Table 1 Family Dynamics Interacting with Pain and Functioning

Overprotection

Belief that restricting patient from activity is needed for improvement in symptoms.

Misguided support

Parental behaviors that either lower expectations or apply excessive pressure for rapid change and improvement in function.

Dysfunctional Communication Patterns

Poor conflict resolution, difficulty communicating affect and avoidance of discussing emotionally charged issues.

Externalized Attributions

Patient and family attribute both illness and recovery solely to factors outside themselves and often beyond their control.

Dependence

Loss of self-confidence due to family members increasingly taking over patient responsibilities and providing assistance that may not necessarily be needed.

Social Isolation and Avoidance

Patient becomes anxious and avoidant of normal peer situations.