Stress, coping, and personality hardiness in the etiology of temporomandibular disorders

This study examined the relationships among perceived life stress, stress coping mechanisms, and the personality construct of hardiness in a sample of patients diagnosed with a temporomandibular disorder (TMD), a form of chronic facial pain. Epidemiological studies suggest that approximately 75% of patients diagnosed with TMD are female. Signs and symptoms of TMD include generalized pain of the head and neck, limited mandibular range of motion, clinically significant joint sounds on functional movement of the mandible, and radiographic evidence of change within the temporomandibular joints. A growing body of research suggests that stress may play a role in the genesis and exacerbation of the disorder, perhaps through tensing of the mandibular muscles and involuntary grinding of teeth (bruxism). The present study proposed that personality hardiness, consisting of feelings of commitment and internal locus of control, would distinguish between a sample of 84 diagnosed TMD patients and a contrast sample of 79 general dental patients. It was also hypothesized that TMD patients would utilize coping mechanisms related to negative health outcomes. Linear discriminant function analysis revealed TMD patients reported significantly higher levels of neuroticism, escape/avoidance coping, intensity of daily hassles, and self-reported pain. The general dental patients reported significantly more commitment, optimism, and planful problem-solving. The control component of hardiness was not a significant discriminating variable. Factor analysis of these discriminating variables suggested four factors which were of conceptual interest: escape/neuroticism, pain, hardiness, and problem solving/optimism. Analyses suggested that TMD patients endorsed items on these factors indicative of a greater tendency to see events as stressful and to respond with less effective coping responses. This was particularly true for the male TMD patients, who reported a much higher incidence of clinically significant anxiety and depression. These results suggest the utility of conceptualizing stress in TMD as a reciprocal transaction between the person and the environment with a focus on the cognitive processes by which patients identify and label life events as stressful