Understanding the relationship between attachment style, pain appraisal and illness behavior in women

Abstract

Insecure attachment has been hypothesized to be an important factor for understanding the experience of pain. Considering the Attachment-Diathesis Model of Chronic Pain developed by Meredith, Ownsworth, and Strong (2008), this cross-sectional study examines the relationship between attachment style, pain appraisal, and illness behavior. Two hundred healthy women recruited from community contexts completed a battery of self-report measures including the Short-form McGill Pain Questionnaire, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Vigilance and Awareness Questionnaire, Illness Attitude Scales, Beck Anxiety Inventory, Beck Depression Inventory, and the Experiences in Close Relationships Questionnaire-Revised. The results showed that attachment anxiety was significantly correlated with pain catastrophizing, pain-related fear, depression, and illness behavior. However, attachment anxiety and avoidance were not associated with pain intensity. Attachment anxiety moderated the relationship between pain catastrophizing and illness behavior, and between pain hypervigilance and illness behavior. Pain catastrophizing and pain-related fear partially mediated the effect of attachment anxiety on illness behavior. The findings highlight potential contributions of attachment style and pain appraisal for explaining illness behavior. This study supports earlier reports and suggests the usefulness of assessing attachment style for early identification of people who might exhibit a high risk of dysfunctional responses to pain. Our findings also suggest that increasing people's insight about their attachment style and modifying some associated dysfunctional responses may be important in the treatment of chronic pain.

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

“…One possible interpretation is that subjects who are generally anxious about the responsiveness of others (high global attachment anxiety or fearful and preoccupied style using the categories of Bartholomew and Horowitz [ 11 ]) are at increased risk of developing chronic pain following episodes of pain without clear pathology. This interpretation is in accordance with studies linking maladaptive coping strategies for acute pain episodes mainly with preoccupied and fearful attachment or high attachment anxiety [ 5 , 15 , 23 , 30 ]. The unequal proportion of global insecure attachment styles, i.e., the different models of self between the pain syndromes, may be partly an effect of a recruitment bias resulting from the influence of attachment style on help-seeking behavior [ 17 , 24 , 47 ].…”

“…Insecure adult attachment patterns are considered a risk factor for the development of chronic pain, as well as poor prognosis in the face of chronic pain [ 4 ]. According to attachment theory, humans have a biologically determined need for proximity [ 5 ], particularly in the face of stressors such as pain. As a result of repeated interactional experiences with primary caregivers, internal working models of attachment start to develop.…”

“…For example, insecure attachment styles occurred more frequently in somatoform facial pain than in trigeminal neuralgia [ 22 ]. Even insecurely attached individuals not currently suffering from chronic pain conditions show increased catastrophizing and hypervigilance, as well as decreased pain thresholds and self-efficacy to episodes of acute pain or experimentally induced pain [ 5 , 15 , 23 ]. These findings suggest that attachment insecurity is related to the development of chronic pain via dysfunctional reactions to episodes of acute pain [ 24 ].…”

Pain in relation to emotion regulatory resources and self-compassion: a non-randomized correlational study involving recollected early childhood experiences and insecure attachment

“…Davies, Macfarlane, McBeth, Morriss, and Dickens (2009) found that insecure attachment styles were associated with approximately twice the experience of chronic widespread pain as other types of attachment. McWilliams et al (2000) found that individuals experiencing chronic pain due to arthritis and an insecure attachment style reported greater pain intensity and disability as seen also in research by Martinez et al (2012). Davies et al (2009), Lee-Chiong et al (2010), and Thakkar and Mc-Canne (2000) all have suggested that increased pain is associated with psychosocial stress experiences including regulating emotions and factors related to early relational experiences, such as an insecure attachment style and childhood experiences of stress.…”

“…Given this known background about the influences of attachment circumstances in normal development, it could be expected that some circumstances would inhibit the development of appropriate responses at a later stage. However, pain and early attachment experiences do not appear to have been studied extensively and the relationship in different groups of adult individuals with pain also had not been studied extensively, though some data on adult attachment styles, pain and a variety of diseases are available (e.g., Kratz, Davis, & Zautra, 2012;Martinez, Miro, Sanchez, Mundo, & Martinez, 2012;McWilliams, Cox, & Enns, 2000). There has been some research on these aspects in relation to those suffering from scleroderma, and our study now examines the background attachment studies available in relation to scleroderma.…”