The Impact of Trauma and Emotional Regulation in Fibromyalgia, Chronic Migraine, and Their Comorbidity: A Comparative study among 3 hospitals in Italy.

Background: Research highlights a high prevalence of early traumatic experiences (psychological, physical and sexual) connected to defense mechanism and alexithymia (difficulty in identifying and expressing emotions) in nociplastic pain. However, little is known about their specificities in different diagnosis such as fibromyalgia (FM), chronic migraine (CM), and their comorbid appearance (Fibromig). Objectives: This study aimed to compare traumatic experiences, defense mechanisms, and alexithymia traits among women diagnosed with FM, CM, and Fibromig. We hypothesized that the Fibromig group would report higher levels of trauma, maladaptive defenses, and alexithymia compared to FM and CM groups. Methods: Data were collected from 295 women across three hospitals in Rome, Milan and Pavia, Italy. Validated tools were used to assess trauma and emotional regulation, including the Traumatic Experience Checklist, the Defense Mechanism Rating Scale, and the Toronto Alexithymia Scale-20. Results: The Kruskal-Wallis test revealed significant differences across several measures: compared to CM, the Fibromig and FM groups reported more traumatic experiences, particularly emotional neglect (p<.003), with the Fibromig group also showing a higher impact of sexual harassment (p<.026). No group differences were observed for emotional, physical, or sexual abuse, nor for the use of immature, neurotic, or mature defenses to cope with stress. Alexithymia was significantly higher in Fibromig and FM groups compared to CM (p<.001). Conclusion: This study highlights emotional neglect and sexual harassment as key areas of trauma in FM and Fibromig patients. Additionally, the findings underscore the importance of addressing alexithymia in these groups to improve emotional well-being and overall patient care.