The Thematic Apperception Test as an aid in understanding the psychodynamics of development of chronic idiopathic pain syndrome.

41 chronically ill low-back pain patients (27 women, 14 men) with a long history of work disablement (median = 2 years and 8 months) were submitted to thematic apperception testing (TAT). The tape-recorded protocols were evaluated by 2 independent, experienced clinicians well acquainted with the TAT, as well as with psychoanalytic theory and technique. The 2 evaluators judged almost all the patients as depressive, alexithymic, passive and antiaggressive with clear tendencies to reaction formation towards underlying aggressivity. Many patients were further judged as guilt-ridden with an unresolved oedipal conflict, while others had a deep oral problem with suicidal tendencies. Two of the patients were judged by both evaluators as having psychotic or prepsychotic traits. Overall interrater reliability was very high, with a correlation for the different categories between 0.50 and 0.76 (median 0.72 and p value never below 0.005). Our results indicate that one of the main characteristics of low-back pain patients is the denial of aggression. Other main features of our patients were depressivity, passivity and oral or oedipal conflicts, alexithymia and lack of internal locus of control. Also we find the TAT as a very suitable test for achieving the understanding of the complexity of the problem of pain.