A new study has found that people living with chronic pain tend to be more perfectionistic, less self-compassionate and – depending on the measure – less confident in their ability to cope. These psychological traits may intensify suffering, but they also point to new avenues for relief.
An international research team led by Australia's Murdoch University, recruited hundreds of Canadian adults, half with chronic conditions such as back pain, arthritis or migraines, and half without. Participants completed detailed online questionnaires regarding personality and coping styles. The team focused on three traits: perfectionism, self-compassion and general self-efficacy. Perfectionism was then split into two categories – self-oriented – the internal drive to meet very high standards – and socially prescribed, or the belief that others expect it. Self-compassion was gauged by how kindly people treat themselves in difficult moments. Self-efficacy measured the extent to which participants believed they can achieve goals and handle challenges.
“We undertook this study because although the association between stress and pain is recognized, little is known about links between chronic pain and stress arising from perfectionist expectations,” said Dr Graeme Ditchburn from Murdoch University's School of Psychology.
The two-part study involved 531 participants aged 18 to 65 years with chronic pain that had endured for longer than three months and 515 individuals with no chronic pain. In the first study, 237 participants with chronic pain and 237 without pain completed an online survey. The researchers found that those with pain had significant higher levels of socially prescribed perfectionism and lower levels of self-compassion than those without pain. In the second study, 294 individuals with chronic pain, and 278 without, completed the online survey. Those with chronic pain reported significantly higher levels of perfectionism and lower levels of self-compassion and self-efficacy than the pain-free group.
What's more, both kinds of perfectionism – self-oriented and socially prescribed – were higher in those with low self-compassion scores. Statistical analyses found that self-oriented perfectionism and self-compassion was positively associated with self-efficacy, while socially prescribed perfectionism was negatively associated with self-efficacy.
“Chronic pain sufferers may experience frustration with difficulties performing day-to-day activities and push themselves toward unrealistic or unachievable goals,” Ditchburn said. “Furthermore, they may also feel that others have expectations that are difficult to meet.
“Self-compassion may reflect fear of judgment or self-criticism, perceiving the pain condition and the burden caused by this condition as their own fault," he added. "These also have negative implications for perceptions of self-efficacy or self-belief in one’s capacity. In turn, these have both direct and indirect associations with stress, which has negative consequences for physical and mental health."
Ultimately, across both studies, there were clear differences between those with chronic pain and those without – especially when it came to perfectionism. People with chronic pain reported higher levels of socially prescribed perfectionism, the sense of being judged and pressured by others. And in one of the two studies, they also scored higher on self-oriented perfectionism, suggesting they have an inner voice that demands constant flawlessness and performance. The researchers suggest this perfectionistic mindset may exacerbate pain by fueling stress, frustration and a relentless drive to “push through” rather than pacing activity in a sustainable way.
In both studies, those with chronic pain scored significantly lower in regards to self-compassion than their pain-free peers. Instead of treating themselves with understanding, chronic-pain sufferers were more likely to be harsh self-critics. The researchers described self-compassion as a protective buffer – so, without it, pain may feel like more of a load, stripping away emotional resources that build resilience.
While the study captures a snapshot in time rather than a direct causal link, and is based on self-reported data, it does highlight the role psychology plays in living with chronic pain. The way people evaluate themselves – and imagine others evaluating them – shapes how they endure long-term pain conditions.
This is important because these traits – perfectionism and self-compassion – can be changed. The researchers suggest that therapy and targeted coaching, including interventions such as cognitive-behavioral therapy, could help people quiet their inner critics. Earlier studies have shown that chronic pain alters brain chemistry and affects emotional regulation.
“Our findings suggest that interventions aimed at increasing self-compassion and addressing perfectionistic tendencies may be beneficial for individuals experiencing chronic pain," Ditchburn.
The team suggest their work opens the door to more nuanced assessment of the relationship between psychology and physical impairment, which could help people with specific conditions better manage their pain and their mental health.
"As the types and number of pain conditions may impact the individual physically and psychologically to different degrees, future research should explore whether the type of condition and degree of impairment, as perceived by the individual and others, are associated with perfectionism, self-compassion and self-efficacy," the researchers noted in the study. "Further studies examining the extent to which age is associated with perfectionism, self-compassion, and self-efficacy for those with and without chronic pain may also be beneficial, particularly if coupled with analysis of any association it may have with inter-relationships between the scales.
"Furthermore, given pain is not experienced in a vacuum but rather involves caregivers, family members and others, research is needed to explore the potential impact of these systems on the expectations, perfectionism, self-compassion, and self-efficacy of those experiencing chronic pain conditions," they added.
As therapeutic intervention is limited, other recent studies looking into non-drug treatments that build mental resilience as well as changes to diet have shown promise in chronic pain management and improved quality of life.
The study was published in the journal Psychology and Health.
Source: Murdoch University
