The relationship of attachment style to depression, catastrophizing and health care utilization in patients with chronic pain

Attachment theory and research suggest that patterns of interpersonal relationships may he important determinants of illness behavior, care seeking, and treatment response in individuals with chronic health problems, including chronic pain. Attachment styles have been shown to be associated with psychological adjustment in the context of chronic illness, but little research has been conducted so far examining these relationships in patients with chronic pain. We assessed 111 patients with chronic pain participating in a multidisciplinary pain treatment program to determine if attachment style is associated with pain, depression, catastrophizing and physical disability at pre-treatment and 12-month follow-up, and with change in health care utilization pre-treatment to follow-up. At both pre-treatment and follow-up, fearful attachment style was associated with significantly greater depression and catastrophizing, and secure attachment was associated with significantly lower levels of depression. Preoccupied attachment style was associated with greater than weekly pain-related visits at 12 months follow-up, even after controlling for depression, catastrophizing and pre-treatment pain-related health care utilization. The findings suggest that attachment style may be a useful construct for examining factors affecting adjustment and treatment response of patients with chronic pain. (C) 2003 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.