The Impact of Attachment Insecurity on Pain and Pain Behaviors in Experimental Pain

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Objectives: Pain perception and pain behaviors are distinct phenomena with different functions. Pain behaviors are protective in their functions, which include eliciting empathy or caring behaviors from others. Moreover, pain behaviors are intertwined with interpersonal relationships with significant others, which is why attachment orientations have been suggested as interpersonal schemas moderating the association between pain and pain behaviors. The aim of the current study was to assess the impact of insecure attachment dimensions on pain behaviors in laboratory-induced pain. Methods: This experimental study included a sample of 60 patients with low back pain recruited from a large spine center in a hospital in Region of Southern Denmark. Patients were recorded on video during a cold pressor procedure and asked to rate their level of pain. Prior to the procedure, attachment orientations were assessed by the Revised Adult Attachment Scale. Two assessors independently coded the recorded video material for protective and communicative pain behaviors. Results: A positive correlation of moderate size was found between pain intensity and pain communication. As hypothesized, attachment anxiety moderated the association between pain and pain behaviors. A high level of attachment anxiety was associated with at weaker association between pain and pain behaviors. None of the attachment dimensions correlated with pain intensity or pain behaviors. Conclusion: The results indicate that patients with high levels of attachment anxiety may downplay pain and communication thereof. This finding is of potential clinical importance, since pain communication, among others, serves the function of eliciting caring behavior from healthcare personnel.

Original languageEnglish
JournalJournal of Psychosomatic Research
Pages (from-to)127-132
Publication statusPublished - Aug 2018


  • Attachment
  • Cold pressor
  • Pain
  • Pain behavior
  • Pain communication
  • Low back pain


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