Pain, catastrophizing, and depressive symptomatology in eating disorders

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.

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.

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.

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.

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.