Masculine Identity, Body Image and Illness-Related Shame: Pathways to Psychological Distress in Men with Fibromyalgia

OBJECTIVE: Although recognition of fibromyalgia (FMS) in men is growing, the mechanisms that contribute to their psychological distress remain poorly understood. This study aims to clarify how FMS alters men's psychological distress and to identify potential protective and risk factors involved in this process in this often-underrepresented population. METHODS: This study comprised a total of 225 men aged 18-75; of these, 102 were men with FMS (based on self-report) and 123 were healthy peers (HPs), all of whom completed questionnaires on demographics, anxiety (GAD-7), depression (PHQ-9), body appreciation (BAS-2), masculine self-esteem (MSES), illness-related shame (CISS), and pain intensity (SF-MPQ). RESULTS: Men with FMS reported significantly higher depression and anxiety, lower body appreciation, and compromised masculine identity. Between-group analysis showed body appreciation mediated the fibromyalgia-distress relationship. However, within the FMS group, compromised masculine identity and illness-related shame were the strongest pathways to distress, while body appreciation showed no effect. Moderation analysis confirmed body appreciation buffered distress in controls but not in men with FMS. CONCLUSION: Masculine identity threats and illness-related shame constitute central mechanisms of psychological distress in men with FMS. Body appreciation operates differently in this population than in healthy men. Findings underscore the need for gender-sensitive interventions addressing identity disruption and emphasizing functionality over appearance-based acceptance.