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Objective: The aim of this study is to evaluate fibromyalgia patients according to the theory of mind and study the relation between attachment and symbolization in those patients.
Methods: Forty-six patients diagnosed with fibromyalgia are taken into the study. During the same time span 48 individuals who did not have any psychiatric disease were picked as a control group. Fibromyalgia patients’ group and the control group were both administered the following battery of tests: Reading The Mind In The Eyes, Dokuz Eylul Theory of Mind Scale, The psychometric evaluation of Experiences in Close Relationships-II, Beck Anxiety Scale, Beck Depression Scale, Rorschach Test. Fibromyalgia patients and control group were interviewed with the non-patient version of the SCID (SCID-NP) to exclude any axis I disorder.
Results: Dokuz Eylul Theory of Mind scale scores were found to be significantly different between the control group and the fibromyalgia patients. Fibromyalgia group had significantly lower scores on Dokuz Eylul Theory of Mind total scores, false belief, irony, metaphor and fauxpas subscores. Reading the Mind in the Eyes scores were not found to be significantly different between the control group and the fibromyalgia patients. We looked into the link between ToM(theory of mind) abilities and symbolization abilities of fibromyalgia patients using Rorschach inkblot test. We noticed slight positive correlation in R (total number of responses), Ka (moving animal responses) and Reading The Mind In The Eyes total points which are all important predictors of abstract thinking, negative correlation was found for G (global number of responses), A% (ratio of animal responses), Akat (categorized animal responses) and Reading The Mind In The Eyes total points. A mid level positive correlation was found between Dokuz Eylul Theory of Mind total scores and H (human responses). Again mid-level positive correlation was found between Hkat (categorized human responses) and Reading the Mind in the Eyes. When fibromyalgia patients were partitioned into two groups according to secure or insecure attachment no significant differences were found between those two groups. When the relation between anxiety and avoidance dimensions and ToM abilities in the patients was looked into, a significant negative correlation was found between Dokuz Eylul Theory of Mind total scores and avoidance dimension. The relationship between attachment patterns and ToM abilities was measured using symbolization parameters as covariant. We found relation between Dokuz Eylul Theory of Mind total points and secure and avoidant attachment and even after we controlled for symbolization parameters H, K, Ka, Akat, Hkat this relationship kept.
Conclusion: Fibromyalgia patients were found to have lower ToM abilities compared to healthy controls. There is a relation between decrease in the symbolization abilities and ToM abilities. Attachment types are also related to ToM abilities. Those with insecure and avoidant attachment have worse ToM scores. The relation between ToM abilities and attachment is independent of symbolization abilities. It could be helpful to conduct a wider scale study with psychosomatic patient groups to further study ToM abilities. It is expected that mentalization-based psychotherapy might be beneficial for fibromyalgia patients.