Personality and pain: Summary and future perspectives.

Abstract

The preceding chapters of this text review the history of personality investigation in chronic pain; personality measures currently in use in the chronic pain population; and promising new instruments to help guide clinicians toward early, accurate diagnosis of personality traits and disorders. A major goal of early, accurate diagnosis is providing clinicians with increased knowledge about how patients' personality function is or is not related to their pain, thereby helping to optimize treatment outcomes. Ultimately, understanding an individual's personality characteristics or disorders should increase early detection of those at risk for developing chronic, debilitating pain, allowing intervention on as many dimensions as possible during the acute and subacute phases of pain as a way to prevent the progression to chronicity.In this chapter, we summarize the advantages of personality assessment and some of the best instruments to use, including a recently developed method of assessing personality pathology from a trait dimensional perspective-the Schedule for Nonadaptive and Adaptive Personality (SNAP). We also present a model of personality disorders in chronic pain recently introduced in the literature-the diathesis-stress model (Weisberg & Keefe, 1997). This model provides a testable hypothesis for the observation that many chronic pain patients have comorbid personality disorders, the presence of which they, their families, and their friends deny before the onset of pain. The Diathesis-Stress ModelA diathesis-stress model of personality disorders in chronic pain has been proposed (Weisberg & Keefe, 1997) to explain the discrepancy between the rates of those disorders in the general population and in the chronic pain population. The model posits that personality disorders develop as an interaction between underlying personality predispositions (or diatheses) and the extreme stress of pain and its physical, psychological, and social consequences. In this model, disorder is a consequence of acute and subacute pain, and it also can perpetuate chronic, disabling pain. The summary here provides a theoretical rationale for such a model to be tested for its heuristic and predictive value, and it provides information to help clinicians assess personality function in the context of long-standing traits and current stressors.It is well-established that personality disorders are highly prevalent in patients with chronic pain (Gatchel, Garofalo, Ellis,

Personality and personality disorders in chronic pain

“…As discussed in a recent book chapter, this is a "double-edged sword" in chronic pain. Pain patients and their significant others often present a very different description of the patient's premorbid personality function from that observed following the onset of pain [53]. By conceptualizing PDs according to the diathesis-stress model the discrepancy between premorbid and postmorbid personality functioning becomes better accounted for and the model provides a testable hypothesis for understanding what happens to the pain patient's personality following the acute onset of pain.…”

“…As proposed by Weisberg and Keefe [5•] and further elaborated by Weisberg et al [53], the application of the diathesis-stress model to PDs in chronic pain hypothesizes that previously marginally adaptive or adaptive coping and defense mechanisms weaken under the stress of chronic pain and its concomitant conditions to the point at which a PD is expressed. Extrapolating the diathesisstress model from other disorders previously mentioned, in order for PDs to develop, the underlying diathesis (vulnerability) must be activated by the stress of chronic pain and its concomitant conditions such as decreased access to health care, difficulties with employers, legal issues, and the like.…”

Exploring the comorbidity between personality and musculoskeletal disorders among adults: A scoping review

“…It is likely that PDs and MSDs have shared and non-shared risk (and protective) factors, however, they are poorly understood. To date, explanations linking PD and types of chronic pain more broadly (rather than MSDs per se ) are consistent with stress-diathesis and biopsychosocial models ( 23 , 91 , 92 ). These models strongly consider the role of psychological and social factors and their interaction with biological factors in the etiology and maintenance of pain.…”

<p>Manifestation of Borderline Personality Symptomatology in Chronic Pain Patients Under Stress: An Understated and Exacerbated Consequence of the COVID-19 Crisis</p>

“…The copious body of empirical investigation supporting the model has been reviewed in a textbook chapter by Weisberg and Keefe. 63 Most relevant to this analysis is the work by Weisberg and Keefe, 64 Weisberg, 65 and Weisberg et al 66 on the possibility that stress of chronic pain and the losses associated with it serving to "trigger" personality disorders to which a patient had been predisposed, yet had not yet manifested themselves. These authors have posited the existence of a bidirectional relationship between chronic pain and personality disorders, as well as claiming that their model provides a rational explanation for the over-representation of personality disorders in the chronic pain population that was discussed earlier in this analysis.…”