AN INTERPERSONALLY BASED MODEL OF CHRONIC PAIN - AN APPLICATION OF ATTACHMENT THEORY

The article examines the applicability of attachment theory to the dev elopment of and adaptation to chronic pain. We begin with an overview of traditional psychological models of chronic pain, including psychoa nalysis, behaviorism, and cognitive-behavioral theory. It is noted tha t psychoanalytic writings on chronic pain are few. Those that exist ar e based on drive theory and place little emphasis on interpersonal fac tors. The behavioral tradition was more interpersonally based, with it s emphasis on social reinforcement of pain behavior. The cognitive-beh avioral 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 b y these theories is discussed further. This is followed by a review of Bowlby's (1969, 1975, 1981) attachment theory. The tenets of attachme nt theory are used as a foundation for furthering our understanding of the development of and adjustment to chronic pain, within an interper sonal framework. Bowlby (1988) suggests that pain and illness evoke at tachment behaviors that are meant to preserve the organism's survival. The four attachment groups identified by Bartholomew and Horowitz (19 91) are described. Descriptions are provided as to the manner in which members of each group are likely to react to onset of chronic pain. E mphasis is placed on accounting for etiology of chronic pain and impli cations of this model for the assessment process.