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“high” poor sleep quality subjects reporting high psychopathology scored signifi cantly higher in impairment than subjects reporting low psychopathology. Discussion This study extends previous research examining the psychopathological profi le of FM patients, the prevalence of “clinical case”, and the contribution of possible psychopathology in the reduced functional status. Finding showed that FM patients have a cognitive-emotional profi le with marked morbidity. FM group exhibited greater severity in all psychopathological scales than non-clinical group, and 76.2% of FM patients were identifi ed as “clinical case”. However, compared with the psychiatric group, the FM group showed equivalent levels in all scales. The hypothesis 1 was confi rmed. These results are similar to those of previous reports that identifi ed in FM patients scores outside the normal values in fi ve of nine dimensions but higher scores than psychiatric patients only in somatization (Garaigordobil & Govillard, 2016). In the FM group poor sleep quality and impairment were signifi cantly correlated with all psychopathological dimensions, but pain intensity only with somatization, obsessive-compulsive, depression, and anxiety, which supports hypothesis 2. Consistent with our results, previous studies in FM found that all psychopathological signifi cantly correlated with physical component (Salgueiro et al., 2012), and that pain correlated with somatization and depression (Rogers et al., 2018), but others studies did not observe a relationship between pain and psychopathological dimensions in Type II-FM (Salgueiro et al., 2012). Somatization, obsessive-compulsive, depression and anxiety were the most important predictors of FM status (pain, sleep and impairment). The role of depression and anxiety is well documented in FM (Gálvez-Sánchez et al., 2019) and included in the widely accepted Fear-Avoidance Model of Chronic Pain (Vlaeyen & Linton, 2012). Most striking is the contribution of somatization and obsessive-compulsive. Neurovegetative symptoms considered somatizations are frequent expressions of stress and emotional dysphoria. Thus, it has been suggested that somatization is a signifi cant factor in explaining the negative impact upon mental health of FM patients (Tesio et al., 2019). Note that somatization refl ects the tendency to experience and communicate psychological distress through indirect body language, and it is closely related to low emotional awareness and problems in managing feelings. In fact, the dimension of alexithymia referred to the diffi culty in identifying, recognizing and labelling feelings is implicated in the somatization process observed in chronic pain patients (Porcelli & Taylor, 2018), being alexithymia a moderator of the impact of pain appraisal upon emotional distress in FM (Martínez et al., 2015). The obsessive-compulsive dimension is congruent with the perfectionism, strong sense of responsibility and need of control. Maladaptive perfectionistic attitudes are involved in chronic fatigue and pain conditions via stress generation that could lead to overexertion/other dysfunctional behaviours, contributing to the dysregulation of stress response system (Kempke et al., 2016). In this sense, it was found that high perfectionistic strivings and concerns are linked to high stress and poor mental/physical health in FM (Sirois et al., 2019). So, obsessive-compulsive (via perfectionism) and somatization (via alexithymia) can play a relevant role in FM status, although this issue requires further investigation. Moderation analysis indicated that psychopathology intensifi ed the impact of non-restorative sleep in the impairment of daily functioning, however, there was not observed this moderator effect in the link between pain intensity and impairment. The hypothesis 3 was partially confi rmed. Analyses revealed that under conditions of “high” poor sleep quality patients with high psychopathology showed higher impairment than patients with low psychopahology. This result emphasizes the interactive role of sleep and psychological distress and can help to understand the mechanisms through which disability is exacerbated in FM. There Table 3 Psychopathology as Moderator in the Relationship between Pain

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