Findings from the journal Frontiers in Psychology shed light on the link between pain invalidation and risk of depression. The study found that participants who felt invalidated in their pain experienced greater shame, and in turn, greater symptoms of depression.
Pain is a subjective experience that is imperceptible to others. Because of this, people who are experiencing pain often have their pain downplayed by others around them, including nurses and doctors. This invalidation can show up in a few different ways. In some cases, an outsider acknowledges a person’s pain experience but does not believe that it requires support, and in other cases, an outsider might not believe that the pain exists at all.
Importantly, having one’s pain invalidated can lead to stigmatization and may even exacerbate pain severity. Pain invalidation has also been associated with a range of poor mental health outcomes. In particular, pain invalidation has been repeatedly tied to depression, and study authors Brandon L. Boring and his team say this may have something to do with shame.
Shame is a feeling of inadequacy, self-consciousness, and low self-worth. Pain on its own has been associated with shame, and Boring and colleagues suggest that these feelings may be intensified when pain is being dismissed by others. The researchers conducted a study to explore the relationship between pain invalidation, depression, and shame among a sample of college students.
A total of 478 students were involved in the study. Most (328) participants were female, 139 were male, 10 did not disclose their gender, and 1 identified as “other”. None of the students were currently suffering from chronic pain. The participants answered questionnaires that assessed pain invalidation from three domains — friends, family, and medical professionals. The questions prompted students to consider how each of these types of people had reacted to the student’s pain experiences in the past year. The respondents also completed assessments of shame and depression.
The prevalence of pain invalidation was remarkably high among the students. Nearly all participants (99.4%) reported at least some pain invalidation from family members. Similarly, 98.9% reported pain invalidation from friends, and 95.5% reported pain invalidation from doctors. As expected, pain invalidation from any of these sources was significantly associated with both shame and depression.
Shame fully mediated the relationships between each source of pain invalidation and depression. In other words, having one’s pain invalidated by others — whether by friends, family, or medical professionals — predicted greater feelings of shame, and in turn, elevated symptoms of depression. Notably, these effects were consistent among men and women, except for pain invalidation from doctors which was trending in the same direction but not significant among men.
These findings suggest that shame is a crucial mechanism through which pain invalidation encourages depression. “When other people invalidate a person’s pain, they may communicate that the person in pain is not worthy of empathy or support,” the researchers explain. “This in turn may cause the person suffering from pain to question their own subjective state and their value as a human, creating feelings of shame, and inadequacy.” These feelings, combined with the continued experience of pain, may then lead to depression.
The findings are especially troubling, the study authors say, given evidence that depression increases the likelihood that acute pain becomes chronic pain. They say their study is unique in that it focused on acute pain that was not experimentally induced in the lab, revealing that even healthy young adults experience pain invalidation related to acute pain. However, in order to extend the clinical implications, a similar study should be conducted among people experiencing chronic pain.
The researchers discuss ways for people to improve their reactions to others experiencing pain. “Listening to the pain reported by patients and validating their subjective pain experience may foster interpersonal trust between patients and providers and improve pain outcomes,” Boring and his colleagues say. “Furthermore, broader cultural understanding about the subjective nature of pain and the importance of social support for those experiencing pain may protect against the mutually reinforcing depression-pain cycle.”
The study, “Shame Mediates the Relationship Between Pain Invalidation and Depression”, was authored by Brandon L. Boring, Kaitlyn T. Walsh, Namrata Nanavaty, and Vani A. Mathur.
