Stress, coping, and personality hardiness in patients with temporomandibular disorders

Objective: To investigate the role of personality factors and stress coping in temporomandibular disorder (TMD), a chronic facial pain-dysfunction syndrome. Design/Participants: Descriptive cross-sectional study of 84 TMD and 79 orthodontic-periodontic contrast patients recruited from a 3-state region. Measures: Questionnaire consisting of validated measures of personality hardiness, microstressors ("hassles"), coping responses, neuroticism, dispositional optimism, depression, and pain perception. Results: Principal-components factor analysis (orthogonal and oblique rotations) suggested 4 conceptual factors: Escape-Neuroticism, Pain, Hardiness. and Problem Solving-Optimism. Linear discriminant analysis showed that these factors significantly distinguished TMD from non-TMD participants at a classification accuracy rare of 85%; this model was replicated in a cross-validation sample. Relative to contrast participants, TMD patients interpreted similar daily life events as more stressful and endorsed more use of nonadaptive coping responses. Conclusions: These findings support the assertion that psychological factors are important in the presentations of patients with TMD. Furthermore, TMD patients may present with a "negative stress coping" constellation distinguishing them from other chronic dental patients, suggesting a role for cognitive-behavioral interventions as part of the comprehensive rehabilitation plan.