{"paper_id":"a79d20a1-0c44-4ce2-b764-4e4d5e79f498","body_text":"Creative Commons licenses: This is an Open Access article distributed under the terms of the Creative Commons  \nAttribution-NonCommercial-ShareAlike 4.0 International (CC BY -NC -SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/).\nClinical research\n*Corresponding author:\nMałgorzata Puchalska-Wasyl\nThe John Paul II \nCatholic University \nof Lublin, Poland \nE-mail: wasyl@kul.pl\n1The John Paul II Catholic University of Lublin, Poland \n2Euro-Medica Child and Adolescent Psychological Clinic, Sieniawa, Poland \nSubmitted: 10 November 2025; Accepted: 29 January 2026\nOnline publication: 20 October 2026\nArch Med Sci\nDOI: https://doi.org/10.5114/aoms/217516\nCopyright © 2026 Termedia & Banach\nIllness perception, pain coping, and self-compassion: \na cross-sectional study of Polish women with \nendometriosis\nMałgorzata Puchalska-Wasyl1*, Katarzyna Wikiera2\nAbstract\nIntroduction: Endometriosis is a  chronic inflammatory gynecological dis-\nease, one of whose main symptoms is chronic pain. Generally, negative per -\nceptions of the disease as an obstacle/loss, harm, or threat are linked to \npoorer adjustment, whereas positive perceptions of illness as a challenge, \nvalue, or profit show the opposite pattern. The study aimed to investigate \nwhether pain-coping strategies and self-compassion in women with endo-\nmetriosis were associated with the perception of their disease in terms of \nobstacle/loss, threat, harm, value, challenge, and profit.\nMaterial and methods: The study group consisted of 265 Polish women with \na diagnosis of endometriosis. The online survey included three measures: \nthe Self-Compassion Scale (SCS-PL), the Coping Strategies Questionnaire \n(CSQ), and the Disease-Related Appraisals Scale (DRAS).\nResults: Perceiving illness in negative terms – as an obstacle/loss, threat, \nor harm – was associated with catastrophizing about pain. Threat and harm \ncategories were also inversely related to self-compassion. Perceptions of \nendometriosis in terms of value or profit were positively associated with \nthe strategy of reinterpreting pain sensations and by self-compassion. The \nprofit category was also negatively associated with coping self-statements, \nwhereas viewing illness as value or challenge was associated with the pray-\ning and hoping strategy.\nConclusions: Higher self-compassion and greater use of reinterpreting pain \nsensations were associated with more positive perceptions of endometri-\nosis, whereas catastrophizing was associated with more negative percep-\ntions. These findings may help inform psychological interventions sup-\nporting women with endometriosis, although longitudinal or intervention \nstudies are needed to determine whether modifying these factors changes \nillness perceptions and improves functioning or quality of life.\nKey words: endometriosis, perception of illness, self-compassion, pain-\ncoping strategies, chronic pain.\nIntroduction\nEndometriosis is a chronic inflammatory disease in which endometri-\nal cells are found outside the uterine cavity [1]. It affects around 10% of \nwomen worldwide [2]. The most common symptoms include chronic pel-\nvic pain, painful and heavy menstruation, dyspareunia, and difficulties \nconceiving [3]. Endometriosis, accompanied by long-lasting pain, fatigue, \n\nMałgorzata Puchalska-Wasyl, Katarzyna Wikiera\n2 Arch Med Sci\nand daily limitations, significantly disrupts wom-\nen’s psychosocial functioning and reduces their \nquality of life, as well as physical and psychologi-\ncal well-being [2, 4]. Low mood, depression, anxi-\nety, feelings of guilt, shame, and low self-esteem \nare typical of women with endometriosis [5–7]. \nAdditionally, lack of understanding from close \nfamily members may result in feelings of loneli-\nness and social withdrawal [8, 9].