Lachlan A. McWilliams

A growing body of research indicates that attachment insecurity is associated with pain-related catastrophizing. Attachment anxiety has consistently been found to be positively associated with pain catastrophizing. In contrast, the relationship between attachment avoidance and pain catastrophizing has been less consistent. The current study was designed to (a) determine whether anxiety accounts for unique variance in catastrophizing beyond that contributed by the overlapping constructs of self-esteem and neuroticism and (b) clarify the relationship between avoidance and catastrophizing by investigating this relationship when controlling for attachment anxiety. The final objective was to investigate whether attachment is also related to catastrophizing about the pain of significant others. A convenient sample of individuals currently in a romantic relationship (N=148) completed self-report measures of attachment anxiety and avoidance, neuroticism, self-esteem, pain catastrophizing, and significant other pain catastrophizing. Multiple regression analyses indicated that attachment anxiety accounted for unique variance in pain catastrophizing and each of its lower-order components (i.e., rumination, magnification, helplessness), beyond that accounted for by the personality variables. Attachment avoidance was negatively associated with the rumination component of catastrophizing, but this association was only found after controlling for attachment anxiety. The attachment dimensions were also associated with some components of significant other pain catastrophizing. Anxiety was positively associated with the helplessness component of significant other pain catastrophizing, and avoidance was negatively associated with the rumination and helplessness components of significant other pain catastrophizing. Future research directions regarding the social context of pain are discussed.

BACKGROUND: Despite the important role positive reinforcement of pain behaviour is believed to play in chronic pain, there is a paucity of research regarding factors that influence the provision of such reinforcement. Attachment theory suggests that individuals high in attachment avoidance view the pain behaviour of others in a negative manner and would, therefore, provide little reinforcement of pain behaviour. As an initial step in evaluating this model, relationships between attachment dimensions and attitudes toward pain behaviour were examined. Attachment avoidance was hypothesized to be negatively associated with accepting attitudes toward pain behaviour.METHODS: A sample of undergraduate students (n=160) completed the Relationships Structures Questionnaire, which provides global ratings of adult attachment dimensions (anxiety and avoidance) by assessing attachment across four relationship targets (friend, mother, father and romantic partner). Attitudes regarding the acceptability of pain behaviour were assessed using male and female versions of the Appropriate Pain Behaviour Questionnaire (APBQ).RESULTS: Consistent with the hypothesis, attachment avoidance was negatively correlated with both APBQ‐Female and APBQ‐Male scores. Multiple regression analyses were used to investigate the relationships between the attachment scales and the APBQ scales while statistically adjusting for sex and testing for interaction effects. The findings revealed complex relationships involving interaction effects that provided further support for the hypothesis.CONCLUSIONS: The findings provided support for the hypothesis that attachment avoidance is associated with less accepting attitudes toward pain behaviour. Additional research regarding the role of attachment and attitudes on responses to pain behaviour is warranted.

Attachment insecurity has been hypothesized to be a risk factor for the development of disease and chronic illness. This study was the first to investigate associations between adult attachment ratings and a wide range of health conditions. Cross-sectional data from the National Comorbidity Survey Replication (N = 5645) were used. Participants completed Hazan and Shaver's (1987) measure of adult attachment and provided reports regarding 15 health conditions. Logistic regression analyses that adjusted for demographic variables indicated that avoidant attachment ratings were positively associated with conditions defined primarily by pain (e.g., frequent or severe headaches). Anxious attachment ratings were positively associated with a wider range of health conditions, including several involving the cardiovascular system (i.e., stroke, heart attack, high blood pressure). Secure attachment ratings were unrelated to the health conditions. Additional analyses investigated whether the attachment ratings accounted for unique variance in the health conditions beyond that accounted for by lifetime histories of depressive, anxiety, and alcohol- or substance-related disorders. In these analyses, anxious attachment ratings continued to have significant positive associations with chronic pain, stroke, heart attack, high blood pressure, and ulcers. The findings were generally supportive of the theory that insecure attachment is a risk factor for the development of disease and chronic illness, particularly conditions involving the cardiovascular system. Further research regarding the role of attachment in the development of specific health conditions is warranted.

BACKGROUND: Behavioural conceptualizations of chronic pain posit that solicitous responses to pain behaviours are positively reinforcing and play a role in the development of chronic pain and disability. Recent research suggests that studies investigating this model were likely limited by the use of only a few narrowly defined categories of responses to pain behaviour. A measure of preferences regarding pain‐related social support has the potential to improve behavioural models of chronic pain by identifying other potentially reinforcing responses to pain behaviour.OBJECTIVE: The Pain Response Preference Questionnaire (PRPQ) was created to assess preferences regarding pain‐related social support. The purpose of the present study was to empirically develop PRPQ scales and examine their psychometric properties.METHODS: A large university student sample (n=487) free of chronic pain completed the 39‐item PRPQ. Factor analysis was applied to the data from the present sample to empirically develop PRPQ scales. Using a second student sample (n=87), relationships between the PRPQ scales and theoretically related measures were examined to evaluate the construct validity of the scales. Factor analysis supported four factors that reflected preferences for emotional and instrumental support, assistance in managing pain and emotions, having one’s pain ignored, and being encouraged to persist with one’s activities. Based on this analysis, scales labelled solicitude, management, suppression and encouragement were created. Correlation analyses supported the construct validity of these scales.CONCLUSIONS: The PRPQ is a psychometrically sound measure of preferences of pain‐related social support. Research with clinical samples is needed to further evaluate its psychometric properties and clinical utility.

Despite the prominence of fear-avoidance models of chronic pain, there is a paucity of research regarding the origins of pain-related fear. Based on the premise that insecure attachment could be a developmentally based origin of elevated fear of pain, associations between adult attachment dimensions and constructs included in fear-avoidance models of chronic pain were investigated. Consistent with Bartholomew and Horowitz's [Bartholomew K, Horowitz LM. Attachment styles among young adults: a test of a four-category model. J Pers Soc Psychol 1991;61:226-44.] model, attachment was conceptualized as being comprised of a model of self dimension (i.e., degree of anxiety regarding rejection based on beliefs of personal unworthiness) and a model of others dimension (i.e., degree of interpersonal mistrust and discomfort with interpersonal closeness). A large university student sample free of chronic pain (N=278) completed a measure of adult romantic attachment (i.e., Experiences in Close Relationships Questionnaire; [Brennan KA, Clark CL, Shaver PR. Self-report measurement of adult attachment: an integrative overview. In: Simpson JA, Rholes WS, editors. Attachment theory and close relationships. New York: The Guilford Press, 1998. p. 46-76.]), the Fear of Pain Questionnaire-III [McNeil DW, Rainwater AJ. Development of the fear of pain questionnaire - III. J Behav Med 1998;21:389-410.], the Pain Vigilance and Awareness Questionnaire [McCracken LM. Attention to pain in persons with chronic pain: a behavioural approach. Behav Ther 1997;28:271-84.], and the Pain Catastrophizing Scale [Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995;7:24-532.]. It was hypothesized that insecure attachment would be positively associated with reports of pain-related fear, hypervigilance, and catastrophizing and that the model of self dimension would be the attachment variable most strongly associated with these variables. Correlation and multiple regression analyses supported these hypotheses. The model of self dimension had significant positive associations with each of the fear-avoidance constructs. The model of others dimension had a significant positive association with pain catastrophizing, but was not significantly associated with fear of pain and pain hypervigilance. Future research directions and potential clinical implications are discussed.

The present paper investigated the relationships between several personality constructs and the use of outpatient mental health services.