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Introduction Carriers of the FMR1 gene premutation (PM) are at increased risk for Fragile X-associated PM Conditions (FXPAC). Some clinically significant symptoms can be further classified as Fragile X-associated Neuropsychiatric Disorders (FXAND). Many FXAND-related cases may go underrated and untreated. This study aimed to investigate the rates of FXAND-related symptoms among female PM carriers. Methods The study was conducted at the Belgrade Fragile X Clinic on a clinical sample of 35 women with the PM and 35 controls using an adapted version of the Symptom Impact Questionnaire and the Fatigue Assessment Scale. The survey was designed to collect data on FXAND symptoms, including chronic pain, fatigue, anxiety, and depressive symptoms. Each symptom was self-rated by participants on a scale from 0 to 10. Data were analyzed using appropriate statistical methods. Results Women with the PM (mean age: 44.51 ± 12.90 y.; 90.51 ± 22.04 CGG repeats) had statistically significant higher frequency and severity of chronic pain ( p = 0.03; p = 0.02) and fatigue ( p = 0.001 for both) in contrast to age-matched controls. Although the prevalence of anxiety symptoms was not significantly different between groups, the severity of anxiety symptoms were significantly higher in the PM group ( p < 0.001), and was positively correlated with chronic fatigue ( p = 0.003 vs. p = 0.27 in controls). Depressive symptom frequency and severity did not differ between groups ( p = 0.47; p = 0.55), but there were a significant positive correlation between anxiety and depressive symptoms in the PM group ( p = 0.003). Depressive symptoms were also positively correlated with chronic fatigue in the PM group ( p = 0.02), but not in controls ( p = 0.58). Compared to controls, PM carriers reported more frequently lower energy, poorer sleep, greater memory issues, cognitive difficulties, balance problems, and increased sensory sensitivity ( p ≤ 0.001, all). Conclusion Female PM carriers experience significantly higher frequency and severity of FXAND-related symptoms. Our findings of an association between fatigue, anxiety, and depressive symptoms highlight the need for comprehensive screening and underscore the importance of recognizing and treating individuals with FXAND.