Temperament

Temperament refers to inborn personality traits or the tendency to respond to and cope with stimuli in predictable ways. Examples include the inclination to approach or avoid novel stimuli and the degree of attentional focus (e.g., hypervigilance, obsessive-ness, perseverative interest) given to somatic symptoms. Temperament as it relates to pain perception and disability has been examined in many different ways. A behaviorally inhibited temperament during childhood has been associated with variability in stress reactivity, a tendency to activate neural circuits that trigger distress responses to threatening stimuli, anxiety disorders, and somatic complaints (Boyce et al. 1992; Degnan and Fox 2007). Based on their research results with a group of children age 6 years with recurrent abdominal pain compared with a control group, Davison et al. (1986) hypothesized that abdominal pain represents an interaction between a vulnerable temperamental style and environmental stresses. Subsequent research has supported this hypothesis.

Campo et al. (2004) found that, compared with controls, pediatric patients with abdominal pain, ages 8-15 years, were significantly more likely to receive a diagnosis of anxiety disorders (79%) and depressive disorders (43%) and had higher levels of anxiety and depressive symptoms, temperamental harm avoidance, and functional impairment. Hy-man et al. (2002) found that 50% of adolescents disabled by functional gastrointestinal disorders were described by their parents as highly organized, neat, and perfectionistic in personality. Pain sensitivity and disability have been linked with a tendency to fixate on pain and pain-related distress (Bennett-Branson and Craig 1993; Gil et al. 1991). Catastrophizing, characterized by rumination, magnification, and helplessness, has been significantly correlated with increased laboratory pain in healthy child and pediatric pain samples (Keefe et al. 2000; Piira et al. 2002; Sullivan et al. 2001; Thastum et al. 1997, 2001). In adults, anxiety sensitivity (i.e., the tendency to interpret anxiety-related bodily sensations, such as rapid heart beat, as dangerous) has been associated with anxiety disorders (Taylor 1999) and chronic pain (Asmundson et al. 1999). In one pediatric pain laboratory study, measures of anxiety sensitivity, anxiety symptoms, and anticipatory anxiety combined explained 62% of the variance in pain intensity (Tsao et al. 2007).

Perceived coping inefficacy is associated with distress, autonomic arousal, and plasma catecholamine secretion (Bandura et al. 1985). Research on children with recurrent abdominal pain reveals that accommodative coping strategies (distraction, acceptance, positive thinking, cognitive restructuring) are correlated with less pain, whereas passive coping strategies (denial, cognitive avoidance, behavioral avoidance, wishful thinking) are correlated with increased levels of pain (Thomsen et al. 2002; Walker et al. 1997). Active coping strategies (problem solving, emotional expression, emotional modulation, decision making) are inconsistent in their relationship to pain (Thomsen et al. 2002; Walker et al. 1997). Claar et al. (1999) studied self-perceived academic, social, and athletic competence as moderators between symptoms of irritable bowel syndrome and functional disability in youth with a history of recurrent abdominal pain. The relationship between symptoms and disability was stronger at lower levels of perceived academic competence. The same relationship was found for females at lower levels of perceived social competence and for males at lower levels of perceived athletic competence.

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