Emotional Dysregulation as a Central Pathogenetic Mechanism of Fibromyalgia

Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread musculoskeletalpain, fatigue, sleep disturbances, and cognitive impairment. Despite its high prevalenceand substantial socioeconomic impact, the pathogenesis of FM remains a matter of debate.This article proposes an integrative synthesis of neuroscientific, psychological, and clinicalevidence converging on a unifying model: emotional dysregulation as a central pathogeneticmechanism of fibromyalgia. Through analysis of recent literature, it is argued that FM ischaracterized by structural and functional alterations in the neural systems responsible foremotional regulation—particularly the amygdala, the salience network, and limbic-corticalcircuits—and that such alterations contribute significantly to amplifying and maintainingpain. Neurobiological mechanisms are examined (amygdala hyperactivity, imbalance betweenthreat and soothing systems, HPA axis dysregulation, reduced vagal tone), along with therole of alexithymia as a deficit in emotional awareness, and the therapeutic implicationsof this model, with particular attention to Emotional Awareness and Expression Therapy(EAET). Clinical implications underscore the need for interventions integrating emotionalregulation into FM treatment. Methodological limitations of available evidence and futureresearch directions are also discussed.