PAIN 149 (2010) 278283

www.elsevier.com/locate/pain

Adult attachment and pain catastrophizing for self and signicant other
Lachlan A. McWilliams *, Diane Holmberg
Department of Psychology, Acadia University, Canada

a r t i c l e i n f o a b s t r a c t

Article history: A growing body of research indicates that attachment insecurity is associated with pain-related catastro-
Received 29 June 2009 phizing. Attachment anxiety has consistently been found to be positively associated with pain catastro-
Received in revised form 1 January 2010 phizing. In contrast, the relationship between attachment avoidance and pain catastrophizing has been
Accepted 11 February 2010
less consistent. The current study was designed to: (a) determine whether anxiety accounts for unique
variance in catastrophizing beyond that contributed by the overlapping constructs of self-esteem and
neuroticism, and (b) clarify the relationship between avoidance and catastrophizing by investigating this
Keywords:
relationship when controlling for attachment anxiety. The nal objective was to investigate whether
Adult attachment theory
Pain catastrophizing
attachment is also related to catastrophizing about the pain of signicant others. A convenience sample
Signicant other catastrophizing of individuals currently in a romantic relationship (N = 148) completed self-report measures of attach-
Couples ment anxiety and avoidance, neuroticism, self-esteem, pain catastrophizing, and signicant other pain
catastrophizing. Multiple regression analyses indicated that attachment anxiety accounted for unique
variance in pain catastrophizing and each of its lower-order components (i.e., rumination, magnication,
helplessness), beyond that accounted for by the personality variables. Attachment avoidance was nega-
tively associated with the rumination component of catastrophizing, but this association was only found
after controlling for attachment anxiety. The attachment dimensions were also associated with some
components of signicant other pain catastrophizing. Anxiety was positively associated with the help-
lessness component of signicant other pain catastrophizing, and avoidance was negatively associated
with the rumination and helplessness components of signicant other pain catastrophizing. Future
research directions regarding the social context of pain are discussed.
2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

1. Introduction Attachment theory [5] posits that an evolutionarily based sys-

Several reviews [22,25,31] have suggested processes by which
attachment insecurity could lead to the development of chronic
pain, or poor adjustment to chronic pain. Much of this research
has focused on pain catastrophizing, which has been found to be
positively associated with a wide range of negative outcomes
[35,36,38]. Research regarding pain catastrophizing has shifted to
a focus on interpersonal topics, such as the possibility that it
may inuence chronic pain patients social environments
[3,8,19]. As well, catastrophizing about pain experienced by signif-
icant others (i.e., signicant other pain catastrophizing) has re-
ceived attention. For example, Cano et al. [9] found chronic pain
patients reports of pain severity, disability, and depressive symp-
toms were positively associated with their spouses reports of sig-
nicant other pain catastrophizing. Additional research based on
attachment theory has the potential to inform interpersonally-fo-
cused models of pain catastrophizing.
* Corresponding author. Address: Department of Psychology, Acadia University,
Wolfville, NS, Canada B4P 2R6. Tel.: +1 902 585 1495; fax: +1 902 585 1078.
E-mail address: Lachlan.Mcwilliams@acadiau.ca (L.A. McWilliams).
tem exists to ensure infants maintain proximity to caregivers dur-
ing times of threat, and that early experiences with caregivers
result in enduring cognitive schemas that guide behavior and
expectations in other relationships. Adult attachment is often
operationalized using self-report measures assessing two dimen-
sions, anxiety and avoidance. Attachment anxiety ranges from an
internalized sense of self-worth to anxiety regarding rejection
based on beliefs of personal unworthiness. Attachment avoidance
ranges from trust and comfort with intimacy to mistrust and
avoidance of close relationships. The anxiety dimension is thought
to involve a hyperactivating, or exaggerated, response to stress
[29]. Consistent with this, it has been found to be positively asso-
ciated with reports of catastrophizing obtained from individuals
with [23] and without [21,24] chronic pain. Attachment avoidance
is thought to involve a deactivating approach to stressors that in-
volves the minimization of threats, avoidant coping, and compul-
sive self-reliance [29]; therefore, a negative association with pain
catastrophizing would be expected. However, in a large university
student sample [21], a small but signicant positive association
was found between attachment avoidance and pain catastrophiz-
ing. In contrast, studies utilizing smaller samples of adults with

