The psychosomatic approach conceptualises the fibromyalgia syndrome (FMS) as a stress-induced pain syndrome with central sentisitation of pain processing systems. FMS is often comorbid with mental or psychosomatic disorders, such as depression, anxiety disorders, somatoform disorders and personality disorders. Early stress and traumatisation lead to vulnerability to subsequent development of FMS. The group of FMS patients is heterogeneous with regard to pathophysiological pathways, which is why mechanism-based differentiation of subgroups seems to be appropriate. Typical vicious circles of chronification of FMS are described and the importance of a successful doctor-patient relationship is emphasised. Different steps of treatment depend on the severity of the disorder and communication strategies are illustrated with a case example.