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There is a dynamic two-way interaction between pain and personality and the psychophysiology and anatomy of this relationship are not elucidated fully. Is there a specific personality type of pain or do some people perceive and express pain more than others? Probably there is no clear answer to this question. So far chronic pain has been shown to affect personality, as indicated by studies using Cloninger's Temperament and Character Inventory. A relationship has been demonstrated between some personality traits and pain. In studies that reported the prevalence of personality disorders, associations with chronic pain vary between 31% to 81%. The most frequently identified personality trait is one with paranoid features.
Today I will talk mainly about studies using Cloninger's model, because Cloninger's integrative psychobiological approach provides a şexible framework for both clinical assessment and treatment planning. The most significant and consistent result of these studies was elevated harm avoidance scores. Harm avoidance scores still remain high even after controlling for the effect of depression and anxiety. Thus this temperament dimension is possibly an important state and trait feature for development of psychosomatic illnesses. These findings also confirmed that serotonergic systems are involved in the process of psychosomatic organization. Cloninger described that people with chronic anxiety, avoid harm that is characterized by more pain, are difficult to calm, tire easily, and display specific signs based on specific anticipatory anxiety. Harm avoidance refers to an inherited tendency to block the behavior in the answers given to the blocking, non-rewarding, and punishment signals. High harm avoidance behavior is observed in the form of social withdrawal, becoming tired easily, staying away from strangers, fear of uncertainty, and being pessimistic that there would be some problems in a situation even when others do not worry.. These people are timid, passive, insecure, and pessimistic individuals.
Looking at the size of the character, it is seen that low self-directedness scores are the most common finding. The original meaning of self-directedness is in accordance with choosing goals and values of the individual, optimization of the behavior to maintain a situation, editing capabilities, and being strong-willed.
Individuals with low self-directedness do not expect to be able to control and positively inşuence an aversive situation and overcome obstacles. Self-directedness is closely related to the concept of self-efficacy. Self-efficacy is defined as the personal conviction that one can successfully show problem-solving behavior in a given situation. There is much evidence which suggests that low self-efficacy plays an important role in pain control, coping with disability, and treatment outcome. Our clinical experiences show that pain can sometimes be the symbol of help, sometimes the quest for attention, and other times problems that can not be expressed. Emotions that are not expressed can mean pain and unexpressed emotions can be the cause of pain for some people that do not heal. In order to understand and to treat these people, employing a holistic assessment and approach are very important.