0304-3959/$36.00 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
doi:10.1016/j.pain.2010.02.019

L.A. McWilliams, D. Holmberg / PAIN 149 (2010) 278283
[23] and without [24] chronic pain yielded non-signicant
associations.
Attachment anxiety shares variance with self-esteem (i.e., a
sense of self-worth) [12] and neuroticism (i.e., a sensitivity to neg-
ative stimuli and tendency to experience negative affect) [11]. Anx-
iety may predict pain catastrophizing because it captures elements
of self-esteem and neuroticism which may also be related to catas-
trophizing. The rst aim of the study was to investigate whether
attachment anxiety accounts for unique variance in pain catastro-
phizing beyond that contributed by self-esteem and neuroticism.
The second objective was to clarify the relationship between avoid-
ance and catastrophizing, by investigating this relationship while
controlling for attachment anxiety. The nal objective was to
investigate whether attachment is also related to catastrophizing
about the pain of signicant others. Observing pain and experienc-
ing pain activate similar regions of the brain [4,16], so it was
hypothesized that the attachment dimensions would predict catas-
trophizing regarding a partners pain in a similar fashion to catas-
trophizing about ones own pain.
2. Methods
2.1. Participants and procedure
The data used in the current study were collected as part of an
ongoing program of research on attachment styles and coping. To
be eligible, participants had to be 18 or older, and currently in-
volved in a romantic relationship (dating or married). The study
was advertised via psychology subject pools, announcements in
large classes, posters, campus-wide e-mails, and word of mouth.
All advertising directed participants to a website, where they com-
pleted an on-line consent form, and a set of on-line questionnaires
regarding stress, coping processes, and relationship issues, includ-
ing the measures used in the current study. Such on-line measures
have psychometric properties comparable to paper-and-pencil ver-
sions [7] and have been successfully used in previous research [30].
Participants provided information that allowed their responses to
be linked with their partners, if their partner also participated in
the study. All procedures were approved by Acadia Universitys Re-
search Ethics Board.
Participants were 148 individuals (88 female, 60 male), ranging
in age from 18 to 50 years of age (M = 21.4). All were currently in-
volved in a romantic relationship, ranging in length from 1 month
to 33 years, with an average of 3.1 years. The majority of partici-
pants (88%) described themselves as seriously dating, with 5%
casually dating, 4% engaged, and 3% married. The sample included
both members of 39 heterosexual couples, plus 70 individuals (21
males, 49 females) whose relationship partner did not participate.
2.2. Measures
The Experiences in Close Relationships Inventory Revised
(ECR-R) [13] includes an 18-item attachment anxiety scale, assess-
ing individuals worries or concerns regarding rejection or aban-
donment by a romantic partner, and an 18-item avoidance scale,
assessing individuals discomfort with getting close to romantic
partners. All items utilized a 7-point scale ranging from 1 (strongly
disagree) to 7 (strongly agree). In this and in all other measures,
scores were computed by averaging across all relevant items, after
reverse-scoring as appropriate, so that higher numbers always
indicated higher levels of the construct in question. This revised
version of the widely-used Experiences in Close Relationships
Inventory [6] shares many items with the original measure, but
possesses slightly superior psychometric properties [13]. Both
ECR-R scales have Cronbachs alphas and 3-week testretest reli-
