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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald

CiteScore 2017: 0.84

SCImago Journal Rank (SJR) 2017: 0.401
Source Normalized Impact per Paper (SNIP) 2017: 0.452

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Volume 17, Issue 1


New evidence for a pain personality? A critical review of the last 120 years of pain and personality

Brooke Naylor
  • Neuroscience Research Australia, Veldhoven, Australia
  • School of Psychology, Macquarie University, Macquarie, Australia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Simon Boag / Sylvia Maria Gustin
  • Corresponding author
  • Neuroscience Research Australia, Veldhoven, Australia
  • School of Psychology, University of New South Wales, New South Wales, Australia
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-10-01 | DOI: https://doi.org/10.1016/j.sjpain.2017.07.011



Personality traits may influence development and adjustment to ongoing pain. Over the past 120 years, there has been considerable research into the relationship between pain and personality. This paper presents new evidence for common personality traits found amongst chronic pain sufferers. In particular, it evaluates evidence for Cloninger’s biopsychosocial model of personality in distinguishing typical personality features of chronic pain sufferers. It evaluates this evidence in the context of the past 120 years of research including psychodynamic formulations, MMPI studies, personality disorder investigations, and the influence of neuroticism on chronic pain.


A literature search was conducted using PubMed, Medline, PsyclNFO, SCOPUS and Cochrane library. Search terms included chronic pain, pain, personality, neuroticism, harm avoidance, self-directedness, attachment, Temperament and Character Inventory (TCI-R), MMPI, MMPI-2, NEO-PI, EPI, Millon Clinical Multiaxial Inventory, Millon Behavioral Health Inventory, Millon Behavioral Medicine Diagnostic, the Personality Assessment Inventory, the Locus of Control Construct and different combinations of these terms.


Recent descriptive studies using Cloninger’s Temperament and Character Inventory (TCI-R) suggest that higher harm avoidance and lower self-directedness may be the most distinguishing personality features of chronic pain sufferers. High harm avoidance refers to a tendency to be fearful, pessimistic, sensitive to criticism, and requiring high levels of re-assurance. Low self-directedness often manifests as difficulty with defining and setting meaningful goals, low motivation, and problems with adaptive coping. Evidence for this personality profile is found across a wide variety of chronic pain conditions including fibromyalgia, headache and migraine, temporomandibular disorder, trigeminal neuropathy, musculo-skeletal disorders and heterogeneous pain groups. Limitations are also discussed. For example, high harm avoidance is also found in those suffering anxiety and depression. While many studies control for such factors, some do not and thus future research should address such confounds carefully. The evidence is also evaluated within the context of past research into the existence of ‘a pain personality’. Psychodynamic formulations are found to be deficient in objective scientific methods. MMPI studies lack sufficient evidence to support ‘a pain personality’ and may be confounded by somatic items in the instrument. More recent neuroticism studies suggest a relationship between neuroticism and pain, particularly for adjustment to chronic pain. Personality disorders are more prevalent in chronic pain populations than non-pain samples.

Clinical implications

Because harm avoidance reflects a tendency to developed conditioned fear responses, we suggest that higher harm avoidance may create more vulnerability to developing a fear-avoidance response to chronic pain. Furthermore, lower self-directedness may contribute to keeping a sufferer within this vicious cycle of fear, avoidance and suffering. Moreover, we suggest that harm avoidance and self-directedness are broader and more complex constructs than current clinical targets of CBT such as fear-avoidance and self-efficacy. Thus, assessing such personality traits may help to address the complexity of chronic pain presentations. For example, it may help to identify and treat sufferers more resistant to treatment, more prone to comorbidity and more vulnerable to entering the vicious cycle of chronic pain, suffering and disability.

Keywords: Chronic pain; Personality; Harm avoidance; Self-directedness; Neuroticism


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About the article

School of Psychology, University of New South Wales, Australia

Received: 2016-12-05

Revised: 2017-07-05

Accepted: 2017-07-05

Published Online: 2017-10-01

Published in Print: 2017-10-01

FundingThis work was supported by the National Health and Medical Research Council of Australia (GNT1084240) and the Rebecca L. Cooper Medical Research Foundation.

Ethical issuesEthic Board approval was not required for this critical review.

Conflicts of interestThe authors have no conflict of interest to report.

Citation Information: Scandinavian Journal of Pain, Volume 17, Issue 1, Pages 58–67, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2017.07.011.

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