Exam (elaborations)

University of Buckingham, Health Psychology Exam 2020

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Module
Health Psychology

Institution
The University Of Buckingham

This was the official exam paper of 2020 at the University of Buckingham, for which I was awarded a first (78%). It has two questions (as required to answer 2 questions for the exam), along with my essays underneath each question.

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Uploaded on April 23, 2021
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health psychology
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Health Psychology

Exam Question 1: In the pain experience and in pain management, Men are from Mars and Women
are from Venus. Critically evaluate the accuracy of this statement.

Pain is defined as an unpleasant bodily sensation (Gorczyca et al., 2013), of which pain management
refers to the reduction or elimination of discomfort caused by pain (American Psychological
Association, n.d.). The discussion of sex differences in the experience of pain is a prominent topic in
research journals, with an abundance of research coming to the common verdict of the female
prevalence in clinical pain (Unruh, 1996; Berkley, 1997; Fillingim et al., 2009) – with women
reporting higher rates of temporary and persistent pain (Crook et al., 1984; Verbrugge, 1985;
Fillingim & Maixner, 1995; Van-Wijk & Kolk, 1997; Riley et al., 1998; Eriksen et al., 1998; Lamberg,
1998), along with pain more extreme, more recurrent, and longer lasting in nature (Taylor & Curran,
1985; Attansio & Andrasik, 1987; Stewart et al., 1991; Henry et al., 1992; Pietri et al., 1992;
Andersson et al., 1993; Honkasalo et al., 1993; Tonelli et al., 2011), in comparison to their male
counterparts. These findings were consistent even in extraordinary conditions, as pronounced pain
was found in refugee women suffering from post-traumatic stress disorder (Renner & Salem, 2009;
El Sount et al., 2019), and homeless women (Ritchey et al., 1991). Sex differences in pain seem to
first manifest during adolescence, sustaining into adulthood (Beiter et al., 1991; Pilley et al., 1992;
Munoz et al., 1993; Lester et al., 1994), providing an explanation regarding analgesic drug use – with
women in greater need of higher levels of analgesia than males (Antonov & Isacson, 1996; Antonov
& Isacson, 1998; Paulose-Ram et al., 2002), in order to obtain a similar analgesic response (Cepeda &
Carr, 2003). However, whilst there is rich literature defending sex differences in pain, there is also
existing literature suggesting the contrary – for instance, in a study demonstrating no significant sex
differences in neonatal pain expression (Stevens et al., 1994; Gibbins et al., 2008), or pain response
in infants during immunization (Guinsburg et al., 2000). This essay will consider the sex differences
in pain experience, and pain management, and why they may emerge.

There are several biological explanations proposed in order to provide an account for the greater
chronicity of pain in women. One such explanation comprises of the hormonal implications in male
and females – with testosterone found to decrease acute pain in men (Choi et al., 2012; Choi et al.,
2014), and improve quality of life in male chronic pain patients (Aloisi et al., 2011). Whereas, the
protective effects of testosterone materialise differently in women, only minimally influencing pain
sensitivity (Teepker et al., 2010), but in close association with higher pain thresholds solely during
the mid-luteal phase of the menstrual cycle (Okifuji & Turk, 2006) – thus demonstrating the
differential implications of the same hormone in the modulation of pain in both sexes. Additionally,
oestrogen has a complex role in modulating pain in women – with literature to suggest its
implication in increased pain thresholds during pregnancy (Cogan & Spinnato, 1986), and in
decreasing severity of systemic lupus erythematosus, but also in triggering osteoarthritis and
rheumatoid arthritis (Wluka et al., 2000) – further illustrating sex differences in pain experience, as

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, Health Psychology

the protective influence of oestrogen is not equally applied to males. Another biological explanation
is differential activity in brain structures in males and females during pain experience, as females
displayed greater activation of the contralateral prefrontal cortex in comparison to males
(Derbyshire et al., 1994; Paulson et al., 1998). Moreover, a notable difference was found in the
parahippocampal grey matter volume that was proven higher in females with migraines in
comparison to males with migraines (Good et al., 2001; Maleki et al., 2012) possibly due to the
hormonal effects of testosterone and oestrogen on hippocampal function (Shors et al., 2001; Craft et
al., 2004) – indicating sex differences in the neurological processes associated with pain (Reite et al.,
1993; Esposito et al., 1996). Despite the wealth of research in pinpointing the biological differences
in the experience of pain between the two sexes, biological explanations do not account for social or
psychological factors, which could exert higher influence in pain perception and management.

According to psychological explanations, men are less willing to report pain whereas women are
more likely to (Ellermeier & Westphal, 1995; Christmas et al., 2002; Keogh & Herdenfeldt, 2002;
Rosseland & Stubhaug, 2004; Haskell et al., 2009; Hunt et al., 2011; Meulders et al., 2012) – enabling
women to utilize healthcare services on a greater scale than men (Taylor & Curran, 1985; Von Korff
et al., 1991; Weir et al., 1996; Eriksen et al., 2004; Jiménez-Sánchez et al., 2012). Males also engage in
pain catastrophizing to a lesser extent than their female counterparts (Reid et al., 1994; Sullivan et
al., 1995; Sullivan et al., 2000; Keefe et al., 2000), as females have the tendency to heavily focus on
their pain and underestimate their own capacity to cope with the pain (Rosenstiel & Keefe, 1983;
Keefe et al., 1989), especially in patients of chronic pain (Jensen et al., 1994). A possible reason for
these profound differences is due to gender role expectations, which conduce sex differences
(Unruh, 1996; Myers et al., 2001; Wise et al., 2002; Bernardes et al., 2008), due to differences in
socialisation, with men being expected to withstand greater levels of pain. This is further reinforced
as individuals possessing more feminine than masculine traits exhibit lesser tolerance to pain (Otto
& Dougher, 1985; Myers et al., 2001, 2006). In addition to this, women with chronic conditions suffer
from depression at higher rates than men (Ernst & Angst, 1992; Kessler, 2003; Tsang et al., 2008),
which has been found to worsen the experience of pain (Doan & Wadden, 1989; Leino & Magni,
1993; Carroll et al., 2004).

In terms of the social explanations of pain, social support also exerted influence in the perception of
pain in both sexes, as there was found to be an increase in the pain of women, in the presence of a
same-sex friend – that was not equally found in men (McClelland & McCubbin, 2008). This could be
due to the differential pain management in both sexes, as women favoured emotion-focused coping
strategies, in contrast to men who had a greater preference for sensory-focused coping strategies.
(Keogh & Herdenfeldt, 2002). The presence of social support decreases the impact of negative stress
in patients with chronic pain (Cohen & Wills, 1985). One such form of social support proves to be of
spousal support – where spousal solicitousness resulted in more extreme chronic pain in men, low

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