Fibromyalgia affects an estimated 2 to 7% of the global population, depending on which diagnostic criteria are used. Women, people with a family history of the condition, and those who have experienced significant physical or emotional trauma are among the most clearly identified risk groups. But the picture is more nuanced than a simple checklist, and recent changes in how fibromyalgia is diagnosed have shifted our understanding of who actually develops it.
Women Are Diagnosed Far More Often
The most consistent finding across decades of research is that women are diagnosed with fibromyalgia at much higher rates than men. In a large UK study using primary care records, roughly 89% of fibromyalgia patients were women, with a mean age at diagnosis of 48 years. The condition can affect people of any age, including children, but most diagnoses happen during middle age, and risk increases as you get older.
That said, the gender gap may be smaller than historically believed. Older diagnostic criteria from 1990 relied heavily on tender point exams, which produced a female-to-male ratio of about 7 to 1. Newer criteria from 2016, which dropped the tender point requirement, found no statistically significant difference in prevalence between women and men. This suggests that many men with fibromyalgia were simply missed under the old system. The true ratio likely falls somewhere in between, but men with widespread chronic pain should not assume fibromyalgia is off the table.
Family History and Genetics
If a close relative has fibromyalgia, your own risk rises substantially. One study found that siblings of people with fibromyalgia had a 27.2% chance of developing it themselves, translating to a risk roughly 13.6 times higher than the general population. That’s a striking number, and it points to a strong genetic component. Researchers have identified variations in genes involved in how your body processes pain signals and regulates mood-related brain chemicals, though no single gene accounts for the condition on its own. Fibromyalgia likely results from a combination of inherited susceptibility and environmental triggers.
Childhood Trauma and PTSD
A history of trauma, particularly in childhood, is one of the strongest non-genetic risk factors. In some studies, as many as 71% of fibromyalgia patients report a history of abuse. A systematic review of 18 studies found that childhood physical abuse was more strongly linked to adult fibromyalgia than other types of adverse childhood experiences, though sexual abuse also showed a significant association.
The consequences go beyond simply developing the condition. Fibromyalgia patients with a trauma history tend to report more pain sites, more severe symptoms, greater difficulty with daily physical tasks, and a heavier burden of other physical complaints compared to fibromyalgia patients without that history. Post-traumatic stress disorder is also common in this population, creating a cycle where psychological distress amplifies pain and pain worsens psychological distress.
Other Chronic Pain and Autoimmune Conditions
Having an existing rheumatic or autoimmune disease significantly raises your likelihood of developing fibromyalgia. The CDC specifically identifies lupus and rheumatoid arthritis as known risk factors. Fibromyalgia also frequently co-occurs with osteoarthritis, ankylosing spondylitis (a type of inflammatory spinal arthritis), irritable bowel syndrome, chronic headaches, and temporomandibular joint disorders.
Notably, the 2016 diagnostic criteria removed the old requirement that fibromyalgia could only be diagnosed if no other condition explained the pain. This was an important shift. It means you can have rheumatoid arthritis and fibromyalgia at the same time, and both should be treated. If you have a known pain condition but your symptoms seem disproportionate to what that condition typically causes, fibromyalgia may be contributing.
How Your Nervous System Becomes Sensitized
The biological thread connecting many of these risk factors is a process called central sensitization. In a healthy nervous system, pain signals travel from an injury site to the brain and fade once the tissue heals. In fibromyalgia, the pain processing system itself becomes overactive. Repeated or persistent pain signals can rewire the spinal cord and brain so that even normal sensations like light touch, mild pressure, or moderate temperatures register as painful.
This helps explain why so many different roads lead to fibromyalgia. Chronic inflammation from an autoimmune disease, tissue damage from an injury, or even the neurological effects of prolonged psychological stress can all serve as the initial input that, over time, pushes a vulnerable nervous system into this hypersensitive state. Once central sensitization takes hold, painful sensations can arise even without any ongoing damage in the body, which is why fibromyalgia scans and blood tests often come back looking normal.
Sleep Problems as an Early Warning
Poor sleep is nearly universal among fibromyalgia patients, but research suggests it may also play a role in triggering the condition. In a classic experiment, researchers disrupted the sleep of healthy volunteers to mimic the fragmented sleep patterns typical of fibromyalgia. All subjects subsequently developed symptoms resembling the condition, including widespread pain and fatigue.
Longitudinal data paints an even clearer picture: baseline sleep problems predicted pain levels a year later, which in turn predicted worsening physical function, which then predicted depression. Sleep disruption appears to kick off a cascade of symptoms rather than simply being one symptom among many. If you’re dealing with chronic insomnia, frequent nighttime awakenings, or consistently unrefreshing sleep alongside emerging pain issues, that combination deserves attention.
Infections as a Trigger
Viral and bacterial infections appear to act as triggers in people who are already predisposed. A large population-based study found that fibromyalgia patients had significantly higher rates of prior infections across the board. Specific associations included symptomatic COVID-19 (76% higher odds), influenza (80% higher odds), cytomegalovirus (85% higher odds), and Epstein-Barr virus, the cause of mononucleosis (90% higher odds). Whether these infections directly cause fibromyalgia or simply unmask it in vulnerable individuals remains an open question, but the pattern is consistent enough to be clinically relevant. People who develop persistent widespread pain in the weeks or months following a significant infection should consider fibromyalgia as a possibility.
Putting the Risk Factors Together
Fibromyalgia rarely emerges from a single cause. The typical profile involves some combination of genetic predisposition, a sensitizing event (trauma, chronic disease, infection, or prolonged sleep disruption), and an amplified nervous system response. You might carry the genetic susceptibility your entire life and never develop symptoms, or a severe infection or period of extreme stress might tip the balance. The more risk factors that overlap, the higher the likelihood. Understanding where you fall on that spectrum can help you and your care team recognize early symptoms for what they are, rather than spending years chasing explanations that don’t fit.