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Section 9
Psychological Distress and Attention Biases in Chronic Pain

Question 9 | Test | Table of Contents

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In the last section, we discussed three concepts related to helplessness.  These three concepts related to helplessness included:  humility vs. humiliation; catastrophizing; and asserting independence. 

In this section, we will examine three considerations regarding self-victimization.  These considerations regarding self-victimization include: sense of betrayal; projections; and resentment.

3 Considerations Regarding Self-Victimization

♦ #1 Sense of Betrayal
The first consideration regarding self-victimization is sense of betrayal.  As a client becomes more and more convinced of the injustice of their position, they also develop a sense of entitlement to sympathy.  If another person does not satisfy the client's needs, he or she feels betrayed.  Eventually, however, a self-victimizing client will find fault with any attempts at sympathy from his or her loved ones.  This results in almost complete isolation from social groups who believe the client to be unbearable or self-absorbed

Lauren, age 27, had developed fibromyalgia.  Moving back home to live with her parents, Lauren expected her mother, Lee, to attend to her every need.  Lauren stated, "I am in so much pain, she doesn't even know!  She said she would help me in any way she could, but when I do ask for help, she says she's too busy or that I need to do it myself.  What kind of a mother is she anyway?" 

In a separate session with Lee, I asked her what she felt about Lauren's condition.  She stated, "I do as best as I can.  I researched the disease so I know what kinds of activities can really hurt her and what can't.  She asks too much of me, and she uses the disease as an excuse for everything. She once asked me for $300 to buy a television for her room, and I said I could only lend her half.  She went berserk!  She kept saying that the fifty foot walk from her downstairs bedroom to the television was just too painful!  That’s ridiculous!" 

Lauren had developed a feeling of entitlement to excessive help.  When her mother does not meet this entitlement, Lauren feels betrayed as a daughter. 

Think of your Lauren.  How extensive is her sense of entitlement and betrayal?

♦ #2 Projections
The second consideration regarding self-victimization is projections.  When a client with chronic pain begins to self-victimize themselves, they lose all sense of objectivity. Because of this, many clients view themselves as undeserving victims, and once this occurs, they begin to look for someone to blame for their pain.  Unable to find anyone, they begin to lash out at those they believe are undeserving of happiness and success.  Essentially, they project a certain interpretation of events onto what they see.  They become jealous of successes and even begin to develop paranoid tendencies. 

Jack, age 41, had undergone painful surgery for his enflamed disc which never truly healed itself.  He believed that his neighbors thought they were superior to him.  Jack stated, "I mean, I know I can't work, but sometimes I feel like my neighbors hold that against me.  I don't get invited to their parties and I'm just the general pariah of the block.  A lot of times, they won't speak to me when they're going out to their cars."  Jack believes his feelings of isolation are a result of his unemployment rather than his own refusal to take the initiative. 

I asked, "Have you ever introduced yourself?"  Jack responded, "Well, no, but I just know they don't want to come into contact with a low-life like me."  I then stated, "There is more to a person than job or income.  Most likely, your neighbors will enjoy your personality despite your unemployment." 

Think of your Jack.  What projection has he or she produced that prevents him or her from seeing the realty of a situation?

♦ #3 Resentment
In addition to a sense of betrayal and projections, the third consideration regarding self-victimization is resentment.  Resentment arises out of an acute jealousy of another person.  Clients who experience resentment towards others view them as undeserving of their success.  Coupled with this is a sense of failure in regards to the client's own achievements.  Unable or unwilling to assert their own success, resentful clients prefer to begrudge others their happiness. 

Lawrence, age 32, believed his brother-in-law didn't deserve his wealth, "Just because he got promoted, they think they own the world.  They're always buying more stuff, a bigger TV, a louder stereo, and parade it in front of the entire neighborhood.  I know they laugh at me when I show up to their fancy parties in my un-ironed shirt and tie.  I'm the life of the party!  They know I can't iron because of my arthritis!  He doesn't deserve all that stuff.  He doesn't deserve a damn thing he owns!" 

Lawrence had built up a great deal of resentment directed at his brother-in-law.  His sense of entitlement and self-victimization had become so strong that he risked losing the connections he had with his family.

♦ Technique:  Assertion List
To help self-victimizing clients like Lauren, Jack, and Lawrence, I asked them to try writing an "Assertion List."  I asked all three clients to write out a columned list that exemplified their victimizing thoughts.  In another column, I asked them to write affirmations that denied the efficacy of these thoughts. 

On his victimizing thoughts list, Lawrence wrote, "I deserve as much as my brother-in-law."  Next to this, he wrote, "My brother-in-law works hard at his job and is always generous when I need financial help." 

Lawrence stated, "I guess I never realized how I sounded until I wrote my thoughts out on paper.  I kind of sounded like a jackass."  When a self-victimizing client is forced to evaluate his or her thoughts, he or she becomes less likely to perpetuate these beliefs.

In this section, we discussed three concepts related to self-victimization.  These concepts related to self-victimization included: sense of betrayal; projections; and resentment.

In the next section, we will examine three sources of guilt for clients with chronic pain.  These three sources of guilt include:  unmet obligations; burden guilt; and external influences.
Reviewed 2023

Peer-Reviewed Journal Article References:
Burns, J. W., Quartana, P. J., Elfant, E., Matsuura, J., Gilliam, W., Nappi, C., Wolff, B., & Gray, E. (2010). Shifts in attention biases in response to acute pain induction: Examination of a model of "conversion" among repressors. Emotion, 10(6), 755–766.

Carleton, R. N., Duranceau, S., McMillan, K. A., & Asmundson, G. J. G. (2018). Trauma, pain, and psychological distress: Attentional bias and autonomic arousal in PTSD and chronic pain. Journal of Psychophysiology, 32(2), 75–84. 

Coren, S. (2016). Growing through pain: An integrative approach to treating chronic pain and emotional distress. Journal of Psychotherapy Integration, 26(4), 394–406.

Salamon, K. S., & Cullinan, C. C. (2019). The integrated prevention model of pain—Chronic pain prevention in the primary care setting. Clinical Practice in Pediatric Psychology, 7(2), 183–191.

Tsur, N., Defrin, R., Levin, Y., Itzhaky, L., & Solomon, Z. (2019). Pain perception and modulation in ex-POWs who underwent torture: The role of subjective and objective suffering. Psychological Trauma: Theory, Research, Practice, and Policy, 11(8), 820–827.

What are three concepts related to self-victimization?
To select and enter your answer go to Test.

Section 10
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