Stamp Gabriella Elisabeth, Iacovides Stella, Wadley Antonia Louise
Brain Function Research Group, Department of Physiology, Faculty of Health Sciences, School of Biomedical Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Br J Health Psychol. 2025 Nov;30(4):e70024. doi: 10.1111/bjhp.70024.
Preliminary epidemiological evidence suggests that within chronic pain cohorts, insecure attachment styles (comprising dismissing, preoccupied and fearful styles) are more prevalent. Our aim was to determine, in a general population, the association between adult attachment style and the presence and burden of chronic pain.
A nationwide online survey in South Africa determined adult attachment style (using the Experience in Close Relationships-Relationship Structures Questionnaire), the presence of chronic pain and typically associated psychological factors. In participants reporting chronic pain, the association with attachment style and pain burden (pain sites, severity and interference, using the Brief Pain Inventory [BPI]) was further explored. Results of the 2371 participants were analysed using multivariable generalized linear models.
In our young (median age 23 years; IQR 20-28), well-educated and primarily female (74%) cohort with a predominantly middle-to-high socioeconomic status, we found a higher than typically reported prevalence of chronic pain (27%). Compared to the secure attachment style, all insecure attachment styles were associated with increased chronic pain presence (secure: 23%; dismissing: 31%, odds ratio [95% CI] = 1.38 [1.02-1.85], p = .037; preoccupied: 42%, odds ratio [95% CI] = 2.26 [1.62-3.13], p < .001; fearful: 49%, odds ratio [95% CI] = 2.95 [2.03-4.29], p < .001). All three insecure attachment styles were associated with worse pain interference, and a Fearful attachment style was associated with increased pain severity and .78 times more pain sites (95% CIs: not spanning 0, ps < .05).
Adult attachment style was associated with chronic pain presence and pain burden. The presence of chronic pain was more than double in the fearfully insecure compared to securely attached individuals.
初步的流行病学证据表明，在慢性疼痛人群中，不安全依恋模式（包括疏离型、痴迷型和恐惧型）更为普遍。我们的目的是在普通人群中确定成人依恋模式与慢性疼痛的存在及负担之间的关联。
在南非进行的一项全国性在线调查确定了成人依恋模式（使用亲密关系经历 - 关系结构问卷）、慢性疼痛的存在情况以及通常相关的心理因素。在报告有慢性疼痛的参与者中，进一步探讨了其与依恋模式及疼痛负担（疼痛部位、严重程度和干扰程度，使用简明疼痛问卷 [BPI]）之间的关联。使用多变量广义线性模型对2371名参与者的结果进行了分析。
在我们这个年轻（中位年龄23岁；四分位间距20 - 28岁）、受过良好教育且主要为女性（74%）、社会经济地位主要为中高的队列中，我们发现慢性疼痛的患病率高于通常报告的水平（27%）。与安全依恋模式相比，所有不安全依恋模式都与慢性疼痛的存在增加相关（安全型：23%；疏离型：31%，比值比 [95%置信区间] = 1.38 [1.02 - 1.85]，p = 0.037；痴迷型：42%，比值比 [95%置信区间] = 2.26 [1.62 - 3.13]，p < 0.001；恐惧型：49%，比值比 [95%置信区间] = 2.95 [2.03 - 4.29]，p < 0.001）。所有三种不安全依恋模式都与更严重的疼痛干扰相关，恐惧型依恋模式与疼痛严重程度增加以及疼痛部位多出0.78倍相关（95%置信区间：不包含0，p值 < 0.05）。
成人依恋模式与慢性疼痛的存在及疼痛负担相关。与安全依恋的个体相比，恐惧型不安全依恋个体的慢性疼痛发生率高出一倍多。
