Withdrawal catastrophizing scale: initial psychometric properties and implications for the study of opioid use disorder and hyperkatifeia

Figures & data

Table 1. Sample characteristics.

Characteristic	Participants (n = 122)
Age mean (SD)
Years	36.4 (9.60)
Gender n (%)
Female	58 (48.7)
Male	61 (51.3)
Racial Identity n (%)
Black	37 (31.1)
White	80 (67.2)
American Indian or Alaska Native	1 (0.8)
Asian	2 (1.7)
More than one race	1 (0.8)
Ethnicity n (%)
Hispanic	4 (3.4)
Non-Hispanic	115 (96.6)
OUD Severity mean (SD)
Number of DSM-5 criteria present	10.8 (0.9)
Opioids Used n (%)
Heroin	11 (9.2)
Illicitly Manufactured Fentanyl	110 (92.4)
Prescription Opioid	15 (12.6)
Any Other Opioid	4 (3.4)
Route of Opioid Administration n (%)
Intravenous	34 (28.6)
Intramuscular or subcutaneous	1 (0.8)
Smoking	53 (44.5)
Snorting/sniffing up the nose	67 (56.3)
Swallowing by mouth	11 (9.2)
Another Route	3 (2.5)
Monetary Cost of Daily Opioid Use mean (SD)
US dollars per day	102.4 (88.8)
History Of Prior OUD Remission n (%)
No prior episodes of remission	28 (23.5)
Prior early remission	91 (76.5)
Prior sustained remission	64 (53.8)

Three participants were missing data for age, race, ethnicity, gender, types of opioids used, route of administration and history of prior OUD remission. Three participants did not respond to cost of daily use and ten responded “I do not know.” Prior history of early and sustained OUD remission was operationalized per DSM-5. All participants had active OUD at the time of participation.

Table 2. Withdrawal catastrophizing scale (WCS).

	Rotated Factor Loading
Questionnaire Item	Factor 1	Factor 2	Communalities	Item Mean (SD)
1. I worry all the time whether the opioid withdrawal sickness will end.	.463	.250	.424	2.76 (1.19)
2. I feel I can’t go on.	−.211	.878	.582	1.83 (1.23)
3. It’s terrible and I think it’s never going to get any better.	−.049	.788	.574	2.09 (1.31)
4. It’s awful and I feel that it overwhelms me.	.069	.690	.541	2.81 (1.16)
5. I feel I can’t stand it anymore.	.181	.628	.571	2.76 (1.18)
6. I become afraid that the opioid withdrawal sickness will get worse.	.400	.402	.525	2.81 (1.19)
7. I keep thinking of other times I’ve had opioid withdrawal sickness.	.570	.131	.436	2.76 (1.17)
8. I anxiously want the opioid withdrawal sickness to go away.	.829	−.121	.575	3.48 (0.83)
9. I can’t seem to keep it out of my mind.	.254	.423	.378	2.96 (1.04)
10. I keep thinking about how sick I feel.	.544	.120	.394	2.99 (1.06)
11. I keep thinking about how badly I want the opioid withdrawal sickness to stop.	.958	−.207	.709	3.36 (0.82)
12. There’s nothing I can do to reduce the intensity of my symptoms except to use opioids.	.358	.308	.362	2.59 (1.21)
13. I wonder whether something serious may happen.	.637	.091	.487	2.44 (1.34)

Factor 1 = Distortion, factor 2 = Despair. All questions were prefaced “We are interested in the types of thoughts and feelings you have when you have OPIOID WITHDRAWAL SICKNESS. Please rate how much each of the following describe how you respond when faced with OPIOID WITHDRAWAL SICKNESS. When I have OPIOID WITHDRAWAL SICKNESS … ” Responses were scaled as not at all (0), to a slight degree (1), to a moderate degree (2), to a great degree (3) all the time (4).

Table 3. Correlations between the withdrawal catastrophizing scale (WCS) and original items.

Item	WCS total score	WCS factor 1	WCS factor 2
1. In order to get well from OPIOID WITHDRAWAL SICKNESS, I do things that are dangerous, or that could get me hurt.	.357**	.238**	.407**
2. In order to get well from OPIOID WITHDRAWAL SICKNESS, I do things that make me feel ashamed.	.366**	.306**	.373**
3. In order to get well from OPIOID WITHDRAWAL SICKNESS, I do things that could get me into trouble with the law.	.330**	.239**	.350**
4. In the past, I have left the hospital against medical advice, or before finishing treatment I needed, because of OPIOID WITHDRAWAL SICKNESS.	.373**	.311**	.415**
5. The most important reason I have been unable to stop using opioids is OPIOID WITHDRAWAL SICKNESS.	.287**	.307**	.215*
6. I have avoided or put off getting addiction treatment because I was worried about going through OPIOID WITHDRAWAL SICKNESS.	.421**	.374**	.425**
7. In the past, I have gotten OPIOID WITHDRAWAL SICKNESS “aka precipitated withdrawal” from taking Buprenorphine too soon after my last dose of another opioid.	.369**	.276**	.398**

Factor 1 = Distortion, factor 2 = Despair. Items one through three were scaled never (0), very rarely (1), rarely (2), occasionally (3), often (4), very often (5). Items four through seven were scaled strongly disagree (0), disagree (1), neutral (2), agree (3), strongly agree (4). **Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level (2-tailed).

Figure 1. Bar graph representing the percent of participants who endorsed agreement, or strong agreement with each displayed statement.

Figure 2. Path diagram illustrating the two-factor solution of the withdrawal catastrophizing scale (WCS) obtained from exploratory factor analysis. Rectangles representing the 13 items of WCS are shaded to represent the strength of their rotated loading on their associated factor (darker = stronger). Items are also labeled magnification (M), rumination (R), or helplessness (H) based on the schema of the pain catastrophizing scale (PCS) from which WCS is derived.

Figure 3. (a) Scatterplot of the relationship between risk-taking (shame) and WCS, and (b) pie chart representing how often participants found themselves doing things that made them feel ashamed to relieve withdrawal. Asterisks (*) in the key correspond to the two exploded pie pieces in the pie chart.