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Personality and personality disorders in chronic pain

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Abstract

Personality characteristics and disorders have long been noted in the chronic pain population. Clinicians and researchers alike will attest to the high rates of personality difficulties encountered in these individuals. Historically, it has been found that certain personality styles such as hypochondriasis and hysteria are common in chronic pain suffers. In addition, the prevalence of personality disorders (PDs) is significantly greater in the pain population than in the general population or in medical or psychiatric populations. A diathesis-stress model has been suggested to account for this finding and is discussed in this article, with implications for both treatment and research.

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References and Recommended Reading

  1. Rey R: The History of Pain. Cambridge, MA: Harvard University Press; 1993:394. An interesting historical account of pain through the ages.

    Google Scholar 

  2. Morris D: Sociocultural and religious meanings of pain. In Psychosocial Factors in Pain: Critical Perspectives. Edited by Gatchel R, Turk D. New York: Guilford Press; 1999:118–131.

    Google Scholar 

  3. Melzack R, Wall PD: Pain mechanisms: a new theory. Science 1965, 150:971–979. Classic paper that introduced the Gate-Control Model of pain, which recognizes the role of cognitive and affective factors in the physiology of pain perception and transmission.

    Article  CAS  PubMed  Google Scholar 

  4. Engel GL: The need for a new medical model: a challenge for biomedicine. Science 1977, 196:129–136.

    Article  CAS  PubMed  Google Scholar 

  5. Weisberg JN, Keefe FJ: Personality disorders in the chronic pain population: basic concepts, empirical findings, and clinical implications. Pain Forum 1997, 6:1–9. A review of the research on chronic pain and personality traits and disorders.

    Article  Google Scholar 

  6. Fishbain D, Cutler B, Rosomoff H, Rosomoff R: Comorbidity between psychiatric conditions and chronic pain. Curr Rev Pain 1998, 2:1–10. Thorough review of both clinical and personality disorders in chronic pain.

    Article  Google Scholar 

  7. Breuer J, Freud S: Studies on Hysteria. New York: Basic Books; 1957. [Original work published 1893–1895 edn.]

    Google Scholar 

  8. Cabot R: Differential Diagnosis. Philadelphia: W.B. Saunders; 1911.

    Google Scholar 

  9. Szasz TS: Pain and Pleasure: A Study of Bodily Feelings. London: Tavistock; 1957.

    Google Scholar 

  10. Engel GL: “Psychogenic” pain and the pain-prone patient. Am J Med 1959, 26:899–918.

    Article  CAS  PubMed  Google Scholar 

  11. Hathaway SR, McKinley J: Minnesota Multiphasic Personality Inventory. Minneapolis, MN: University of Minnesota Press; 1943.

    Google Scholar 

  12. Costa PT, McCrae RR: The NEO Personality Inventory Manual. Orlando, FL: Psychological Assessment Resources; 1985.

    Google Scholar 

  13. Millon T: Millon Clinical Multiaxial Inventory, edn 2. Minneapolis: National Computer Systems; 1982.

    Google Scholar 

  14. Lauver S, Johnson J: The role of neuroticism and social support in older adults with chronic pain behavior. Pers Individual Differences 1997, 23:165–167.

    Article  Google Scholar 

  15. Affleck G, Tennen H, Urrows S, Higgens P: Neuroticism and the pain-mood relation in rheumatoid arthritis: insights from a prospective daily study. J Consult Clin Psychol 1992, 60:119–126.

    Article  CAS  PubMed  Google Scholar 

  16. BenDebba M, Torgerson W, Long D: Personality traits, pain duration and severity, functional impairment, and psychological distress in patients with persistent low back pain. Pain 1997, 72:115–125.

    Article  CAS  PubMed  Google Scholar 

  17. Hanvik LJ: MMPI profiles in patients with low back pain. J Consult Psychol 1951, 15:350–353. The classic MMPI study on which most subsequent studies were based.

