I have a friend who is constantly complaining about her back pain. Yet she’s out there running marathons and never seems to stop driving herself. It just seems like there’s a disconnect between what she says and what she does. Can you help me understand this? I find I’m losing patience with her whining given the fact that she can do things I can’t do and I don’t have any pain.

People with chronic low back pain often have to learn to live with it because all efforts to get rid of it or control it have failed. There seem to be two different ways people with chronic low back pain respond to their situation.

They either avoid activities that might cause pain or they persist in being extremely active despite their pain. Like your friend, this second approach lends itself to what looks like “overdoing it.” Pain experts suggest these behaviors called avoidance and persistence are the result of self-discrepancy.

What is self-discrepancy? Let me explain it like this. Even without pain, you have probably experienced self-discrepancy at times in your life. Some people refer to this as the “split-mind.” You perceive yourself one way but think you should be (or think) different. There are several different ways self-discrepancy plays a role in our lives.

There’s the actual self or how you really are in your natural state. That is compared with your ideal or perfect self — the way you would like to be. Then there’s the “ought” self (i.e., I ought to be …you fill in the blank here). And finally, the “feared” self. The feared self is the one you are most afraid of being like or becoming (i.e., becoming someone you do not want to be).

Any of these discrepancies or conflicts can result in emotional distress such as anxiety, depression, and pain. In addition to emotional experiences, the person may develop these other behaviors mentioned earlier (avoidance or persistence). It sounds like your friend may be overdoing it as a way of coping based on her internal thoughts and beliefs.

The good news is persistence behavior doesn’t seem to have any negative effect on outcomes, disability, or quality of life. In other words, it won’t hurt to overdo in this fashion and may possibly help. If you find yourself in a place where your patience is wearing thin, you may want to consider stepping back for a time and taking a breather in the relationship. It may help both of you!