Which facets of emotion dysregulation are uniquely associated with emotional allodynia in fibromyalgia? A preliminary analysis using the emotional allodynia questionnaire and the difficulties in emotion regulation scale

Background: Emotional allodynia, a condition in which neutral or low-intensity interpersonal stimuli provoke disproportionate emotional distress, has been proposed as a clinically relevant feature of fibromyalgia. The Emotional Allodynia Questionnaire (AEQ) was recently preliminarily validated and showed a strong association with emotion dysregulation as measured by the Difficulties in Emotion Regulation Scale (DERS). However, which specific DERS facets underlie emotional allodynia, independently of depression, anxiety, pain catastrophizing and central sensitization, remains unknown.Methods: Cross-sectional data from 136 adults with fibromyalgia (91.9% female; mean age 57.6 ± 11.3 years) were analyzed. AEQ total score was examined against each DERS subscale (Non-Acceptance, Goals, Impulse, Awareness, Strategies, Clarity) using Spearman correlations, partial correlations controlling for BDI-II, STAI-Y2, PCS and CSI, and hierarchical linear regression with incremental R2.Results: At zero order, five subscales correlated with AEQ with the exception of Awareness. After controlling for all covariates, Impulse (ρ_partial = 0.286, p = 0.001), Strategies (ρ_partial = 0.245, p = 0.005), Non-Acceptance (ρ_partial = 0.220, p = 0.011) and Clarity (ρ_partial = 0.201, p = 0.021) remained significantly associated with AEQ, and each contributed incremental variance above the base model (ΔR2 = 0.019–0.038, p < 0.05). Awareness was not significant.Conclusion: Emotional allodynia in fibromyalgia is associated with loss of behavioral control (Impulse), limited confidence in emotion regulation (Strategies), non-acceptance and difficulty identifying emotional states (Clarity), but not reduced attention to emotional states (Awareness), suggesting emotions that are noticed but difficult to identify and regulate, with implications for targeted psychological treatments.