    Article  CAS  PubMed  Google Scholar 

  18. Gough HE: Diagnostic patterns on the Minnesota Multiphasic Personality Inventory. J Clin Psychol 1946, 2:23–37.

    Article  CAS  PubMed  Google Scholar 

  19. Gentry WD, Shows WD, Thomas M: Chronic low back pain: a psychological profile. Psychosomatics 1974, 25:174–177.

    Article  Google Scholar 

  20. McCreary C, Turner J, Dawson E: Differences between functional versus organic low back pain patients. Pain 1977, 4:73–78.

    Article  CAS  PubMed  Google Scholar 

  21. Sternbach RA, Wolf SR, Murphy RW, Akeson WH: Aspects of chronic low back pain. Psychosomatics 1973, 14:52–56.

    Article  CAS  PubMed  Google Scholar 

  22. Sternbach RA, Wolf SR, Murphy RW, Akeson WH: Traits of pain patients: the low-back “loser”. Psychosomatics 1973, 14:226–229.

    Article  CAS  PubMed  Google Scholar 

  23. Armentrout D, Moore J, Parker J, et al.: Pain-patient MMPI subgroups: the psychological dimensions of pain. J Behav Med 1982, 5:201–211.

    Article  CAS  PubMed  Google Scholar 

  24. Bradley L, Prokop C, Margolis R, Gentry W: Multivariate analyses of the MMPI profiles of low back pain patients. J Behav Med 1978, 1:253–257.

    Article  CAS  PubMed  Google Scholar 

  25. Butcher JN, Dahlstrom WG, Graham JR, et al.: MMPI-2: Manual for the Administration and Scoring. Minneapolis, MN: University of Minnesota Press; 1989

    Google Scholar 

  26. Deardorff WW, Chino AF, Scott DW: Characteristics of chronic pain patients: factor analysis of the MMPI-2. Pain 1993, 54:153–158.

    Article  CAS  PubMed  Google Scholar 

  27. Gatchel R, Epker J: Psychosocial predictors of chronic pain and response to treatment. In Psychosocial Factors in Pain: Critical Perspectives. Edited by Gatchel R, Turk D. New York: Guilford Press; 1999:412–434.

    Google Scholar 

  28. McCreary C, Turner J, Sawson E: The MMPI as a predictor of response to conservative treatment for low back pain. J Clin Psychol 1979, 3:278–284.

    Article  Google Scholar 

  29. Waring EM, Weisz GM, Bailey SI: Predictive factors in the treatment of low back pain by surgical intervention. In Advances in Pain Research and Therapy. Edited by Bonica JJ, Albe-Fessard D. New York: Raven Press; 1976:939–942.

    Google Scholar 

  30. Wiltse LL, Rocchio PD: Preoperative psychological tests as predictors of success of chemonucleolysis in the treatment of the low back syndrome. J Bone Joint Surg 1975, 57:478–483.

    CAS  PubMed  Google Scholar 

  31. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  32. Widiger TA, Trull TJ, Hurt SW, et al.: A multidimensional scaling of the DSM-III personality disorders. Arch Gen Psychiatry 1987, 44:557–563.

    Article  CAS  PubMed  Google Scholar 

  33. Gatchel R: Psychological disorders and chronic pain: cause and effect relationships. In Psychological Approaches to Pain Management: A Practitioner’s Handbook. Edited by Turk DC, Gatchel R. Guilford Press; 1996:33–52. Excellent summary chapter of psychological disorders in chronic pain.

  34. Livengood J, Johnson B: Personality disorders in chronic pain patients. Pain Digest 1998, 8:292–296.

    Google Scholar 

  35. Reich J, Thompson D: DSM-III personality disorder clusters in three populations. Br J Psychiatry 1987, 150:471–475.

    Article  CAS  PubMed  Google Scholar 

  36. Gatchel R, Polatin P, Mayer T, Garcy P: Psychopathology and the rehabilitation of patients with chronic low back pain disability. Arch Phys Med Rehabil 1994, 75:666–670.

    Article  CAS  PubMed  Google Scholar 

  37. Kaplan H, Sadock B: Personality disorders. In Synopsis of Psychiatry, edn 6. Edited by Kaplan H, Sadock B. Baltimore: Williams and Wilkins; 1991:525–542.

