Date of Award


Degree Type


Degree Name

Doctor of Philosophy


This study examined psychological factors associated with coping and adjustment in hemophilia, a chronic condition characterized by recurrent pain.;Mild (n = 23) and severe (n = 26) hemophiliacs were compared with rheumatoid arthritic (n = 22) patients and pain-free controls (n = 30) on personality, health beliefs, perceived social support, and experimental pain perception. Pain history, pain coping strategies and disability were compared among medical groups. Hemophiliacs' psychological functioning was within normal limits. Hemophiliacs and arthritics made similar attributions about health control from powerful others, despite hemophiliacs' stronger internality. Medical groups reported greater family support than did controls, but did not differ in their perceptions of support from friends.;Disability of severe hemophiliacs was low-moderate and intermediate between rheumatoids and milds. Chronic arthritic pain in hemophilia was equal in intensity to that of rheumatoid arthritis, but less interfering. In contrast, acute hemorrhagic pain was rated higher in intensity and disruptiveness. Relative to comparison groups, hemophiliacs, particularly milds, were less responsive to experimental pain. Hemophiliacs used more adaptive strategies in coping with their arthritic pain than did rheumatoids, but did not differ from each other in strategies used for acute bleed pain.;Hierarchical regressions indicated that some psychological variables contributed directly to the prediction of hemophiliacs' physical and psychosocial adjustment, whereas others showed a moderating effect with disease severity. Perceived social support from family and friends differentially predicted specific aspects of functioning. Support from friends influenced depression and hemorrhagic pain independently of disease severity. Both types of support interacted with disease severity to predict physical dysfunction, whereas family support also exerted moderating effects on depression. Health locus of control, pain control, and self-efficacy beliefs did not predict pain or functioning. Clinical pain intensity was predicted by hypochondriasis, anxiety and depression, whereas only harmavoidance predicted experimental pain perception. Neither avoidant nor attentional strategies facilitated coping with chronic or hemorrhagic pain, although catastrophizing about hemorrhagic pain predicted greater physical and psychosocial dysfunction.;Thus, hemophiliacs appeared to be coping adequately with the stressors of their condition. The possible facilitating role of the pain experience of hemophilia, strong family support and absence of catastrophizing are discussed.



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