Attachment, Symptom Severity, and Depression in Medically Unexplained Musculoskeletal Pain and Osteoarthritis: A Cross-Sectional Study

Abstract

BackgroundAttachment insecurity relates to the onset and course of chronic pain via dysfunctional reactions to pain. However, few studies have investigated the proportion of insecure attachment styles in different pain conditions, and results regarding associations between attachment, pain severity, and disability in chronic pain are inconsistent. This study aims to clarify the relationships between insecure attachment and occurrence or severity of chronic pain with and without clearly defined organic cause. To detect potential differences in the importance of global and romantic attachment representations, we included both concepts in our study.Methods85 patients with medically unexplained musculoskeletal pain (UMP) and 89 patients with joint pain from osteoarthritis (OA) completed self-report measures of global and romantic attachment, pain intensity, physical functioning, and depression.ResultsPatients reporting global insecure attachment representations were more likely to suffer from medically unexplained musculoskeletal pain (OR 3.4), compared to securely attached patients. Romantic attachment did not differ between pain conditions. Pain intensity was associated with romantic attachment anxiety, and this relationship was more pronounced in the OA group compared to the UMP group. Both global and romantic attachment anxiety predicted depression, accounting for 15% and 17% of the variance, respectively. Disability was independent from attachment patterns.ConclusionsOur results indicate that global insecure attachment is associated with the experience of medically unexplained musculoskeletal pain, but not with osteoarthritis. In contrast, insecure attachment patterns seem to be linked to pain intensity and pain-related depression in unexplained musculoskeletal pain and in osteoarthritis. These findings suggest that relationship-informed focused treatment strategies may alleviate pain severity and psychological distress in chronic pain independent of underlying pathology.

Adult attachment insecurity is positively associated with medically unexplained chronic pain

“…61.2%) among patients with medically unexplained chronic pain (MUCP) (Schroeter et al, 2015), but the relationship between attachment insecurity and MUCP has not yet been examined. One study found the prevalence of insecure attachment to be very high (i.e.…”

“…One study found the prevalence of insecure attachment to be very high (i.e. 61.2%) among patients with medically unexplained chronic pain (MUCP) (Schroeter et al, 2015), but the relationship between attachment insecurity and MUCP has not yet been examined. This study addressed this gap in the literature by investigating: (i) relationships between selfreports of adult attachment styles and past-year MUCP in a sample of the general U.S. population, and (ii) the ability of attachment ratings to account for variance in past-year MUCP beyond that accounted for by potential confounders, such as demographic variables and psychopathology.…”

Can patients be ‘attached’ to healthcare providers? An observational study to measure attachment phenomena in patient–provider relationships

“…These predictions are consistent with correlations that have been found between patterns of attachment and overutilisation or underutilisation of healthcare and mutually frustrating interactions. 17 24–26 …”

Study protocol - efficacy of an attachment-based working alliance in the multimodal pain treatment

“…These findings are especially relevant given that insecure attachment styles are overrepresented in patients suffering from chronic pain [ 12 , 46 ]. Attachment insecurity also negatively influences the working alliance with health-care professionals [ 4 ], and outcome in psychosocial interventions [ 31 ].…”