279
abilities in excess of .90, and there is strong evidence of their con-
vergent and discriminant validity [33].
The Big Five Inventory (BFI) [17] consists of 44 items assessing
the Big Five personality traits of extraversion, conscientiousness,
openness to experience, neuroticism, and agreeableness. Questions
consist of short, easy-to-understand phrases assessing characteris-
tic feelings and behaviors connected to each personality trait, and
are rated on 5-point scales, ranging from (1) disagree strongly to (5)
agree strongly. The BFI was administered in order to utilize its 8-
item neuroticism subscale. The BFI subscales show strong internal
consistency and testretest reliability, and display considerable
convergent validity with longer Big Five measures [17].
The Rosenberg Self-Esteem Inventory [32] is a 10-item global
measure of feelings of self-worth. It utilizes response options rang-
ing from 1 (very strongly disagree) to 9 (very strongly agree). It pos-
sesses strong internal consistency, excellent testretest reliability,
and a unidimensional factor structure [15].
The Pain Catastrophizing Scale (PCS) [35] consists of 13 items
assessing how frequently individuals experience catastrophic
thoughts and feelings during pain episodes, with responses ranging
from 0 (not at all) to 4 (all the time). It can be further subdivided
into subscales assessing rumination (engaging in persistent pain-
related thinking), magnication (exaggerating pain-related
threats), and helplessness (perceiving an inability to cope with
pain-related situations). The PCS and its subscales show strong
internal consistency, testretest reliability, and good construct
validity [35].
The signicant other version of the Pain Catastrophizing Scale
(PCS-S) [9] is a modied version of the original PCS. The scale intro-
duction and item wordings were altered by Cano et al. [9] to focus
on the catastrophic thoughts and feelings an individual might
experience when his or her signicant other is experiencing pain.
Cano et al. demonstrated that this modied scale showed the same
three-factor structure as the original PCS, and that the overall scale
and the three subscales showed excellent internal consistency and
adequate content validity.
3. Results
3.1. Preliminary analyses
Standard statistical analyses assume that all observations (i.e.,
participants) are independent. It is possible that the presence of
both members of couples in the current dataset might cause the
data to violate this assumption. Following the recommendations
of Kenny et al. [20], correlations were rst computed between cou-
ple members scores on all variables. Kenny and colleagues suggest
that couple correlations exceeding .45 represent consequential
non-independence, or levels of interdependence in the data that
are sufciently strong to affect p-values. Of our 12 variables, only
one (viz., the PCS rumination subscale) exceeded this cut-off, with
a value of .47; all other couple correlations were substantially low-
er. Therefore, it was deemed appropriate to treat the couple data as
statistically independent.
Ten of the 12 variables (i.e., all but neuroticism and PCS-S Over-
all) revealed signicant departures from a normal distribution
using the ShapiroWilks test; however, the degree of departure
was not marked (e.g., values ranged from .88 to .98, where 1.0
equals perfect normality). Self-esteem revealed a moderate nega-
tive skew and was transformed using a reected and square root
transformation; all other variables had a mild to moderate positive
skew and were transformed using a square root transformation.
Transformations improved the normality of the variables slightly
(e.g., ShapiroWilks values now ranged from .93 to .99), but all ex-
cept the two attachment variables continued to display small but

