Primary emotional systems and personality functioning in women with endometriosis receiving brief psychotherapy: a...

Endometriosis is a chronic gynecological condition often associated with severe pelvic pain, reduced quality of life, and significant psychological and sexual distress. Although psychological factors are known to influence pain and adaptation, psychodynamic and personality-informed interventions remain rarely explored. It is also unclear whether endometriosis shares an emotional signature with other conditions involving psychic pain, such as functional neurological disorder (FND).

Women attending a tertiary endometriosis clinic in Trieste, Italy, who reported psychological or sexual distress were offered a psycho-sexual orientation interview and, if they agreed, a brief psychotherapeutic pathway. Seventeen women with endometriosis (7 operated, 10 non-operated) completed a 10-session intervention and an assessment protocol. Primary emotional dispositions were assessed with the Affective Neuroscience Personality Scales (ANPS) at pre-treatment, post-treatment, and 2-month follow-up. Personality configuration was evaluated at baseline with the Shedler Westen Assessment Procedure (SWAP-200). Repeated-measures analyses tested changes in ANPS scales, and correlations examined links between ANPS and SWAP-200 indices.

Participants showed high medical and psychiatric comorbidity and a predominantly high-functioning depressive-obsessive personality profile. Across time, only the ANPS SADNESS scale showed a significant reduction from baseline to follow-up, while other primary emotions remained stable. More high-functioning obsessive features were associated with adaptive emotional profiles, whereas more dysregulated features correlated with higher negative affect.

A brief psychodynamic intervention integrated into gynecological care was associated with a selective reduction in chronic dysphoric affect. These exploratory convergent findings across endometriosis and FND might suggest a shared mechanism of affect regulation relevant to complex pain-related conditions.