Clinical Rheumatology

, Volume 38, Issue 1, pp 149–157 | Cite as

The role of personality in patients with fibromyalgia

  • Andrew Seto
  • Xingyi Han
  • Lori Lyn Price
  • William F. Harvey
  • Raveendhara R. Bannuru
  • Chenchen WangEmail author
Original Article


Previous studies suggest personality, the multifaceted characteristics underlying a person’s affect, cognition, and behavior, may influence fibromyalgia. We examined associations among personality, fibromyalgia impact, and health-related outcomes in patients with fibromyalgia. We further tested whether anxiety and depression mediated the effect of personality on fibromyalgia impact. We performed a secondary analysis using baseline data from a randomized trial on fibromyalgia. Personality was assessed using the NEO-Five Factor Inventory 3. Fibromyalgia impact was evaluated using the revised Fibromyalgia Impact Questionnaire (FIQR). We also measured symptom severity, anxiety, depression, stress, quality of life, social support, self-efficacy, outcome expectations, and mindfulness. Multivariable linear regression was performed to evaluate each association. Mediation analysis assessed whether anxiety and depression mediated the relationship between personality and FIQR. There were 92 participants, 95% female, mean age 52 years, body mass index (BMI) 30 kg/m2, 52% white, and mean duration of body pain 14 years. Higher neuroticism was significantly associated with higher FIQR (P = 0.002) and symptom severity (P = 0.008), as well as higher levels of anxiety, depression and stress, worse mental component quality of life, and lower self-efficacy, mindfulness, and social support. Higher conscientiousness and extraversion were associated with better psychological health and health-related outcomes. The effect of neuroticism on fibromyalgia impact was mediated by anxiety and depression. Personality was associated with fibromyalgia impact and a variety of health outcomes. Identifying the factors that influence fibromyalgia will help us better understand the condition and provide insight for more effective treatment.


Anxiety Chronic pain Depression Fibromyalgia Personality 



The authors gratefully appreciate Teresa Wu for her contribution to the initial manuscript writing. We also thank Stephanie Hyon and Michelle Park for feedback on the written manuscript. We thank our study staff who tirelessly collected the data and the study participants who took the time to complete each outcome measure.


The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the NCCIH/NIH. The investigators are solely responsible for the content of the manuscript and the decision to submit for publication.


The study was supported by the National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health (R01 AT006367, K24 AT007323, and K23 AT009374) and the National Center for Research Resources, National Institutes of Health (UL1 RR025752), and the National Center for Advancing Translational Sciences, National Institutes of Health (UL1TR000073 and UL1TR001064).

Compliance with ethical standards

This study was approved by the Tufts University Human Institutional Review Board.




