Influence of defensiveness on disability in a chronic musculoskeletal pain population

Objective: This study aimed to identify the following: (1) the proportion of the defensive high-anxious personality type in a chronic pain population; (2) whether personality type affects the relationships between cognitive factors and disability. Method: Sixty patients with chronic musculoskeletal pain, referred to a hospital for treatment, completed questionnaires assessing defensiveness, trait anxiety, pain intensity, disability, depression, catastrophizing, self-efficacy, and kinesiophobia. Personality type was assessed using the State-Trait Anxiety Inventory and the Marlowe-Crowne Social Desirability Scale. Results: Within the defensive high-anxious group, lower levels of self-efficacy, and high levels of depression and catastrophizing most strongly predicted perceptions of disability. Interestingly, the cognitive variables failed to significantly predict disability for individuals lower in anxiety and defensiveness; however, pain intensity did have a greater effect, explaining 36% of the variance. Conclusions: The interaction between defensiveness and anxiety plays an important role in patients' perceptions of, and outcomes from, chronic pain. Differentiating the defensive high-anxious group revealed different patterns of relationship between a range of cognitive factors and disability. This highlights the necessity of assessing personality characteristics that include defensiveness in order to identify those individuals who may be more vulnerable to cognitive factors influencing their perceptions of disability. If personality type is identified as a predictor of poor adjustment, interventions could be customized to the unique needs of this group (eg. high defensive and anxious individuals)