A high degree of co-morbidity has been observed in general between chronic pain and various anxiety disorders and specifically between chronic pain and social anxiety disorder (or social phobia) both in clinical pain populations and in general populations. What is the etiology behind this co-morbidity? One clue may come from the concept of self-focused attention. A personality trait that refers to people’s individual differences in the degree of self-focused attention is self-consciousness, which has been observed to consist of two separate aspects. One is a private aspect addressing a person’s inner experiences as thoughts, feelings and somatic symptoms. The other aspect is a public aspect addressing a person’s attention to the self as a social object. Social anxiety disorder is characterized by a marked fear of scrutiny in a variety of social situations which implies a high degree of public self-consciousness. High degree of public self- consciousness has been associated both with higher degree of sensitivity to being socially rejected, and with physical (sexual) pain. However, research related to public self-consciousness and pain is very limited. Interesting to note is that from a neurobiological perspective the same area in the brain is activated both in physical pain and in social exclusion. In line with this, it has also been observed that sensitivity to physical pain and sensitivity to social rejection are mutually reinforcing. In Western societies we build much of our identity from what we achieve. For people who develop chronic pain and the often accompanying labor reduction should the social environment be experienced more invalidating if the person at the same time worries a lot for how others will perceive him/her (i.e., being high on public self-consciousness). This in turn may reinforce the impulse to avoid not only situations involving activities of a physical nature but also social activities. Overall, it should be of interest to examine public self-consciousness in relation to both pain and social anxiety. It has to our knowledge not been done before.
Aim: The aim of the present study was to examine and identify possible patterns (by cluster analysis) of self-consciousness (public and private), social anxiety and pain in a non-clinical population. These profiles were examined in relation to disabling social anxiety respectively disabling pain.
Methods: In this study, cluster analysis was used to identify subgroups of people characterized by different profiles of social anxiety, self-consciousness (public and private) and pain. University students (19-46 years old; N = 302) participated in a cross-sectional study.
Results: We identified six clusters, including one group scoring high on all variables (the co-morbidity cluster). Further, we found a significant relation between the cluster solution and both disabling pain and disabling social anxiety where people belonging to the co-morbidity cluster were overrepresented.
Conclusions: This suggests that public self-consciousness may be important to consider in terms of co-morbidity between pain and social anxiety. A next step is to try to replicate this result and thereby increase the external validity. Finally, if a person has a pattern in which he/she scores high on pain, social anxiety and public and private self-consciousness this may point to an enhanced risk for that person to developing both social anxiety disorder and chronic pain.
2012.