    Google Scholar 

  38. Reich J, Tupin JP, Abramowitz SI: Psychiatric diagnosis of chronic pain patients. Am J Psychiatry 1983, 140:1495–1498.

    Article  CAS  PubMed  Google Scholar 

  39. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 3. Washington, DC: American Psychiatric Association; 1980.

    Google Scholar 

  40. Fishbain DA, Goldberg M, Meagher BR, et al.: Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain 1986, 26:181–197.

    Article  CAS  PubMed  Google Scholar 

  41. Large RG: DSM-III diagnoses in chronic pain: confusion or clarity? J Nerv Ment Dis 1986, 174:295–303.

    Article  CAS  PubMed  Google Scholar 

  42. Weisberg JN, Gallagher RM, Gorin A: Personality disorder in chronic pain: a longitudinal approach to validation of diagnosis. 15th Annual Scientific Meeting of the American Pain Society. Washington, DC; 1996.

  43. Pfohl B, Blum N, Zimmerman M, Stangl D: Structured Interview for DSM-IV Personality Disorders. Iowa City, Iowa: University of Iowa; 1995.

    Google Scholar 

  44. Spitzer R, Endicott J: Schedule for Affective Disorders and Schizophrenia-Lifetime Version. New York: New York State Institute, Biometrics Research; 1979.

    Google Scholar 

  45. Spitzer RL, Williams JB, Gibbon M, First MB: Structured Clinical Interview for DSM-III-R. New York: New York State Psychiatric Institute; 1988.

    Google Scholar 

  46. Siever LJ, Coccaro EP, Klar H, et al.: Biologic markers in borderline and related personality disorders. In al. CSe, ed. World Congress of Biologic Psychiatry: Elsevier; 1986:566–568.

    Google Scholar 

  47. Silverman JM, Siever LJ, Horvath TB, et al.: Schizophreniarelated and affective personality disorder traits in relatives of probands with schizophrenia and personality disorders. Am J Psychiatry 1993, 150:435–442.

    Article  CAS  PubMed  Google Scholar 

  48. Weisberg J: Assessment of formal thought disorder in personality disorders. Dissertation Abstracts Int 1992, 54.

  49. Polatin PB, Kinney RK, Gatchel RJ, et al.: Psychiatric illness and chronic low-back pain. The mind and the spine-which goes first? Spine 1993, 18:66–71.

    Article  CAS  PubMed  Google Scholar 

  50. Gatchel RJ, Garofalo JP, Ellis E, Holt C: Major psychological disorders in acute and chronic TMD: an initial examination. J Am Dent Assoc 1996, 127:1365–1374.

    Article  CAS  PubMed  Google Scholar 

  51. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 3 (revised). Edited by Spitzer RL and Williams JB. Washington, DC: American Psychiatric Association; 1987.

    Google Scholar 

  52. Monti D, Herring C, Schwartzman R, Marchese M: Personality assessent of patients with complex regional pain syndrome Type I. Clin J Pain 1998, 14:295–302.

    Article  CAS  PubMed  Google Scholar 

  53. Weisberg J, Vittengl JR, Clark L, Gatchel R: Personality and pain: summary and future perspectives. In Personality Characteristics of Patients with Pain. Edited by Gatchel R, Weisberg J. Washington, DC: American Psychological Association; 2000, in press.

    Google Scholar 

  54. Bleuer M: Conception of schizophrenia within the last 50 years and today. Proc Royal Soc Med 1963, 56:945–952.

    Google Scholar 

  55. Meehl P: Schizotaxia, schizotypy, schizophrenia. Am Psychol 1962, 17:827–838.

    Article  Google Scholar 

  56. Monroe S, Simmons A: Diathesis-stress theories in the context of life stress research: implications for depressive disorders. Psychol Bull 1991, 110:406–425.

    Article  CAS  PubMed  Google Scholar 

  57. Rosenthal D: A conceptual framework. In The Genian Quadruplets. Edited by Rosenthal D. New York: Basic Books; 1963:505–516.

