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A fearful adult attachment style is associated with double the presence of chronic pain compared to secure attachment: A national survey of a South African population

Year: 2025

Type: article

Abstract: OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Source: British Journal of Health Psychology

DOI: 10.1111/bjhp.70024

Authors: Gabriella Elisabeth Stamp, Stella Iacovides, Antonia Louise Wadley

Institution: University of the Witwatersrand

Language: English

Topic: Attachment and Relationship Dynamics

Subfield: Social Psychology

Field: Psychology

Domain: Social Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,240