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evaluación del perfi l psicopatológico puede permitir la identifi cación precoz de los pacientes más vulnerables al deterioro funcional debido a la presencia de posible psicopatología, así como facilitar las adaptaciones terapéuticas. Palabras clave: fi bromialgia, psicopatología, moderador, dolor, sueño, deterioro. Psicothema 2021, Vol. 33, No. 2, 214-221 doi: 10.7334/psicothema2020.338 Received: September 5, 2020 • Accepted: November 23, 2020 Corresponding author: M. Pilar Martínez Department of Personality, Assessment and Psychological Treatment University of Granada 18071 Granada (Spain) e-mail: mnarvaez@ugr.es Psychopathology as a Moderator of the Relationship Between Physical Symptoms and Impairment in Fibromyalgia Patients 215 80%) which are associated with a worse physical status and quality of life in FM patients (Gálvez-Sánchez et al., 2019), being hypochondriasis, depression, and hysteria the most frequently elevated clinical dimensions in FM (Novo et al., 2017). This profi le appears to be specifi c of FM and is not identifi ed in other chronic pain conditions such as rheumatoid arthritis (González et al., 2019). Several studies have examined the links between FM and possible psychopathology via the Symptom Checklist-90-Revised (SCL90-R; Derogatis, 1994), one of the most widely used instruments for screening psychological distress. The SCL-90-R explores cognitive, emotional and somatic aspects, and both internalizing and externalizing symptoms, through simple and easily understandable items that make this instrument less invasive than other measures that directly ask about the symptoms of mental disorders (Preti et al., 2019). The SCL-90-R has been administered to compare the psychopathological profi le of FM patients versus that of patients with other CSS (Fillingim et al., 2020), having been widely used to assess the therapeutic changes in FM symptoms (Lami et al., 2018). Furthermore, it is a recommended instrument by the Spanish Society of Rheumatology (Rivera et al., 2006) to examine psychopathology in FM. Using the SCL-90-R, Keller et al. (2011) found that Type IIFM patients (characterized by high levels of pain, fatigue, morning tiredness, stiffness, anxiety and depressive symptoms) showed greater psychopathology (general index) than Type I-FM patients (characterized by low levels of the previous clinical parameters). Salgueiro et al. (2012) observed that Type II-FM patients exhibited higher level of psychopathology (in all dimensions) than Type I-FM patients, displaying scores above the diagnostic cutoff in somatization, obsessive-compulsive and depression. Also in Type II-FM patients all psychopathological dimensions (except hostility) were inversely correlated with the physical component of health but none of them correlated with clinical pain. Glazer et al. (2009) found that FM patients and relatives with FM reported higher level on most psychopathological dimensions compared to healthy relatives. Garaigordobil and Govillard (2016) observed that FM patients showed higher percentile-scores in somatization, obsessivecompulsive, interpersonal sensibility, depression and anxiety compared with the non-clinical group, but only higher percentilescores in somatization compared with the psychiatric group. Although cognitive processes/emotional states may be involved in the onset of CSS (including FM), they are mainly considered as maintenance factors of these syndromes, amplifying the perception of noxious sensory information and interfering with disease’s adaptation (Adams & Turk, 2018). Advancing in the knowledge about how psychological factors affect the FM symptoms and/or the daily functioning of patients is of great relevance since they are the elements on which treatment programs can impact. Emotional distress, stressful periods, and negative cognitive style are known to aggravate symptoms and worsen functional adjustment (Linton et al., 2018). However, few studies have analyzed the moderating role of psychological factors in FM experience, focusing the evidence on variables such as alexithymia and catastrophizing. For example, Martínez et al. (2015) observed that alexithymia moderated the
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