A simplified Venn-map of environmental stimuli and FMS.
The Venn-diagram map shows the flow of environmental stimuli while approximating interactions. External environment stimuli exist along a dual continuum from physical to non-physical stimuli and across negative to positive influences. Physical trauma often encompasses elements of emotional trauma and both represent extremes of negative influences. Stressors impart negative influence and can involve non-physical percepts. Physical and emotional soothers represent more positive influences and can include non-physical percepts, which also have a degree of negative to positive influence. All contribute to the total external environment influence. The external environment directly regulates the internal environment, which is created from subconscious autonomic homeostatic mechanisms and conscious subvocalizations. The internal environment, which encompasses an individual’s affective disposition, will directly influence both physiologic functioning and behavior, both of which influence the internal and external environments, respectively. Increased negative influence from external stressors and/or decreased external soothers can create a negative internal environment through dysregulated autonomic homeostasis and/or negative subvocalization (i.e. catastrophizing; type D personality). In FMS, altered central processing of stimuli and debilitating changes in physiologic functionality may be related to events that skew these environments toward negative influences. A feed-forward cycle can become established whereby a negative internal (affect) environment continues to drive altered physiology and behavior, reinforcing the negative influence of the external and internal environments.