280 L.A. McWilliams, D. Holmberg / PAIN 149 (2010) 278283

statistically signicant violations of normality. However, the pat-
tern of ndings obtained with the transformed variables was iden-
tical to that obtained with the untransformed variables. To
facilitate interpretation of the ndings, only those obtained with
the non-transformed variables are presented.
Table 1 displays the Cronbachs alpha internal consistency
scores, means, and standard deviations for all measures. All mea-
sures displayed acceptable internal consistency. Table 1 also pre-
sents correlations between all the variables. The attachment
variables were moderately and positively correlated. As expected,
attachment anxiety was positively associated with neuroticism
and negatively associated with self-esteem. Avoidance was also
negatively associated with self-esteem, which is consistent with
approximately half of the previous studies that have examined
associations between these variables [28]. The PCS and PCS-S vari-
ables were all positively correlated with each other. Female gender
was positively associated with neuroticism, total PCS scores, and
the PCS rumination subscale. Neuroticism had signicant positive
associations with all but one of the PCS and PCS-S variables, and
self-esteem had signicant negative associations will all but one
of the PCS and PCS-S variables. As expected, anxiety was positively
associated with the PCS and its subscales. Anxiety was also posi-
tively associated with the helplessness subscale of the PCS-S.
Avoidance was not signicantly associated with any of the PCS or
PCS-S variables.
3.2. Initial regressions
The initial set of analyses consisted of eight hierarchical regres-
sion analyses, predicting the pain catastrophizing variables.
Attachment anxiety and avoidance were entered as predictor vari-
ables in the rst step of each analysis. An interaction term (created
by centering the two attachment variables and multiplying them
together) (see Aiken and West [1]) was entered at the second step
of each analysis, to explore for possible moderation; however, this
interaction term was never signicant and is therefore not dis-
cussed further. Gender was also associated with some of the inde-
pendent variables (viz., neuroticism and avoidance) and
catastrophizing, so it was entered as a control variable in the rst
step of all analyses.
Standardized betas from these regression analyses are shown in
Table 2. As expected, higher attachment anxiety predicted more
pain catastrophizing for self, showing strong effects for the overall
scale and for all three subscales. In contrast to the correlation anal-
yses, when attachment avoidance was adjusted for, attachment
anxiety was also positively associated with signicant other pain
catastrophizing, showing signicant effects for all measures except
the rumination subscale.
Although attachment avoidance showed no signicant correla-
tions with the catastrophizing variables, when attachment anxiety
was adjusted for, attachment avoidance was signicantly nega-
tively associated with pain catastrophizing, both for self and signif-
icant other, suggesting the presence of a suppression effect. The
effects of avoidance for self seemed to be primarily driven by the
rumination subscale, but the effects of avoidance for signicant
other applied to all subscales.
3.3. Regressions controlling for neuroticism and self-esteem
Next, all regressions were rerun with gender, neuroticism and
self-esteem entered in Step 1, attachment anxiety and avoidance
entered in Step 2, and the anxiety by avoidance interaction entered
in Step 3. Again, the interaction term was never signicant, and is
therefore not shown. Table 3 displays standardized betas from the
rst two steps of the analyses.
In the correlation analyses, both neuroticism and self-esteem
were signicantly correlated with all of the pain catastrophizing
measures except the magnication subscale of the PCS-S. The ef-
fects of the two variables were weakened considerably when they
were entered together in the regression analyses (see Table 3, Step
1). In these analyses, low self-esteem continued to predict more
pain catastrophizing for self, but the connections to the signicant
other pain catastrophizing variables became non-signicant. Neu-
roticism was a signicant predictor of only two catastrophizing
variables (i.e., total signicant other pain catastrophizing, and its
helplessness subscale).
When the attachment variables were added in Step 2, neuroti-
cism was no longer a signicant predictor of any catastrophizing
variable. Low self-esteem continued to predict most aspects of pain
catastrophizing for self, and the rumination subscale of pain catas-
trophizing for signicant other. When self-esteem and neuroticism
were adjusted for, the magnitude of the betas for attachment anx-
iety did drop somewhat, suggesting that some of the connection
between attachment anxiety and catastrophizing variables can be
attributed to anxietys overlap with those variables. Still, even with
neuroticism and self-esteem controlled, attachment anxiety con-
tinued to be a signicant predictor of overall pain catastrophizing
for self and all of its subscales, as well as the helplessness subscale

Table 1
Means (Ms), standard deviations (SDs), Cronbachs alpha (a) and correlations for all variables.

Measure a M SD 1 2 3 4 5 6 7 8 9 10 11 12 13
(1) Anxiety .93 2.94 1.20 .50*** .41*** .62*** .44*** .37*** .35*** .45*** .16 .03 .11 .28** .05
(2) Avoidance .91 2.59 0.81 .05 .36*** .08 .01 .09 .12 .11 .16 .11 .04 .14+
(3) Neuroticism .80 2.80 0.73 .58*** .38*** .37*** .27*** .38*** .27** .21* .19 .29*** .35***
(4) Self-esteem .91 7.10 1.43 .46*** .40*** .33*** .47*** .25** .20* .13 .31*** .03
(5) PCS (Overall) .94 1.01 0.76 .90*** .86*** .93*** .40*** .25** .31*** .46*** .17*
(6) Rumination .89 1.35 0.97 .67*** .72*** .37*** .29*** .29*** .38*** .22**
(7) Magnication .78 1.02 0.88 .74*** .41*** .25** .43*** .41*** .13
(8) Helplessness .89 0.78 0.74 .31*** .17* .18* .43*** .11
(9) PCS-S (Overall) .91 1.45 0.78 .88*** .85*** .87*** .02
(10) Rumination .88 2.02 1.08 .68*** .60*** .00
(11) Magnication .76 1.65 1.01 .63*** .04
(12) Helplessness .81 0.97 0.72 .06
(13) Gendera

Note. PCS = Pain-Catastrophizing Scale; PCS-S = Pain-Catastrophizing Scale Signicant Other Version.
a
Male = 0; female = 1.
+
p < .10.
*
p < .05.
**
p < .01.
***
p < .001.

