Original article
Coping with emotions and abuse history in women with chronic pelvic pain

https://doi.org/10.1016/j.jpsychores.2005.04.011Get rights and content

Abstract

Objective

The purpose of this study was to investigate whether past abuse and the tendency to repress or suppress unwanted thoughts and emotions contribute to the experience of pain in patients with chronic pelvic pain (CPP).

Methods

A group of CPP patients without endometriosis and a group with endometriosis were compared with a pain-free control group. Participants completed measures of pain, emotional repression, suppression of unwanted thoughts and emotions, and past abuse history.

Results

Both CPP groups were more likely to be emotional suppressors when compared with the control group and reported significantly higher levels of thought suppression and abuse. Endometriosis patients were also more likely to be repressors of emotions when compared with controls. Suppression but not repression was related to higher levels of abuse and pain.

Conclusion

Suppression of unwanted thoughts and emotions and past abuse distinguishes CPP patients from healthy controls. Assisting patients to express distressing emotions may impact on pain levels.

Introduction

People with chronic pelvic pain (CPP) experience ongoing pain that may worsen around the time of menstruation and during sexual activity [1]. The pathology most commonly found to explain CPP is endometriosis, where endometrial tissue develops outside the lining of the uterus [2]. There are also patients who have no obvious evidence of pelvic pathology to explain their symptoms [3]. In this paper, these patients are referred to having CPP without endometriosis.

CPP has been associated with a lifetime incidence of physical and sexual abuse [4], [5], [6], [7], [8]. The purpose of this paper is to investigate whether maladaptive ways of coping with emotions may help to explain the link between abuse and CPP. Emotional coping styles that are thought to be maladaptive in the long term include repression, the defensive denial of negative emotions, and suppression, the conscious effort to avoid distressing thoughts or expressing negative emotions for reasons of social desirability [9], [10], [11], [12]. Emotional repression has been linked to medically aversive physiological changes [13], [14], [15], [16], while suppression has been associated with the experience of medically unexplained somatic symptoms such as chronic fatigue and chronic back pain [9], [17], [18], [19].

We therefore hypothesised that when compared with healthy controls, CPP patients without endometriosis would report significantly higher levels of suppression, while CPP patients with endometriosis would report higher levels of repression. We also predicted that both CPP groups would report higher levels of abuse when compared with controls and that repression and suppression will be related to reports of abuse and pain intensity.

Section snippets

Participants

Ninety-eight female participants completed questionnaires for the study: 37 with endometriosis-related CPP, 24 with CPP without endometriosis, and 37 nonpain controls. The response rate for the CPP patients was 92%, with five patients declining to participate. CPP patients were recruited through a Pelvic Pain clinic after they had been diagnosed through laparoscopic investigation by one of two consultant gynaecologists as having either endometriosis, or CPP without endometriosis if there was

Between-group differences on emotional coping styles

The means, percentages, and inferential statistics used to compare the three participant groups across the emotional coping styles are listed in Table 2. A significant difference was found on all the coping styles.

Chi square was used to compare the three groups across the four the Weinberger repression categories (see Table 2). Post hoc pairwise analyses showed that repression was significantly more prevalent in the endometriosis CPP group than in the other two groups. Suppression was more

Discussion

The results support previous findings of an association between CPP and abuse [4], [5], [6], [7], [8]. This study is the first to suggest that CPP patients with and without endometriosis have a tendency to use ways of coping with past trauma and emotions such as suppression, which are thought to be maladaptive in the long term.

Certain limitations of the study should be noted. The number of patients in each of the groups was relatively small. Abuse was measured using a self-report scale that has

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