title: Attachment, symptom severity, and depression in medically unexplained musculoskeletal pain and osteoarthritis: a cross-sectional study.
abstract: BACKGROUND
  Attachment insecurity relates to the onset and course of chronic pain via dysfunctional reactions to pain. However, few studies have investigated the proportion of insecure attachment styles in different pain conditions, and results regarding associations between attachment, pain severity, and disability in chronic pain are inconsistent. This study aims to clarify the relationships between insecure attachment and occurrence or severity of chronic pain with and without clearly defined organic cause. To detect potential differences in the importance of global and romantic attachment representations, we included both concepts in our study.
  
  
  METHODS
  85 patients with medically unexplained musculoskeletal pain (UMP) and 89 patients with joint pain from osteoarthritis (OA) completed self-report measures of global and romantic attachment, pain intensity, physical functioning, and depression.
  
  
  RESULTS
  Patients reporting global insecure attachment representations were more likely to suffer from medically unexplained musculoskeletal pain (OR 3.4), compared to securely attached patients. Romantic attachment did not differ between pain conditions. Pain intensity was associated with romantic attachment anxiety, and this relationship was more pronounced in the OA group compared to the UMP group. Both global and romantic attachment anxiety predicted depression, accounting for 15% and 17% of the variance, respectively. Disability was independent from attachment patterns.
  
  
  CONCLUSIONS
  Our results indicate that global insecure attachment is associated with the experience of medically unexplained musculoskeletal pain, but not with osteoarthritis. In contrast, insecure attachment patterns seem to be linked to pain intensity and pain-related depression in unexplained musculoskeletal pain and in osteoarthritis. These findings suggest that relationship-informed focused treatment strategies may alleviate pain severity and psychological distress in chronic pain independent of underlying pathology.
authors: Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany.
authors: Corinna
authors: C
authors: Schroeter
authors: Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Thibautstr. 2, 69115 Heidelberg, Germany.
authors: Johannes C
authors: JC
authors: Ehrenthal
authors: Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany.
authors: Martina
authors: M
authors: Giulini
authors: Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany.
authors: Eva
authors: E
authors: Neubauer
authors: Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany.
authors: Simone
authors: S
authors: Gantz
authors: Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany.
authors: Dorothee
authors: D
authors: Amelung
authors: SRH Gesundheitszentrum Bad Wimpfen, Bei der alten Saline 2, 74206 Bad Wimpfen, Germany.
authors: Doreen
authors: D
authors: Balke
authors: Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany.
authors: Marcus
authors: M
authors: Schiltenwolf
mesh_terms: D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000209:etiology; D003430:Cross-Sectional Studies; D003710:Demography; D003863:Depression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000473:pathology*; D009769:Object Attachment; D016017:Odds Ratio; D010003:Osteoarthritis / Q000150:complications / Q000473:pathology*; D011594:Psychometrics; D012044:Regression Analysis; D057566:Self Report; D012720:Severity of Illness Index; D055815:Young Adult