Date of Award


Level of Access Assigned by Author

Open-Access Dissertation

Degree Name

Doctor of Philosophy (PhD)




Sandra T. Sigmon

Second Committee Member

Robert J. Ferguson

Third Committee Member

Marie J. Hayes


High rates of comorbidity have been reported between PTSD and musculoskeletal pain (e.g., Asmundson & Hadjistavropolous, 2006; Asmundson et al., 1998). Comorbid PTSD and chronic pain have been associated with elevated levels of affective distress, greater perceptions of pain, interference in daily activities, and high rates of disability (Otis et al., 2003; Sherman et al., 2000). Overall, comorbid conditions of PTSD and chronic pain are associated with large personal costs for the individual and economic costs for society. The triple vulnerability model was originally proposed to account for anxiety symptoms in general, and it was later applied to the specific development of PTSD (Barlow, 2000; Barlow, 2002; Keane & Barlow, 2002). Otis and colleagues (2003) further proposed that the triple vulnerability model may account for the relationship between PTSD and chronic pain. According to the triple vulnerability model, individuals must present with a generalized biological, generalized psychological, and a specific psychological vulnerability for either of these conditions to develop (Keane & Barlow, 2002; Otis et al., 2003). In the current study, aspects of the triple vulnerability model were examined within the following groups of women: women who have PTSD without chronic pain (n = 11), women who have musculoskeletal pain without PTSD (n = 10), women with both PTSD and musculoskeletal pain (n = 10), and women without PTSD and chronic pain (n = 15). Cortisol reactivity and anxious mood were assessed before and after the Trier Social Stress Task (TSST). Participants also completed questionnaires to assess for other potential indicators of the triple vulnerability model. Results indicate that: 1) the roles of generalized biological, generalized psychological, and specific psychological vulnerabilities toward developing PTSD were supported; 2) limited findings supported the potential role of these vulnerabilities toward developing chronic pain; however, results of these measures were not similar to that of PTSD (e.g., family history of chronic pain); 3) it is not thought that PTSD and chronic pain are associated with the same vulnerabilities; 4) having a diagnosis of PTSD and chronic pain was associated with an increase in symptoms across many measures utilized in the current study.