\nAccording to Lazarus and Folkman [10], stress \nexperienced during illness is influenced both by \nits physical consequences and by the meaning \nthat patients assign to it (i.e., their subjective in-\nterpretation). Lipowski [11] distinguished sever -\nal categories that people commonly attribute to \ntheir condition. Categories with positive meaning \ninclude: challenge – seeing illness as a chance for \nmobilization or growth; profit – perceiving sec-\nondary gains such as receiving care or reduced \nduties; and value – attributing deeper significance \nto the illness and seeing it as an opportunity for \nlife reflection. Categories with negative meaning \ninclude: obstacle/loss – viewing illness as blocking \ngoals and causing loss of health or independence; \nthreat – experiencing it as dangerous and unpre-\ndictable; and harm – interpreting it through guilt \nor a sense of being wronged.\nExtensive research shows that perception of \none’s illness plays a key role in patient adaptation, \npsychosocial functioning, and emotional respons-\nes. For example, women with endometriosis often \nhold negative beliefs about the consequences, \nchronicity, and controllability of their condition, \nwhich are associated with higher stress and low-\ner quality of life [12, 13]. At the same time, their \npersonal narratives emphasize emotional burden, \ndisrupted life plans, and challenges to self-identity \n[14]. In this article, we do not aim to focus on the \nconsequences of illness perception for patients’ \nadaptive functioning. Rather, we seek to deter -\nmine how illness perception is shaped in women \nwith endometriosis – specifically, whether it can \nbe predicted based on pain-coping strategies and \nself-compassion. This raises an important ques-\ntion: why these particular predictors?\nCoping strategies for pain are acquired early \nin life [15]. Thus, the ways individuals have pre-\nviously learned to cope with pain may shape their \nperception of endometriosis – a disease in which \npain is a core symptom. Coping with pain involves \ncognitive (i.e., reinterpreting pain sensations, ig-\nnoring pain sensations, coping self-statements, \nand catastrophizing) and behavioral strategies \n(i.e., increased behavioral activity, diverting at-\ntention, and praying and hoping) aimed at re-\nducing discomfort [16]. Studies based on the \nCommon-Sense Model [17] have primarily con-\nceptualized illness perception as an antecedent of \ncoping and health outcomes, with evidence link-\ning it to general coping strategies and psychologi-\ncal adjustment in chronic illness and pain [18–20]. \nIn research on illness perception, pain-specific \ncoping strategies are less frequently investigated \ncompared to general coping, and when examined, \nboth illness perception and pain-specific coping \nare typically treated as predictors of the same psy-\nchological or functional outcomes, such as depres-\nsive symptoms, anxiety, or quality of life [21, 22]. \nHowever, the potential role of pain-specific coping \nstrategies as predictors of illness perception re-\nmains underexplored, although a recent study has \nshown that a  pain catastrophizing strategy can \npredict an accepting attitude toward illness [23]. \nThe present research addresses this gap by ex-\namining whether different pain-coping strategies \npredict distinct categories of illness perception in \nwomen with endometriosis.\nIn the context of pain coping and illness per -\nception, self-compassion may also play an import-\nant role. It is defined as an attitude of kindness \nand understanding toward oneself in the face of \nsuffering, acceptance of one’s flaws and failures, \nmindful awareness of one’s emotions, and the \nrecognition that suffering is a part of the human \ncondition [24]. The existing literature has not di-\nrectly examined the relationship between levels of \nself-compassion and specific categories of illness \nperception. However, research shows that higher \nself-compassion in individuals with chronic con-\nditions is associated with better pain adaptation, \nlower distress, improved quality of life [25, 26], ill-\nness acceptance, greater resilience, and construc-\ntive coping with problems [27–30]. \nAlthough pain