L.A. McWilliams, D. Holmberg / PAIN 149 (2010) 278283 281

Table 2
Initial regression analyses, predicting pain catastrophizing measures using gender and attachment variables.

Dependent variables
Pain catastrophizing for self Pain catastrophizing for signicant other
Total Rumination Magnication Helplessness Total Rumination Magnication Helplessness
Betas
Gendera .17* .21** .14+ .11 .04 .02 .02 .08
Anxiety .53*** .49*** .40*** .51*** .29** .14 .21* .39***
Avoidance .17+ .23** .09 .12 .26** .23* .21* .24*
Summary statistics
R2 .25*** .23*** .15*** .23*** .08* .04 .04+ .12***
F(3, 144) 16.00*** 14.30*** 8.47*** 14.35*** 3.96** 1.94 2.24+ 6.72***

a
Male = 0; female = 1.
+
p < .10.
*
p < .05.
**
p < .01.
***
p < .001.

of the PCS-S. The results for attachment avoidance were unchanged
when self-esteem and neuroticism were adjusted for, with all betas
remaining similar in direction and magnitude to the original
regression analyses. This pattern suggests that the connections be-
tween attachment avoidance and the pain catastrophizing vari-
ables cannot be attributed to any overlap between avoidance and
self-esteem or neuroticism.
4. Discussion
The rst aim of the study was to investigate whether attach-
ment anxiety accounts for unique variance in pain catastrophizing
beyond neuroticism and self-esteem. Consistent with the previous
research, attachment anxiety shared variance with both of these
personality traits. However, attachment anxiety also accounted
for unique variance in pain catastrophizing beyond these personal-
ity variables. This unique variance might be related to the hyperac-
tivating style of support seeking used by those high in attachment
anxiety. This style refers to an approach to coping in which exag-
gerated and affectively charged assessments of both the severity
of a stressor and ones own helplessness are communicated to
attachment gures in an effort to elicit care [29].
This hyperactivating approach to coping bears similarity to Sul-
livan et al.s [39] communal coping model, which posits that those
with a communal orientation to coping catastrophize to communi-
cate distress and elicit support. Although they did not indicate that
a communal orientation to coping is inherently maladaptive, Sulli-
van et al. did suggest that it may inadvertently become maladap-
tive, because the associated catastrophizing and increased
attention to pain would likely heighten the pain experience. Given
the prominence of the communal coping model of pain catastro-
phizing and the growing literature on attachment and catastro-
phizing, further research aimed at integrating these two bodies
of research is warranted. For example, there may be both adaptive
and maladaptive forms of communal coping. Those with low levels
of attachment anxiety might seek others support in an adaptive
and direct manner, such as openly requesting support when
needed. In contrast, highly anxious individuals might seek support

Table 3
Regression analyses, predicting pain catastrophizing measures using attachment variables, controlling for gender, self-esteem, and neuroticism.

Dependent Variables
Pain catastrophizing for self Pain catastrophizing for signicant other
Total Rumination Magnication Helplessness Total Rumination Magnication Helplessness
Step 1 Betas
Gendera .12 .17* .10 .05 .10 .06 .03 .15+
Self-esteem .38 ***
.34 **
.29** .39 ***
.12 .10 .03 .17+
Neuroticism .12 .11 .06 .14 .23* .17 .19+ .24*
Step 1 Summary statistics
R2 .24*** .21*** .13*** .24*** .10** .05* .04 .13***
F(3, 144) 15.18*** 12.94*** 6.83*** 15.08*** 5.02** 2.74* 1.91 7.22***
Step 2 Betas
Gendera .14+ .18* .13 .07 .11 .09 .03 .15+
Self-esteem .28** .27* .18 .27* .19 .24* .06 .15
Neuroticism .04 .02 .00 .07 .17 .14 .14 .18
Anxiety .35** .32** .30** .32** .09 .07 .11 .22*
Avoidance .18* .24** .11 .13 .25** .23* .19+ .23*
Step 2 summary statistics
DR2 .07** .07** .05* .05** .04* .06* .03 .04*
F(2, 142) 6.62** 6.61** 3.84* 5.22** 3.65* 4.34* 1.96 3.82*
a
Male = 0; female = 1.
+
p < .10.
*
p < .05.
**
p < .01.
***
p < .001.

