Catastrophizing Not Simply a Ploy for Attention

Several questionnaires were administered to evaluate pain intensity, fatigue severity, pain and fatigue behaviors, significant other responses, and catastrophic thinking. Path analysis was used to evaluate whether perceived solicitous responses mediate the relationship of catastrophizing to self-reported pain and fatigue behaviors, as predicted by the CCM; and whether self-reported pain and fatigue behaviors mediate the relationship of catastrophizing to perceived solicitous responses, as predicated by the CBM.

Analyses using the CCM showed statistically significant direct effects of catastrophizing on pain and/or fatigue behaviors (.56; P < .01), as well as a significant effect of perceived solicitousness on these behaviors (.31, P < .01). However, there was no significant relationship between catastrophizing and perceived solicitousness (–.04), and the indirect pathway had no effect on pain and fatigue behavior (–.01), as would be predicated by the CCM.

“This tells us that the catastrophizing-illness-behavior link may not be mediated simply by the perception of available support or solicitousness,” Dr Romano explained.

When examining the CBM, direct effects of catastrophizing on solicitousness (–.29; P < .01) and on pain and fatigue behaviors (.55; P < .01) were observed, and these behaviors were also found to have a direct effect on solicitousness (.44; P < .01). A statistically significant indirect effect of catastrophizing on solicitousness through pain and fatigue behaviors was also found (.24; P < .01), supporting CBM predictions that catastrophizing would be associated with solicitous responses through its effects on pain and fatigue behavior.

“These findings underscore the importance of patients’ pain and fatigue behaviors as the critical linkage between catastrophizing thoughts and perceptions of how others respond when one is in pain or fatigued,” Dr Romano said.

“It also means we need to more explicitly differentiate the patient’s ‘mental set’ of catastrophizing from external behavior, which can be influenced by different factors. Some patients who catastrophize may be very expressive of their distress, while others may be less so, or may even withdraw. Patients who are depressed, for example, may catastrophize but be socially withdrawn,” Dr Romano added.

More Research Needed

Study limitations include a homogenous patient population, adaptation of certain questionnaires to include fatigue, and use of self-reported, cross-sectional data. Nevertheless, the findings show that catastrophizing is a complex process that warrants future investigation, including using more comprehensive models of pain communication.

“Certainly, this study is not an exhaustive test of either model, and it may be that each of these models explains catastrophizing in certain situations or subsets of patients,” Dr Romano noted.

“Future studies would ideally test these models in larger samples of patients with different conditions and using observational data. Multiple factors are likely to drive both catastrophizing and outward expressions of pain and distress related to chronic illness,” Dr Romano concluded.


1. Romano JM, Molton IR, Alschuler KN, Jensen MP, Schmaling KB, Buchwald DS. Reported pain and fatigue behaviors mediate the relationship between catastrophizing and perceptions of solicitousness in patients with chronic fatigue. J Pain. 2016;17(3):328-335.

2. Romano JM, Jensen MP, Schmaling KB, Hops H, Buchwald DS. Illness behaviors in patients with unexplained chronic fatigue are associated with significant other responses. J Behav Med. 2009;32(6):558-569.

This article originally appeared on Clinical Pain Advisor