Researchers in China sought to explore the origin of chronic pain in patients with depression. Their findings indicate that anxious attachment may be a pathway between childhood trauma and pain symptoms. Additionally, anxious attachment may not always be negative for individuals with depression, and those with moderate levels of anxious attachment and severe childhood trauma may experience less pain.
The new findings have been published in Clinical Psychology & Psychotherapy.
The correlation between poor mental and physical health is well-documented, especially when it comes to depression. Studies suggest that approximately 65% of individuals with depression also experience chronic pain.
Childhood trauma, which includes physical, emotional, or sexual abuse or neglect, is also common among individuals with depressive disorders. Childhood trauma also increases the likelihood of developing treatment-resistant depression and other physical illnesses, such as chronic pain.
The third variable in this study is attachment style. Attachment theory suggests that infants seek proximity to their caregivers to receive care and reduce stress. The initial interactions with caregivers impact the perception of self-worth and trust in others, which affects social activities and the ability to manage stress in adulthood.
People with anxious attachment tend to have low self-esteem and high regard for others, making them more reliant on others and more sensitive in close relationships.
The research team predicted the following:
- As depressive symptoms increase, so do pain ratings.
- Those who report more pain are more likely to have experienced childhood trauma.
- Those who are depressed and reporting high levels of pain are more likely to have experienced childhood trauma and have an anxious attachment style.
For their sample, the researchers utilized 139 adult inpatients and outpatients who were diagnosed with depression. To measure the relevant variables, the researchers used the Hamilton Rating Scale for Depression (C-HRSD-17) to evaluate the current depressive symptoms of the patients. Additionally, the Childhood Trauma Questionnaire-Short Form (CTQ-SF) was used to assess the severity of childhood trauma, while the Revised Adult Attachment Scale (RAAS) was used to measure the dimensions of anxious attachment. Pain severity was measured using an 11-point pain intensity numerical rating scale (NRS).
The findings revealed that adults with depression who have experienced childhood trauma and anxious attachment are more likely to have severe pain. The study also found that anxious attachment was crucial in mediating the relationship between childhood trauma and pain severity.
These findings highlight the significance of childhood trauma and anxious attachment in the pain experience of individuals with depression. It also suggests that effective interventions to reduce pain severity in individuals with depression must address childhood trauma and anxious attachment.
Interestingly the study also discovered that moderate levels of anxious attachment were associated with lower pain levels in patients exposed to high levels of trauma, which helped reduce pain ratings. The research team posits, “during development if an individual’s pain signals tend to elicit rejection by caregivers, as an adaptive strategy, the individual chooses to repress the pain behaviours.”
Pain is a complex phenomenon that can be affected by social context. Even though individuals with anxious attachments often report excessive pain, they tend to report less pain under certain conditions. These findings have implications for developing appropriate clinical assessments and interventions for depressed patients with pain symptoms, particularly those who have experienced childhood trauma.
The study, “The association between childhood trauma and pain symptoms in depressed adults: The moderating role of anxious attachment,” was authored by Kai Zhang, Junyuan Sun, Qunlei Zhang, Jianwei Zhang, Long He, Ziyang Wang, Lei Hu.