Author ORCID Identifier

Lisa M. McAndrew: 0000-0002-1350-8773

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Patients with chronic physical symptoms (e.g., chronic pain) often have significant functional impairment (i.e., disability). The fear avoidance model is the dominant theoretical model of how the relationship between chronic physical symptoms and functional impairment develops and proposes a cyclical/bidirectional relationship. There has never been a definitive test of the proposed bi-directional relationship. The current study followed 767 Operation Enduring Freedom/Operation Iraqi Freedom soldiers from pre-deployment, when they were relatively healthy, to one year after deployment, when it was anticipated that symptoms would increase or develop. Over the four assessment time points, physical symptom severity consistently predicted worse functional impairment at the subsequent time point. Functional impairment did not show a consistent relationship with worsening of physical symptom severity. These findings suggest that changes to functional impairment do not have a short-term impact on physical symptom severity


This article is the accepted version of an article in Journal of Behavioral Medicine. The version of record appears here: McAndrew, L.M., Helmer, D.A., Lu, S-E., Chandler,H.K., Slotkin, S., Quigley, K.S. (In Press). Longitudinal relationship between onset of physical symptoms and functional impairment. Journal of Behavioral Medicine.