coping strategies and self-com-\npassion have been studied in relation to pain \nintensity, emotional distress, and quality of life \nin chronic illness populations [16, 31–33], their \ncombined role in illness perception – particularly \nin women with endometriosis – remains under -\nstudied. Our study adds to the existing body of \nresearch by emphasizing the meaning of illness \nrather than solely symptom severity, while high-\nlighting pain-coping strategies and self-compas-\nsion as potentially modifiable factors associated \nwith illness perception and potentially relevant to \npatient quality of life and adaptation to the illness.\nMaterial and methods\nParticipants\nThe study group consisted of 265 Polish wom-\nen with a diagnosis of endometriosis. The subjects \nwere in early and middle adulthood; the age range \nwas 20–52 years (M = 31.3; SD = 7.28). Most of \nthem (N = 73, 27.5%) lived in a city with a popula-\ntion of up to 150,000, 70 (26.4%) respondents lived \n\nIllness perception, pain coping, and self-compassion: a cross-sectional study of Polish women with endometriosis\nArch Med Sci 3\nin a city with a population of more than 500,000, \n64 (24.2%) participants lived in a city with a popu-\nlation of 150,000 to 500,000, and the fewest lived \nin a  rural area (N = 58, 21.9%). The majority of \nwomen had a university degree (N = 165, 62.3%), \n56 of them (21.1%) had a high school education, \n34 participants (12.8%) were in college, while the \nfewest respondents had vocational education  \n(N = 8, 3%) or primary education (N = 2, 0.8%). \nThe vast majority of women (N = 203, 76.6%) \nwere in a relationship at the time of the survey, \n52 (19.6%) described their status as single, while \nthe fewest women declared their marital status as \ndivorced (N = 9, 3.4%) or widowed (N = 1, 0.4%). \nIn the study group, 79 (29.8%) women had at least \none child, while 186 (70.2%) women were child-\nless. The range of years of experiencing symptoms \nof the disease ranged from one to thirty years  \n(M = 9.92; SD = 7.05), while the mean pain in-\ntensity score assessed on a scale of 1 to 10 was  \nM = 6.75 (SD = 2.84).\nProcedure \nThe research was conducted online using con-\nvenience sampling. From November 2024 to March \n2025, the survey link was posted on Facebook \ngroups and portals for women with endometriosis. \nParticipation was voluntary and anonymous. Wom-\nen aged 18 or older with a physician-diagnosed en-\ndometriosis, who gave informed consent, complet-\ned the survey. It included three questionnaires and \nseven sociodemographic items (see Participants). \nCompletion took approximately 20–25 min. \nMeasures\nThe online survey included three measures, de-\nscribed below. Table I shows internal consistency \ncoefficients for all the analyzed variables.\nSelf-Compassion Scale (SCS-PL) \nBased on Neff’s original scale (2003) [34], the \nPolish adaptation [35] consists of 26 items rated \non a 5-point scale (1 = “almost never” to 5 = “al-\nmost always”). Items correspond to six subscales \n(self-kindness, self-judgment, common humanity, \nisolation, mindfulness, over-identification), but \nonly the total mean score was used in this study. \nA higher score reflects greater self-compassion (see \nIntroduction).\nCoping Strategies Questionnaire (CSQ) \nRosenstiel and Keefe’s (1983) scale [16] in the \nPolish adaptation by Juczyński (2001) [36] was \nused. It contains 42 items across seven coping \nstrategies (see Introduction). Respondents answer \nusing a  7-point scale (0 = “I  never do this”; 3 = \n“I sometimes do this”; 6 = “I always do this”) to \nindicate how often they use each strategy when \nin pain. For each strategy, we calculated the mean \nscore. A higher score reflects more frequent use of \nthat coping strategy. \nThe Disease-Related Appraisals Scale \n(DRAS)\nJanowski, Steuden, Kuryłowicz, and Nieśpia-  \nłowska-Steuden’s (2009) scale [37] assesses \nTable I. Correlations (Pearson’s r) and internal consistency coefficients of the analyzed variables\nVariables 