# Fibromyalgia: Neuropsychological and Clinical Correlates in Suicidal Behavior Based on Ideation-to-Action Models—A Critical Review

## TL;DR

This paper reviews how suicidal behavior in fibromyalgia is linked to psychological and clinical factors, using models that distinguish between suicidal thoughts and actions.

## Contribution

The paper integrates ideation-to-action suicide models with clinical and neuropsychological data specific to fibromyalgia.

## Key findings

- Suicidal ideation in fibromyalgia is linked to hopelessness, pain, fatigue, and mood issues.
- Suicidal action is associated with impulsivity, executive dysfunction, and exposure to pain.
- Current suicide risk tools lack specific validation for fibromyalgia patients.

## Abstract

Fibromyalgia (FM) is associated with increased suicidal behavior (SB). This critical review integrates the ideation-to-action models—Interpersonal Theory of Suicide (IPTS), Three-Step Theory (3ST), and Integrated Motivational–Volitional (IMV) Model—with clinical and neuropsychological correlates to discriminate between suicidal ideation (the motivational component) and suicidal action (the volitional component) in FM. Ideation is related to hopelessness, perceived burden, thwarted belongingness, and entrapment, as well as to pain/interference, sleep disturbances, fatigue, mood, pain catastrophizing, and attentional pain vigilance. The transition to action is associated with impulsivity, executive dysfunction (including inhibitory control, flexibility, and decision-making under ambiguity/risk), acquired capability due to repeated exposure to pain and medical procedures, and access to lethal means. Suicidal planning is conceptualized as high-severity ideation, while action includes preparatory behaviors and suicide attempts. Evidence from Spanish instruments is synthesized—Columbia Suicide Severity Rating Scale (C-SSRS), Plutchik Suicide Risk Scale (PSRS), Beck Depression Inventory-II (Item 9 of the BDI-II), and Suicide Behaviors Questionnaire—Revised (SBQ-R)—pointing out overlaps with pain/depression and the lack of specific validation in FM. Prospective cohorts, standardization of definitions/windows, comparable neuropsychological batteries, and mechanistic trials on motivational and volitional targets and interventions focused on pain reduction are proposed.