An interpersonally based model of chronic pain: An application of attachment theory

Abstract

The article examines the applicability of attachment theory to the development of and adaptation to chronic pain. We begin with an overview of traditional psychological models of chronic pain, including psychoanalysis, behaviorism, and cognitive—behavioral theory. It is noted that psychoanalytic writings on chronic pain are few. Those that exist are based on drive theory and place little emphasis on interpersonal factors. The behavioral tradition was more interpersonally based, with its emphasis on social reinforcement of pain behavior. The cognitive—behavioral perspective signalled a return to an emphasis on intrapsychic factors in the etiology and maintenance of chronic pain syndrome. The interpersonal dimensions of the pain experience suggested or implied by these theories is discussed further. This is followed by a review of Bowlby's (1969, 1975, 1981) attachment theory. The tenets of attachment theory are used as a foundation for furthering our understanding of the development of and adjustment to chronic pain, within an interpersonal framework. Bowlby (1988) suggests that pain and illness evoke attachment behaviors that are meant to preserve the organism's survival. The four attachment groups identified by Bartholomew and Horowitz (1991) are described. Descriptions are provided as to the manner in which members of each group are likely to react to onset of chronic pain. Emphasis is placed on accounting for etiology of chronic pain and implications of this model for the assessment process.