282 L.A. McWilliams, D. Holmberg / PAIN 149 (2010) 278283
in an indirect and maladaptive manner, such as expressing cata-
strophic thoughts and engaging in pain behavior. Anxiously at-
tached chronic pain patients might benet from interventions
aimed at reducing pain behavior or enhancing their ability to com-
municate support needs effectively.
The second aim was to investigate the relationship between
attachment avoidance and pain catastrophizing. These variables
were not signicantly correlated; however, multiple regression
analyses indicated that when attachment anxiety and other vari-
ables were controlled, attachment avoidance was negatively asso-
ciated with pain catastrophizing, particularly the rumination
component. It is possible that the variance shared by attachment
anxiety and avoidance reects a tendency to experience negative
affect and cope ineffectively, and that once this overlapping vari-
ance is adjusted for, the unique effects of attachment avoidance
on pain-catastrophizing emerge. This avoidance-specic variance
may reect the deactivating style of coping that characterizes
those high in avoidance. This style involves the minimization of
threats, efforts to appear self-reliant, and attempts to convince
attachment gures that support is not needed [29]. In the context
of chronic pain, this may involve the avoidance of pain-related
thoughts and a stoical presentation in which pain behavior is
suppressed.
The observed negative association between attachment avoid-
ance and pain catastrophizing is inconsistent with the past re-
search. The current ndings are difcult to compare to those of
Meredith and colleagues [23,24] because they used only correla-
tion analyses. However, the present regression approach was very
similar to that used by McWilliams and Asmundson [21], who ob-
tained a small but signicant positive association between avoid-
ance and catastrophizing. One potential explanation for these
inconsistent ndings relates to the nature of the two samples. To
obtain the individuals able to report on reactions to partners pain,
the present study recruited individuals currently in a romantic
relationship. Avoidant individuals in relationships may catastro-
phize less because they have learned from past experience that
revealing distress to an attachment gure elicits neglect or rejec-
tion [29] and that they are more likely to receive a minimal level
of support when they do not appear overly needy [2]. In contrast,
McWilliams and Asmundson [21] did not specically recruit par-
ticipants in romantic relationships. Avoidant individuals without
a romantic attachment gure may be more prone to catastrophiz-
ing because doing so would be less likely to elicit aversive interper-
sonal consequences, such as rejection and hostility. Thus, the
relationship between attachment avoidance and pain catastrophiz-
ing could be moderated by the presence or absence of a romantic
relationship. This possibility is consistent with the notion that
the attachment system is exible and inuenced by appraisals of
the availability and responsiveness of attachment gures [29].
The nal objective of the study was to investigate whether
attachment also predicts catastrophizing regarding the pain of sig-
nicant others. Bowlby [5] posited an innate caregiving system,
activated by observing others in distress, that is, the bio-behavioral
complement of the attachment behavioral system [27]. Based on
research indicating that similar brain regions are activated by
experiencing pain and by observing pain [4,16], it was hypothe-
sized that the attachment dimensions would have similar relation-
ships with the PCS and PCS-S variables. This hypothesis was not
supported. Attachment anxiety was more strongly and consistently
associated with the PCS variables than was attachment avoidance,
whereas the reverse pattern was found with regard to the PCS-S
variables.
Attachment anxiety was positively associated with only the
PCS-S helplessness subscale, in both the initial correlation analyses
and the nal regression analyses. The broader attachment litera-
ture suggests that anxiety is associated with becoming distressed
in response to the distress of others [26,42]. Items in the helpless-
ness subscale of the PCS-S clearly focus on ones own distress in the
face of the signicant others pain (e.g., Its awful and I feel that it
overwhelms me); in contrast, the other PCS-S subscales include
more items that indicate empathy for the signicant other
(e.g., I keep thinking about how much it hurts for my partner).
Attachment anxiety may better predict a self-centred tendency to
