Pain, catastrophizing, and depressive symptomatology in eating disorders

Background: Though eating disorders (EDs) are associated with numerous physiologic complications, very little research has examined subjective reports of pain and pain-related risk factors in patients with EDs. Objectives: The present study aimed to examine the relationship between ED symptomatology and pain-related variables, including pain intensity, pain location, and catastrophizing. Another aim was to compare women with EDs with women with varying degrees of pain on both pain intensity and pain-related catastrophizing. Further, we aimed to evaluate associations among depressive symptomatology, catastrophizing, and pain intensity in patients with EDs. Methods: Seventy women with EDs and 422 other women, ranging from healthy controls to those with a pain syndrome (migraine headaches, temporomandibular disorders, or back pain), participated in this study and completed self-report measures of pain, catastrophizing, and depressive symptomatology. Results: Neither ED diagnosis (anorexia nervosa vs. bulimia) nor behavioral subtype (binge-purging subtype vs. restricting) was associated with location of pain, pain intensity, or pain-related catastrophizing in women with EDs, who, on average, reported pain that was mild and less intense than women with painful conditions. However, a substantial subset of patients with EDs (36%), many of whom had clinically significant Beck Depression Inventory scores, reported moderate to severe pain. Results of a regression analysis showed that depression, not catastrophizing, was associated with pain intensity ratings in patients with EDs. Discussion: Depression and pain are intimately related in EDs. Future investigations should characterize patients who present with elevated pain and examine the relationship between pain, psychologic factors, and treatment outcome.