimental, on the one hand, and anxiety, depression and pain intensity, on the other hand.

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Positive correlations were only detected between the latter measures anxiety, depression, and pain and the total score and scores for the F1 and F2 subscales of the TAS This result is consistent with previous studies that have investigated the presence of alexithymia in FM patients [ 18 , 20 , ]. In particular, Steinweg et al. However, they also revealed that alexithymia was strongly associated with moderate-to-severe depression, but no group differences were detected when mood disturbance was controlled for.

Taken together, as far as the first aim of this study is concerned, the results show the presence of several impairments in social cognition skills in patients with FM. As for the second aim, i. The only exception seems to be represented by alexithymia; in fact, psychological disorders, but not EF deficits, seem to play a role in explaining the high levels of alexithymia found in the FM sample.


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Concerning other measures of social cognition, no relationship was found with EF deficits or symptoms of psychological distress. In our sample, impairments in ToM and emotional processing ability appeared to be independent of the EF domain.

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This study also has some limitations. Firstly, even though we enrolled an adequate number of patients with FM, our study is still limited by a relatively small sample size.


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Secondly, the self-reported measures we used might have elicited a bias towards social desirability, masking the real profile of some individuals. Thirdly, although in patients with FM there is evidence of structural and functional alterations in brain areas crucial for ToM and emotional processing abilities i.

Future studies should include neuroimaging evaluations and use performance-based instruments for the analysis of both empathic capacity and alexithymia, in addition to traditional self-reported tests. In spite of these limitations, the findings reported in the present study represent the first contribution towards understanding the complex social-cognitive profile of patients with FM. The impairments reported in tasks that evaluate ToM and emotional processing abilities highlight the importance of adequately assessing these abilities in clinical practice.

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The authors would like to thank Valentina Tesio, Stefania Brighenti and Francesca Monoli for their help in collecting data. Lorys Castelli and Rita B. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.


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National Center for Biotechnology Information , U. PLoS One. Published online Jan Ardito , 1 and Mauro Adenzato 1 , 4. Rita B. Cosimo Urgesi, Academic Editor. Author information Article notes Copyright and License information Disclaimer. Competing Interests: The authors have declared that no competing interests exist. Received Sep 12; Accepted Dec This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.

This article has been cited by other articles in PMC. Abstract Background Fibromyalgia FM is a syndrome primarily characterised by chronic, widespread musculoskeletal pain. Methodology Forty women with FM and forty-one healthy women matched for education and age were involved in the study.

Conclusions The results show the presence of several impairments in social cognition skills in patients with FM, which are largely independent of both executive function deficits and symptoms of psychological distress.

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Introduction Fibromyalgia FM is a syndrome primarily characterised by chronic, widespread musculoskeletal pain [ 1 — 2 ]. Participants and procedure Forty female participants with FM Results Demographic, clinical and psychological data Data on the demographic and psychological variables are presented in Table 1. Open in a separate window. Neuropsychological assessment The comparisons between the neuropsychological scores of the two groups are shown in Table 2.

Table 2 Neuropsychological tests scores. Table 3 Number and percentage of patients with FM and healthy controls with impaired or borderline performance E. Social cognition tasks Data from social cognition tasks are reported in Table 4. Table 4 Theory of Mind and emotional functioning measures scores. Correlations The second aim of this study was to investigate the possible relationships between social cognition tasks and EF measures in patients with FM.

Discussion The present study aimed to address two main objectives. Acknowledgments The authors would like to thank Valentina Tesio, Stefania Brighenti and Francesca Monoli for their help in collecting data. Data Availability All relevant data are within the paper. References 1. Mease P Fibromyalgia syndrome: J Rheumatol Clin Exp Rheumatol 27 Accessed 14 October The influence of psychological symptoms and mental disorder on healthcare seeking behavior.

Eur Psychiatry Prevalence of fibromyalgia: Semin Arthritis Rheum 39 6: Nat Rev Rheumatol 7 9: Br J Rheumatol Psychosomatics Van Houdenhove B, Luyten P Fibromyalgia and related syndromes characterised by stress intolerance and pain hypersensitivity: Do we need a new nosology? Curr Rheumatol Rev 3: Arthritis Res Ther 7: Int J Rheum Dis Psychosom Med Acta Biomed Clin Rheumatol J Psychosom Res Clin Exp Rheumatol Front Psychol 4: Sifneos PE Short-term psychotherapy and emotional crisis.

Harvard University Press. Alexithymia in medical and psychiatric illness. Cambridge University Press. Facial emotion recognition and alexithymia in adults with somatoform disorders. Depress Anxiety Psychosom Med 72 4: Evidence of preserved Theory of Mind and impaired emotional functioning. Clinical Neuropsychiatry Behav Med Adolphs R The neurobiology of social cognition. Curr Opin Neurobiol Adolphs R Investigating the cognitive neuroscience of social behaviour.

Neuropsychologia Behav Brain Sci 1: Leslie AM Pretense and representation: Psychol Rev Behav Cogn Neurosci Rev 3: Lieberman MD Social cognitive neuroscience: A review of core processes. Annu Rev Psychol A functional magnetic resonance imaging study in a nonverbal task. NeuroImage Decety J The neurodevelopment of empathy in human.


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