become upset in the face of others pain, rather than a more
other-focused, empathic type of distress.
In the nal regression model, avoidance had a signicant nega-
tive association with the total PCS-S and its rumination and help-
lessness subscales. This pattern is consistent with the notion that
attachment avoidance is characterized by a deactivating approach
to stressors, involving suppression of negative thoughts and emo-
tional detachment, which emerges clearly only when the overlap-
ping variance with attachment anxiety is controlled. Avoidance
was more strongly related to the PCS-S variables than to the PCS
variables, suggesting that the deactivating response may be more
pronounced in response to others pain, rather than ones own.
Avoidant individuals have been characterized as compulsively
self-reliant [29]. When dealing with their own pain, they may
experience a conict between efforts to ignore or distance them-
selves from the pain, and efforts to emphasize their self-sufciency
by confronting the pain. When dealing with the pain of signicant
others, they may be more prone to simply withdraw.
Several limitations of the study should be noted. First, the gen-
eralizability of the ndings is limited by the use of a self-selected,
relatively young, primarily dating sample. Second, the participants
pain experiences were not assessed, so it was not possible to inves-
tigate whether the relationships found in the present study might
be moderated by the participants personal experiences with pain.
However, the positive association found between attachment anx-
iety and pain catastrophizing is consistent with the past research
on individuals with [23] and without [21,24] chronic pain, so it is
likely that this relationship generalizes across pain contexts. Third,
pain experiences of participants signicant others were not as-
sessed. Thus, it remains to be determined whether the ndings
regarding the PCS-S generalize to samples involving a signicant
other with chronic pain.
Furthermore, attachment research [26,42] and pain-specic
conceptualizations of empathy [14] have both noted that re-
sponses to the distress of others involve both self-oriented reac-
tions of personal distress, and other-oriented responses of
sympathy and empathy. The PCS-S is primarily a measure of per-
sonal distress. While it does include some items that reect a more
sympathetic response to such pain, it is not ideally suited to assess-
ing heightened concern about a signicant other in pain. A mea-
sure that assesses such other-oriented reactions would
complement the PCS-S, and could contribute to an improved
understanding of interpersonal inuences on the pain experience.
The current study did not examine the roles of attachment and
catastrophizing in the dynamic interplay between one partners
help-seeking behaviors and the other partners support provision.
Nonetheless, past research and the current ndings suggest some
specic hypotheses. First, positive associations between catastro-
phizing and both attachment anxiety and pain behavior
[18,34,37,40,41] suggest that catastrophizing may have a social
support-seeking component that involves exaggerating pain sever-
ity and ones inability to cope. Second, the previous research in
both the attachment [10] and chronic pain literatures [3] suggests
that this approach to seeking help would likely elicit negative re-
sponses from signicant others. Third, highly anxious individuals,
who reported feeling helpless to deal with signicant others pain,
might be expected to provide particularly ineffective forms of so-
cial support. This hypothesis is consistent with the suggestion [9]
that individuals high in signicant other pain catastrophizing

L.A. McWilliams, D. Holmberg / PAIN 149 (2010) 278283
may provide care characterized by over-involvement that results
in their signicant others perceiving themselves to be a burden.
Additional research investigating how both partners attachment
characteristics predict catastrophizing regarding their own and
their partners pain, and how such catastrophizing in turn predicts
the dynamics of support interactions between those partners, is
clearly warranted.
Acknowledgements
The authors thank Justin Milne and Trista Takacs for their assis-
tance with the data collection. This research was supported by a
Standard Operating Grant from the Social Sciences and Humanities
Research Council granted to Dr. McWilliams, and an Acadia Univer-
sity Research Fund award to Dr. Holmberg. The authors do not have
conicts of interest to declare.
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