    Google Scholar 

  58. Harshfield G, Grim C: Stress hypertension: the “wrong” genes in the “wrong” environment. Acta Physiol Scand Suppl 1997, 161:129–132.

    Google Scholar 

  59. Mullins L, Chaney J, Pace T, Hartman V: Illness uncertainty, attributional style and psychological adjustment in older adolescents and young adults with asthma. J Pediatr Psychol 1997, 22:871–880.

    Article  CAS  PubMed  Google Scholar 

  60. Lehman C, Rodin J, McEwen B, Brinton R: Impact of environmental stress on the expression of insulin-dependent diabetes mellitus. Behav Neurosci 1991, 105:241–245.

    Article  CAS  PubMed  Google Scholar 

  61. Koch R, Graliker B, Fishler K, Ragsdale N: Clinical aspects of phenylketenuria. In First Inter-American Conference on Congenital Deficits. Philadelphia: Lippincott; 1963.

    Google Scholar 

  62. Spangler D, Simons A, Monroe S, Thase M: Comparison of cognitive models of depression: relationships between cognitive constructs and cognitive diathesis-stress match. J Abnorm Psychol 1997, 106:395–403.

    Article  CAS  PubMed  Google Scholar 

  63. Joiner TJ, Rudd M, Heatherington T, Schmidt N: Perfectionism, perceived weight status, and bulimic symptoms: two studies testing a diathesis-stress model. J Aborm Psychol 1997, 106:145–153.

    Article  Google Scholar 

  64. Paris J: Significance of biological research for a biopsychosocial model of the personality disorders. In Biology of Personality Disorders. Edited by Silk K. Washington, DC: American Psychiatric Press; 1998:129–148.

    Google Scholar 

  65. Cloninger C, Martin R, Guze S: The empirical structure of psychiatric comorbidity and its theoretical influence. In Comorbidity of Mood and Anxiety Disorders. Edited by Maser J, Cloninger C. Washington, DC: American Psychiatric Press; 1990:439–462.

    Google Scholar 

  66. Siever LJ, Davis KL: A psychobiological perspective on the personality disorders. Am J Psychiatry 1991, 148:1647–1658.

    Article  CAS  PubMed  Google Scholar 

  67. Flor H, Turk DC: Etiological theories and treatments for chronic back pain: I. Somatic models and interventions. Pain 1984, 19:105–121.

    Article  CAS  PubMed  Google Scholar 

  68. Turk DC, Flor H: Etiological theories and treatment for chronic back pain. II. Psychological models and interventions. Pain 1984, 19:209–233.

    Article  CAS  PubMed  Google Scholar 

  69. Banks SM, Kerns RD: Explaining the high rates of depression in chronic pain: a diathesis-stress framework. Psychol Bull 1996, 119:95–110. An excellent discussion of the diathesis-stress model and its application in the chronic pain population.

    Article  Google Scholar 

  70. Blumer D, Heilbronn M: Chronic pain as a variant of depressive disease: the pain-prone disorder. J Nerv Ment Dis 1982, 170:381–406.

    Article  CAS  PubMed  Google Scholar 

  71. Weisberg JN, Keefe F: Personality, individual differences, and psychopathology in chronic pain. In Psychosocial Factors in Pain: Critical Perspectives. Edited by Gatchel R, Turk D. New York: Guilford Publications; 1999:56–73.

    Google Scholar 

  72. McFall R, Townsend J, Viken R: Diathesis-stress model or “just so” story? Behav Brain Sci 1995, 18:565–566.

    Article  Google Scholar 

  73. Dworkin R, Banks S: A vulnerability-diathesis-stress model of chronic pain: herpes zoster and the development of postherpetic neuralgia. In Psychosocial Factors in Pain. Edited by Gatchel R, Turk D. New York: Guilford Press; 1999:247–269.

    Google Scholar 

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Weisberg, J.N. Personality and personality disorders in chronic pain. Current Review of Pain 4, 60–70 (2000). https://doi.org/10.1007/s11916-000-0011-9

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