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,