Withdrawal Catastrophizing Scale: Initial Psychometric Properties and Implications for the Study of Opioid Use Disorder and Hyperkatifeia

Discovery of modifiable factors influencing subjective withdrawal experience might advance opioid use disorder (OUD) research and precision treatment. This study explores one factor - withdrawal catastrophizing - a negative cognitive and emotional orientation toward withdrawal characterized by excessive fear, worry or inability to divert attention from withdrawal symptoms. We define a novel concept - withdrawal catastrophizing - and present an initial evaluation of the Withdrawal Catastrophizing Scale (WCS). Prospective observational study ( = 122, 48.7% women). Factor structure (exploratory factor analysis) and internal consistency (Cronbach's α) were assessed. Predictive validity was tested via correlation between WCS and next-day subjective opiate withdrawal scale (SOWS) severity. The clinical salience of WCS was evaluated by correlation between WCS and withdrawal-motivated behaviors including risk taking, OUD maintenance, OUD treatment delay, history of leaving the hospital against medical advice and buprenorphine-precipitated withdrawal. WCS was found to have a two-factor structure (distortion and despair), strong internal consistency (α = .901), and predictive validity - Greater withdrawal catastrophizing was associated with next-day SOWS (r (99) = 0.237,  = .017). Withdrawal catastrophizing was also correlated with risk-taking behavior to relieve withdrawal (r (119) = 0.357,  < .001); withdrawal-motivated OUD treatment avoidance (r (119) = 0.421,  < .001), history of leaving the hospital against medical advice (r (119) = 0.373,  < .001) and buprenorphine-precipitated withdrawal (r (119) = 0.369,  < .001). This study provides first evidence of as a clinically important phenomenon with implications for the future study and treatment of OUD.