Shame Mediates the Relationship Between Pain Invalidation and Depression

Abstract

The experience of pain is subjective, yet many people have their pain invalidated or not believed. Pain invalidation is associated with poor mental health, including depression and lower well-being. Qualitative investigations of invalidating experiences identify themes of depression, but also social withdrawal, self-criticism, and lower self-worth, all of which are core components of shame. Despite this, no studies have quantitatively assessed the interrelationship between pain invalidation, shame, and depression. To explore this relationship, participants recounted the frequency of experienced pain invalidation from family, friends, and medical professionals, as well as their feelings of internalized shame and depressive symptoms. As shame has been shown to be a precursor for depression, we further explored the role of shame as a mediator between pain invalidation and depressive symptoms. All sources of pain invalidation were positively associated with shame and depressive symptoms, and shame fully mediated the relationship between each source of pain invalidation and depression. Relative to other sources, pain invalidation from family was most closely tied to shame and depression. Overall, findings indicate that one mechanism by which pain invalidation may facilitate depression is via the experience of shame. Future research may explore shame as a potential upstream precursor to depression in the context of pain. Findings provide more insight into the harmful influence of pain invalidation on mental health and highlight the impact of interpersonal treatment on the experiences of people in pain.

Psychosocial factors associated with pain and health‐related quality of life in Endometriosis: A systematic review

“…Eriksen et al (2008) reported that emotion suppression, which is prevalent in Endometriosis (Zarbo et al, 2018), could result in the underreporting of depressive symptoms and mask the association between depression and pain. Stigma is another factor that could mediate the association between pain invalidation and depression (Boring et al, 2021). Further research, which controls for confounders and has longitudinal designs, is needed to elucidate the relationship between depression and pain in this population.…”

“…These experiences not only have an impact on the diagnosis of this condition, which takes 8–9 years on average (Ghai et al, 2020; Tewhaiti‐Smith et al, 2022) but also increase psychological distress. For instance, feelings of pain invalidation by medical professionals have been shown to increase shame and depressive symptoms (Boring et al, 2021). Understanding the role of psychosocial factors in relation to outcomes in Endometriosis could raise awareness among healthcare professionals about their importance in the conceptualisation and management of this condition; this, in turn, can contribute to a shift from a biomedical view of the condition to a broader conceptualization that is more comprehensive.…”

Longitudinal association of mindfulness with aggression and non‐suicidal self‐injury in adolescence: The mediating role of shame‐proneness

“…These findings are consistent with the results of other cross‐sectional studies (Garofalo et al, 2020; Leavitt et al, 2020), revealing that describing, acting with awareness, and nonjudging can act as negative predictors of aggression and NSSI by the shame‐proneness's mediating effects. Shame is considered as one variety of social pain (Boring et al, 2021; Elison et al, 2006, 2014; Iwakabe, 2021). As MacDonald and Leary (2005) hypothesizing that because social pain coopted the physical pain mechanisms, the links extend to physical threat‐defense mechanisms proposed by researchers (Jonas et al, 2014; Park et al, 2023), the results of current study can be explained by the threat‐defense mechanism.…”

Over-Rating Pain is Overrated: A Fundamental Self-Other Bias in Pain Reporting Behavior

“…7,58 Such prevalent beliefs often go unchecked, allowing entry for bias into pain assessment and contribute to suboptimal care and continued suffering. 4,8,16,32,52 However, suspicion of others' pain has more upstream causes and is rooted in stereotypes that pervade cultural assumptions. 14 The results of our study challenge the pervasive cultural assumption that people tend to over-report pain, and indicate that normative pain reporting behavior is accurate reporting.…”