Chronic TMJ pain is most strongly associated with which psychological state?

Correct answer: D. Depression

• A. Borderline personality disorder can complicate the management of any chronic condition through unstable relationships and affect, but it is not the characteristic association tested here.
• B. Antisocial personality disorder is characterised by disregard for and violation of others' rights. It has no established association with chronic TMD.
• C. Schizotypal traits involve odd beliefs, perceptual distortions and social discomfort, with no specific link to TMD.
• D. CORRECT. DEPRESSION (and closely linked anxiety and somatisation) is by far the most consistently demonstrated psychological correlate of chronic temporomandibular disorders. The relationship is bidirectional: persistent pain drives depressive symptoms through sleep disruption, functional limitation and loss of activity, while depression amplifies central pain processing and lowers pain thresholds. This is why the RDC/TMD and its successor DC/TMD are explicitly structured on TWO AXES — Axis I for the physical diagnosis and AXIS II for pain-related disability and psychosocial status.

Note: Practical consequence: chronic TMD is managed as a chronic pain condition, not a mechanical one. Conservative reversible therapy comes first — patient education, soft diet, jaw rest, heat, NSAIDs, physiotherapy, a stabilisation splint — and tricyclics such as low-dose amitriptyline are used both for their analgesic and their mood effects. Irreversible occlusal adjustment or surgery is not first-line.