The bodily self in fibromyalgia: A systematic review and meta‐analysis of body image, body representation, and interoceptive dysfunction

Fibromyalgia is a complex chronic pain condition associated with widespread symptoms and perceptual distortions beyond nociception. Alterations in body image, body representation, and interoception may contribute to symptom severity and reduced quality of life. This review synthesizes evidence related to body image in adults with fibromyalgia. A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science were searched. Eligible studies included quantitative and qualitative designs examining body image, body awareness, and body esteem in adults with fibromyalgia. Risk of bias was assessed using the Newcastle-Ottawa Scale and the CASP checklist. A random-effects meta-analysis was performed. Meta-regression and subgroup analyses explored sources of variance. Twenty-five studies were included. Patients with fibromyalgia showed significant impairments in body image, body awareness, and body esteem compared to healthy controls and other rheumatic conditions (pooled ES = 0.99; 95% CI [0.64-1.35]). These disturbances were positively associated with pain intensity and disease impact, and negatively with quality of life, anxiety, depression, and alexithymia. Qualitative findings described bodily alienation and transformation of bodily identity. Evidence was limited by cross-sectional designs and variability in outcome measures. Fibromyalgia involves multidimensional disturbances of the bodily self with perceptual, cognitive, and affective components, associated with greater symptom burden and poorer quality of life. Longitudinal and mixed-methods research integrating neurobiological and subjective measures is needed, alongside standardized tools and targeted interventions for body awareness and interoceptive regulation.