Fibromyalgia and Somatic Symptom Disorder: Two Sides of the Same Coin?

Fibromyalgia affects about 1.78% of the population worldwide and has been recognized and studied since the 16th century. Despite that, the etiopathogenesis of fibromyalgia is still unknown. Consequently, there is still an ongoing debate whether fibromyalgia should be considered within the category of somatization disorders, or as a central pain sensitization syndrome, or even as a peripheral nerve disease. We consider that this is a relevant issue, since it impacts the referral of these patients to the different healthcare professionals, the type of assessment that is provided and the therapeutic approaches that are proposed to them.Several aspects point to similarities between fibromyalgia and somatic symptom disorder: both diagnoses share high comorbidity with several psychiatric disorders, a history of childhood trauma, the presence of alexithymia and other personality traits, insecure attachment styles and comorbidity with the so-called chronic overlapping pain conditions. Therefore, we hypothesize that fibromyalgia can be conceptualized as a somatic symptom disorder. However, the debate continues, since there is still a lack of scientific evidence supporting either in favor or against this perspective. More studies are needed to unveil the etiopathogenesis behind these two diagnoses.