SUMMARY
Background: The role that psychological factors and personality traits play in the pathogenesis of Fibromyalgia Syndrome (FMS) is currently controversial. Most of the studies on FMS used self-report measures, and to date only a doctoral dissertation was conducted to compare the Rorschach responses of patients with FMS to the normative sample. Aim and Method: By using the Rorschach Performance Assessment System (R-PAS), we compared the scores of 35 women with FMS with those of 35 women with rheumatoid arthritis (RA). R-PAS is a performance-based task able to provide information on psychological processes occurring in the context outside and beyond the test. Furthermore, we chose RA patients as a contrast group because they both share the same medical picture in terms of pain experiences.Results: Compared to the RA group, the FMS group seemed to experience considerable implicit distress (YTVC’) associated with a sense of helplessness and despair (Y) that interferes with coping and adaptive mechanisms. Moreover, we found that these patients showed a cognitive processing focused mostly on the straightforward components of the environment (SI and Sy), but the interpretation of the environment was more unconventional (FQo%). Finally, we observed that almost half of the FMS group exhibited an excessive worry on the body (An). Conclusions: Our study has two implications for practicing psychologists. First, by using a performance-based test such as the R-PAS, we were able to provide a different clinical picture than self-reports (e.g., we did not find alexithymia features in the FMS protocols) and to identify the problematic features even at different levels of Complexity. Second, the increased levels of implicit stress found in the FMS group require psychological interventions focused on empowering these patients with self-management, active coping strategies when dealing with stressors and pain, so to defy their sense of helplessness.