  1. 1.
    Walitt B, Nahin RL, Katz RS, Bergman MJ, Wolfe F (2015) The prevalence and characteristics of fibromyalgia in the 2012 National Health Interview Survey. PLoS One 10(9):e0138024CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Carville SF, Arendt-Nielsen L, Bliddal H, Blotman F, Branco JC, Buskila D, da Silva JA, Danneskiold-Samsøe B, Dincer F, Henriksson C, Henriksson KG, Kosek E, Longley K, McCarthy G, Perrot S, Puszczewicz M, Sarzi-Puttini P, Silman A, Späth M, Choy EH, EULAR (2008) EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis 67(4):536–541CrossRefPubMedGoogle Scholar
  3. 3.
    Nuesch E, Hauser W, Bernardy K, Barth J, Juni P (2013) Comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia syndrome: network meta-analysis. Ann Rheum Dis 72(6):955–962CrossRefPubMedGoogle Scholar
  4. 4.
    Goldenberg DL, Burckhardt C, Crofford L (2004) Management of fibromyalgia syndrome. JAMA 292(19):2388–2395CrossRefPubMedGoogle Scholar
  5. 5.
    Carver CS, Connor-Smith J (2010) Personality and coping. Annu Rev Psychol 61:679–704CrossRefPubMedGoogle Scholar
  6. 6.
    Martin MY, Bradley LA, Alexander RW, Alarcon GS, Triana-Alexander M, Aaron LA et al (1996) Coping strategies predict disability in patients with primary fibromyalgia. Pain 68(1):45–53CrossRefPubMedGoogle Scholar
  7. 7.
    Johnson LM, Zautra AJ, Davis MC (2006) The role of illness uncertainty on coping with fibromyalgia symptoms. Health Psychol 25(6):696–703CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Malin K, Littlejohn GO (2012) Personality and fibromyalgia syndrome. Open Rheumatol J 6:273–285CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Malin K, Littlejohn GO (2012) Neuroticism in young women with fibromyalgia links to key clinical features. Pain Res Treat 2012:730741PubMedCentralPubMedGoogle Scholar
  10. 10.
    Malin K, Littlejohn GO (2016) Psychological factors mediate key symptoms of fibromyalgia through their influence on stress. Clin Rheumatol 35(9):2353–2357CrossRefPubMedGoogle Scholar
  11. 11.
    Bucourt E, Martaille V, Mulleman D, Goupille P, Joncker-Vannier I, Huttenberger B et al (2017) Comparison of the big five personality traits in fibromyalgia and other rheumatic diseases. Joint Bone Spine 84(2):203–207CrossRefPubMedGoogle Scholar
  12. 12.
    Raselli C, Broderick JE (2007) The association of depression and neuroticism with pain reports: a comparison of momentary and recalled pain assessment. J Psychosom Res 62(3):313–320CrossRefGoogle Scholar
  13. 13.
    Kersh BC, Bradley LA, Alarcon GS, Alberts KR, Sotolongo A, Martin MY et al (2001) Psychosocial and health status variables independently predict health care seeking in fibromyalgia. Arthritis Rheum 45(4):362–371CrossRefPubMedGoogle Scholar
  14. 14.
    Martinez MP, Sanchez AI, Miro E, Medina A, Lami MJ (2011) The relationship between the fear-avoidance model of pain and personality traits in fibromyalgia patients. J Clin Psychol Med Settings 18(4):380–391CrossRefPubMedGoogle Scholar
  15. 15.
    Torres X, Bailles E, Valdes M, Gutierrez F, Peri JM, Arias A, Gomez E, Collado A (2013) Personality does not distinguish people with fibromyalgia but identifies subgroups of patients. Gen Hosp Psychiatry 35(6):640–648CrossRefPubMedGoogle Scholar
  16. 16.
    Clark LA, Watson D, Mineka S (1994) Temperament, personality, and the mood and anxiety disorders. J Abnorm Psychol 103(1):103–116CrossRefPubMedGoogle Scholar
  17. 17.
    Kadimpati S, Zale EL, Hooten MW, Ditre JW, Warner DO (2015) Associations between neuroticism and depression in relation to catastrophizing and pain-related anxiety in chronic pain patients. PLoS One 10(4):e0126351CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Lachaine J, Beauchemin C, Landry PA (2010) Clinical and economic characteristics of patients with fibromyalgia syndrome. Clin J Pain 26(4):284–290CrossRefPubMedGoogle Scholar
  19. 19.
    White KP, Nielson WR, Harth M, Ostbye T, Speechley M (2002) Chronic widespread musculoskeletal pain with or without fibromyalgia: psychological distress in a representative community adult sample. J Rheumatol 29(3):588–594PubMedGoogle Scholar
  20. 20.
    Kurtze N, Gundersen KT, Svebak S (1998) The role of anxiety and depression in fatigue and patterns of pain among subgroups of fibromyalgia patients. Br J Med Psychol 71(Pt 2):185–194CrossRefPubMedGoogle Scholar
  21. 21.
    Thieme K, Turk DC, Flor H (2004) Comorbid depression and anxiety in fibromyalgia syndrome: relationship to somatic and psychosocial variables. Psychosom Med 66(6):837–844CrossRefPubMedGoogle Scholar
  22. 22.
    Wang C, McAlindon T, Fielding RA, Harvey WF, Driban JB, Price LL, Kalish R, Schmid A, Scott TM, Schmid CH (2015) A novel comparative effectiveness study of Tai Chi versus aerobic exercise for fibromyalgia: study protocol for a randomized controlled trial. Trials 16:34CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    McCrae RR, Costa PT (2010) NEO inventories for the NEO personality inventory-3 (NEO-PI-3) NEO five-factor inventory-3 (NEO-FFI-3) NEO personality inventory-reviewed (NEO PI-R) : professional manual. Psychological Assessment Resources, FloridaGoogle Scholar
  24. 24.
    Bennett RM, Friend R, Jones KD, Ward R, Han BK, Ross RL (2009) The revised fibromyalgia impact questionnaire (FIQR): validation and psychometric properties. Arthritis Res Ther 11(4):R120CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB (2010) The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 62(5):600–610CrossRefGoogle Scholar
  26. 26.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370CrossRefGoogle Scholar
  27. 27.
    Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24(4):385–396CrossRefGoogle Scholar
  28. 28.
    Ware J, Kosinski M, Keller SD (eds) (1994) SF-36 physical and mental health summary scales: a User’s manual. Health Assessment Lab, BostonGoogle Scholar
  29. 29.
    Sherbourne CD, Stewart AL (1991) The MOS social support survey. Soc Sci Med 32(6):705–714CrossRefGoogle Scholar
  30. 30.
    Lorig K, Chastain RL, Ung E, Shoor S, Holman HR (1989) Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum 32(1):37–44CrossRefPubMedGoogle Scholar
  31. 31.
    Resnick B, Zimmerman SI, Orwig D, Furstenberg AL, Magaziner J (2000) Outcome expectations for exercise scale: utility and psychometrics. J Gerontol B Psychol Sci Soc Sci 55(6):S352–S356CrossRefPubMedGoogle Scholar
  32. 32.
    Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L (2006) Using self-report assessment methods to explore facets of mindfulness. Assessment 13(1):27–45CrossRefGoogle Scholar
  33. 33.
    Baron RM, Kenny DA (1986) The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51(6):1173–1182CrossRefGoogle Scholar
  34. 34.
    Connor-Smith JK, Flachsbart C (2007) Relations between personality and coping: a meta-analysis. J Pers Soc Psychol 93(6):1080–1107CrossRefPubMedGoogle Scholar
  35. 35.
    Yavne Y, Amital D, Watad A, Tiosano S, Amital H (2018) A systematic review of precipitating physical and psychological traumatic events in the development of fibromyalgia. Semin Arthritis Rheum 48(1):121–133CrossRefPubMedGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  1. 1.Center for Integrative Medicine & Division of Rheumatology, Tufts Medical CenterTufts University School of MedicineBostonUSA
  2. 2.The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center; Tufts Clinical and Translational Science InstituteTufts UniversityBostonUSA
  3. 3.Center for Treatment Comparison and Integrative AnalysisTufts Medical CenterBostonUSA

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