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15\n1. SelfComp –\n2. DivAtten 0.29*** –\n3. ReinPaSen 0.30*** 0.49*** –\n4. Catastr 0.44*** –0.10 –0.17** –\n5. IgnoPaSen 0.22*** 0.38*** 0.61*** –0.31*** –\n6. PrayHop 0.09 0.48*** 0.21*** 0.24*** 0.09 –\n7. CopSState 0.28*** 0.44*** 0.44*** –0.31*** 0.70*** 0.16** –\n8. InBehActiv 0.20*** 0.59*** 0.45*** –0.23*** 0.55*** 0.21*** 0.62*** –\n9. Obst/Loss –0.26*** –0.07 –0.03 0.47*** –0.09 0.03 0.21*** –0.16** –\n10. Threat –0.36*** –0.11 –0.12 0.49*** –0.01* 0.14* –0.22*** –0.14* 0.77*** –\n11. Harm –0.36*** –0.01 –0.06 0.48*** 0.08 0.16** –0.10 –0.09 0.59*** 0.63*** –\n12. Value 0.24*** 0.31*** 0.27*** –0.02 0.13* 0.31*** 0.14* 0.18** 0.10 0.08 0.02 –\n13. Challen 0.20*** 0.28*** 0.23*** –0.01 0.12* 0.37*** 0.21*** 0.21*** 0.17** 0.25*** 0.16* 0.54*** –\n14. Profit 0.14* 0.10 0.18** 0.05 0.01 0.12* –0.09 –0.00 0.26*** 0.17** 0.19** 0.53** 0.30*** –\n15. Import –0.25*** –0.11 –0.19** 0.44*** –0.23*** 0.09 –0.18** –0.12 0.52*** 0.65*** 0.46*** –0.08 0.15* –0.06 –\nα 0.93 0.82 0.82 0.86 0.82 0.73 0.85 0.70 0.92 0.88 0.86 0.82 0.60 0.72 0.76\nSelfComp – Self-compassion, DivAtten – Diverting Attention, ReinPaSen – Reinterpreting Pain Sensations, Catastr – Catastrophizing, \nIgnoPaSen – Ignoring Pain Sensations, PrayHop – Praying and Hoping, CopSState – Coping Self-Statements, InBehActiv – Increased \nBehavioral Activity, Obst/Loss – Obstacle/Loss, Challen – Challenge, Import – Importance; *p < 0.05; **p < 0.01; ***p < 0.001.\n\nMałgorzata Puchalska-Wasyl, Katarzyna Wikiera\n4 Arch Med Sci\nways of perceiving one’s illness. It draws on \nLazarus and Folkman’s [10] transactional stress \nmodel and Lipowski’s [11] concept of illness per -\nception (see Introduction). It contains 47 items \nrated on a  5-point scale (“Yes”; “Rather yes”; \n“Don’t know”; “Rather no”; “No”). The DRAS in-\ncludes six subscales (obstacle/loss, threat, harm, \nvalue, challenge, profit) and a  control scale of \nImportance, which reflects whether the illness \ndisturbs life balance or is seen as minor. In this \nstudy, the mean Importance score was 4.26 (SD  \n= 0.74). Subscale scores were computed as mean \nvalues, with higher scores indicating stronger \nperceptions of endometriosis in that category.\nResults\nPreliminary analyses \nFirst, descriptive statistics were calculated \nand the assumption of normality was tested \nusing the Shapiro-Wilk test. The results indicat-\ned that only the self-compassion score met the \nassumption of normality. Therefore, skewness \nand kurtosis were further examined. The scores \nfor catastrophizing (CSQ subscale) and four \nsubscales of the DRAS – obstacle/loss, threat, \nharm, and challenge – were slightly negative-\nly skewed (from –0.20 to –0.86). The remain-\ning subscales exhibited slight positive skew-\nness (from 0.13 to 1.12). All skewness values \nfell within the acceptable range of –2 to +2, as \nrecommended by George and Mallery [38], con-\nfirming the suitability of parametric tests for \nthe subsequent analyses. Similarly, although \nwe found statistically significant deviations \nfrom the normality of residuals, the low skew-\nness and kurtosis values, as well as the Q–Q \nplot analysis, suggested that these deviations \nwere subtle and did not substantially affect the \nmodel’s conclusions. \nSecond, Pearson’s bivariate correlations and in-\nternal consistency indices were also computed for \nall measured variables (Table I).\nRegression analyses\nThe next step involved conducting linear re-\ngression analyses using the enter method, which \nis employed for exploratory purposes [39]. The \noverall self-compassion score and seven pain cop-\ning strategies were simultaneously entered as pre-\ndictors, while the categories of perceived illness \n(obstacle/loss, threat, harm, value, challenge, and \nprofit) were sequentially analyzed as dependent \nvariables. The results are presented in Table II.