title: A cross-cultural investigation of attachment style, catastrophizing, negative pain beliefs, and symptom severity in irritable bowel syndrome.
abstract: BACKGROUND
  Little information exists regarding whether psychosocial variables in irritable bowel syndrome (IBS) vary by geographic location. Adult attachment is an important psychological concept rooted in childhood relationship experience that has not been previously studied in IBS. Catastrophizing and negative pain beliefs have been described in IBS and may be affected by attachment.
  
  
  OBJECTIVE
  In this cross-cultural study, we determined: (i) whether attachment differs between IBS patients and controls, (ii) whether geographic location has a significant effect on attachment style, catastrophizing and negative pain beliefs, and (iii) how all three variables correlate with IBS symptom severity.
  
  
  METHODS
  463 IBS patients, with moderate to severe symptom scores, and 192 healthy controls completed validated questionnaires about attachment, catastrophizing, negative pain beliefs and IBS-SSS in nine locations, USA (New York, Los Angeles), Mexico, Italy (Rome, Bari), Romania, Iran, India, and China.
  
  
  RESULTS
  Attachment anxiety and avoidance scores were significantly higher in IBS patients than in controls (p < 0.001). This was particularly true for the fearful-avoidant attachment category, especially in China and Romania. Path analysis showed that attachment anxiety and avoidance had indirect effects on IBS-SSS through catastrophizing (p < 0.0001) and negative pain beliefs (p = 0.005). All three psychosocial measures varied significantly depending on location.
  
  
  CONCLUSIONS
  In the IBS population studied, attachment style was significantly different in IBS compared to a control population. Geographic differences in attachment, catastrophizing and negative pain beliefs were documented and their correlation with symptom severity and thus, research of psychosocial variables in IBS should take into account the location of the population studied.
authors: Division of Gastroenterology, Mount Sinai School of Medicine, New York, NY, USA.
authors: C D
authors: CD
authors: Gerson
authors: M-J
authors: MJ
authors: Gerson
authors: L
authors: L
authors: Chang
authors: E S
authors: ES
authors: Corazziari
authors: D
authors: D
authors: Dumitrascu
authors: U C
authors: UC
authors: Ghoshal
authors: P
authors: P
authors: Porcelli
authors: M
authors: M
authors: Schmulson
authors: W-A
authors: WA
authors: Wang
authors: M
authors: M
authors: Zali
mesh_terms: D000328:Adult; D058443:Catastrophization / Q000523:psychology*; D003431:Cross-Cultural Comparison; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D043183:Irritable Bowel Syndrome / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009769:Object Attachment; D010146:Pain / Q000523:psychology*; D012720:Severity of Illness Index
keywords: attachment; catastropohizing; cross-cultural; irritable bowel syndrome; negative pain beliefs