Catastrophic thinking has widely been recognized in the development and maintenance of
hypochondriasis
Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. An old concept, the meaning of hypochondria has repeatedly changed. It has been claimed that this debilitating cond ...
and
anxiety disorder
Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physi ...
s. This broadly accepted understanding has classified catastrophizing as a tendency to misinterpret and exaggerate situations that may be threatening.
Pain
Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...
is an undesirable sensory and emotional experience in response to potential or actual tissue damage.
A general consensus of
pain catastrophizing Pain catastrophizing is the tendency to describe a pain experience in more exaggerated terms than the average person, to ruminate on it more (e.g., "I kept thinking 'this is terrible'"), and/or to feel more helpless about the experience ("I thought ...
involves an exaggerated negative perception to painful stimuli. The components of catastrophizing that are considered primary were long under debate until the development of the Pain Catastrophizing Scale (PCS) by Michael J. L. Sullivan and Scott R. Bishop of Dalhousie University in 1995. The PCS is a 13 item scale, with each item rated on a 5-point scale: 0 (Not at all) to 4 (all the time). The PCS is broken into three subscales being magnification, rumination, and helplessness. The scale was developed as a
self-report
A self-report study is a type of survey, questionnaire, or poll in which respondents read the question and select a response by themselves without any outside interference. A ''self-report'' is any method which involves asking a participant abou ...
measurement tool that provided a valid index of catastrophizing in clinical and non-clinical populations.
The results of the initial development and validation studies indicated that the PCS is a reliable and valid measurement tool for catastrophizing. The high test-retest relationships concluded that individuals may possess enduring beliefs with regards to the threat value of painful stimuli. It was also found that from a clinical perspective, the PCS may be useful in identifying individuals that may be more susceptible to high distress responses from aversive medical procedures such as chemotherapy or surgery.
Further psychometric evaluation
A secondary study was conducted by Augustine Osman of the
University of Northern Iowa
The University of Northern Iowa (UNI) is a public university in Cedar Falls, Iowa. UNI offers more than 90 majors across the colleges of Business Administration, Education, Humanities, Arts, and Sciences, Social and Behavioral Sciences and grad ...
to replicate the findings found in the development and validation studies of Sullivan and Bishop. At the time of the study there was a great deal of interest in understanding the cognitive factors involving pain and an individual's response to persistent pain experiences. Before the development of the Pain Catastrophizing Scale (PCS) there had been no other self-report measurement tool that focused primarily on catastrophizing. Other self-report measurement tools such as: the Coping Strategies Questionnaire (CSQ), the Pain-Related Self-Statements Scale (PRSS) and the Cognitive Coping Strategy Inventory (CCS) had subscales for assessing catastrophizing but failed to explore specific dimensions of catastrophizing. Osman conducted a series of experiments to replicate the findings of Sullivan and Bishop, as well as evaluated the validity of the PCS's ability to effectively differentiate between adult outpatient and nonclinical community samples using adult subjects.
The study that Osman conducted effectively replicated the findings of Sullivan and Bishop. The Study confirmed the ability of the PCS to isolate general catastrophizing characterized by the three primary related factors (rumination, magnification, and helplessness). The PCS was found to effectively differentiate between clinical and nonclinical samples, through verifying a clear distinction between overall and subscale scores of the PCS of the tested subjects. The findings of the study provided empirical support for the PCS in future studies.
As the Pain Catastrophizing Scale has been developed, the goal of studies has shifted to its usability as a universal scale. Through various studies the PCS was shown to be invariant (with most accuracy in the three oblique factor structure) across genders and both clinical and non-clinical groups. The gender focused study expressed that female subjects report more frequent experiences of pain, varied intensity with increased persistence, and lower
pain tolerance
Pain tolerance is the maximum level of pain that a person is able to tolerate. Pain tolerance is distinct from pain threshold (the point at which pain begins to be felt).thresholds. With minimal modification (to address the subject of the catastrophizing) the PCS can also be applied to pain catastrophizing in a social context. The social aspects studied were parents of disabled children and spouses of individuals with
chronic pain
Chronic pain is classified as pain that lasts longer than three to six months. In medicine, the distinction between Acute (medicine), acute and Chronic condition, chronic pain is sometimes determined by the amount of time since onset. Two commonly ...
. Specifically it has been shown to determine illness related stress and depression issues that arise from parent's catastrophizing about their child's pain in regards to a
disability
Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be Cognitive disability, cognitive, Developmental disability, dev ...
or
illness
A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that ar ...
. Similarly with respect to pain catastrophizing between romantic partners, spouse catastrophizing about a partner's chronic pain was related to depressive and pain severity levels in both spouses.
Applications
Research of pain catastrophizing has found that catastrophic thinking can result in a more intense experience of pain. By this association, catastrophizing has led to over predictions of pain, increased use of health care and longer hospital stays. The use of the PCS in clinical and nonclinical settings can provide a more specific tool for healthcare professionals to better care for their patients. A greater understanding of a person's experience of pain can allow for a better care regimen to be implemented helping reduce problems that have previously come from catastrophizing.