Fibromyalgia is currently viewed as a disorder of pain and stress processing in the central nervous system. Various stressors in combination with constitutional and genetic factors can trigger the syndrome, and the way the brain processes stress has been linked to early relationship experiences. The author discusses the relationship between fibromyalgia and attachment dynamics in the context of a clinical analysis, and draws inferences about the intrapsychic origins of functional brain abnormalities seen in neuroimaging studies. The patient had core deficits in his capacity to mentalize and self-soothe, and catastrophized somatic sensory information. Because his capacity for self-reflective mentalization was so limited, interpretation of underlying conflict-ridden affect at first did little good. The analyst's most productive intervention was a consistent meta-communication of belief in the patient's capacity to know his own mind.