Self-discrepancy theory and chronic pain

The focus of this study was to assess the impact of one aspect of a person’s identity,
self-discrepancies, on adjustment to chronic pain. It was also the first test of the
schema-enmeshment model of pain (Pincus and Morley, 2001) which proposes that
distress in chronic pain results from a comprehensive overlap or enmeshment of three
schemas representing pain, illness and the self.
89 chronic pain patients attending pain clinics in Leeds and Manchester were asked to
describe three possible selves - actual self, hoped for self and feared self. To measure
the degree of enmeshment between the self schema and pain schema they were asked
whether their hoped for attributes and feared attributes were conditional on the presence
or absence of pain. Levels of depression, anxiety, disability and pain acceptance were
also measured. It was predicted, in line with self-discrepancy theory (Higgins, 1987),
that the magnitude of the actual-hoped for discrepancy would be related to depression.
The magnitude of the actual-feared discrepancy was predicted to be related to anxiety. It
was hypothesised that the proportion of hopes possible with pain would be negatively
related to distress.
It was found that the actual-hoped discrepancy was a significant predictor of depression
and anxiety. A large actual-hoped discrepancy was associated with increased
depression, anxiety and disability and reduced acceptance. The actual-feared
discrepancy did not significantly predict anxiety or depression but it was negatively
related to depression, anxiety and disability and positively related to acceptance. The
proportion of hopes possible with pain was also a significant predictor of depression in
the expected direction.
The findings are discussed in relation to self-discrepancy theory, previous findings
relating to the actual-feared discrepancy and the schema-enmeshment model of pain.