\nThe assumption of no multicollinearity among \nthe predictors was verified. The highest variance \ninflation factor (VIF) was 2.672, and the lowest \ntolerance value was 0.374, both corresponding \nto the pair of variables: ignoring pain sensations \nand the dependent variable (obstacle/loss, threat, \nharm, value, challenge, and profit).\nRegression analyses revealed the extent to \nwhich self-compassion and pain coping strategies \nwere associated with distinct categories of illness \nperception. The explained variance in the study \ngroup ranged from 7% for profit to 26% for threat. \nAll models showed a good fit.\nPerception of illness as obstacle/loss was pos-\nitively associated with the catastrophizing strate-\ngy, explaining 24% of the variance. A similar pat-\ntern was found for threat (26%) and harm (25%). \nThese two categories were positively associated \nwith catastrophizing and inversely related to \nself-compassion. This demonstrates that negative \nillness perception is preceded by intense unpleas-\nant emotions, a  sense of helplessness in coping \nwith pain (catastrophizing), and, in some cases, an \ninability to engage in self-care in the face of illness \n(self-compassion).\nPositive perceptions of illness were associated \nwith more adaptive strategies. Viewing illness as \nvalue was positively associated with self-compas-\nsion, reinterpreting pain sensations, and pray-\ning and hoping, explaining 15% of the variance. \nSimilarly, self-compassion and reinterpreting pain \nsensations were positively associated with, while \nTable II. Predicting illness perceptions from self-compassion and coping strategies for pain: a linear regression \nanalysis\nVariable B SE β t P-value\nObstacle/Loss  \nF(8;256) = 11.22; \np < 0.001;  \nR2 adj. = 0.236\n(Constant) 2.72 0.407 6.69 < 0.001\nSelf-compassion –0.88 0.103 –0.055 –0.86 0.393\nDiverting Attention 0.05 0.071 0.055 0.70 0.487\nReinterpreting Pain Sensations 0.07 0.082 0.062 0.84 0.404\nCatastrophizing 0.38 0.053 0.473 7.01 < 0.001\nIgnoring Pain Sensations 0.15 0.081 0.166 1.88 0.061\nPraying and Hoping –0.08 0.056 –0.090 –1.39 0.167\nCoping Self-Statements –0.13 0.072 –0.152 –1.82 0.071\nIncreased Behavioral Activity –0.08 0.083 –0.080 –1.02 0.309\n\nIllness perception, pain coping, and self-compassion: a cross-sectional study of Polish women with endometriosis\nArch Med Sci 5\nVariable B SE β t P-value\nThreat\nF(8;256) = 12.53; \np < 0.001;  \nR2 adj. = 0.259\n(Constant) 3.61 0.320 11.26 < 0.001\nSelf-compassion –0.21 0.081 –0.167 –2.64 0.009\nDiverting Attention –0.05 0.056 –0.068 –0.88 0.381\nReinterpreting Pain Sensations –0.03 0.07 –0.034 –0.46 0.646\nCatastrophizing 0.24 0.042 0.379 5.78 < 0.001\nIgnoring Pain Sensations 0.12 0.064 0.155 1.79 0.074\nPraying and Hoping 0.08 0.044 0.112 1.74 0.083\nCoping Self-Statements –0.11 0.057 –0.152 –1.84 0.066\nIncreased Behavioral Activity 0.02 0.065 0.024 0.31 0.757\nHarm\nF(8;256) = 11.77; \np < 0.001;  \nR\n2 adj. = 0.246\n(Constant) 2.87 0.374 7.69 < 0.001\nSelf-compassion –0.34 0.095 –0.225 –3.53 < 0.001\nDiverting Attention 0.05 0.065 0.059 0.75 0.455\nReinterpreting Pain Sensations 0.01 0.075 0.012 0.16 0.876\nCatastrophizing 0.28 0.049 0.384 5.81 < 0.001\nIgnoring Pain Sensations 0.06 0.075 0.066 0.76 0.451\nPraying and Hoping 0.05 0.052 0.059 0.91 0.363\nCoping Self-Statements 0.03 0.066 0.037 0.44 0.660\nIncreased Behavioral Activity –0.07 0.076 –0.073 –0.94 0.348\nValue\nF(8;256) = 6.83; \np < 0.001;  \nR\n2 adj. = 0.150\n(Constant) 0.98 0.338 2.91 0.004\nSelf-compassion 0.21 0.086 0.168 2.49 0.014\nDiverting Attention 0.07 0.059 0.097 1.16 0.246\nReinterpreting Pain Sensations 0.15 0.068 0.167 2.13 0.034\nCatastrophizing 0.02 0.044 0.027 0.39 0.698\nIgnoring Pain Sensations –0.04 0.068 –0.048 –0.52 0.605\nPraying and Hoping 0.15 0.047 0.214 3.12 0.002\nCoping Self-Statements –0.02 0.060 –0.022 –0.25 0.805\nIncreased Behavioral Activity 0.01 0.069 0.015 0.19 0.852\nChallenge\nF(8;256) = 7.38; \np < 0.001;  \nR\n2 adj. = 0.162\n(Constant) 2.30 0.266 8.64 < 0.001\nSelf-compassion 0.12 0.067 0.122 1.81 0.071\nDiverting Attention –0.01 0.046 –0.010 –0.125 0.901\nReinterpreting Pain Sensations 0.08 0.054 0.121 1.55 0.122\nCatastrophizing 0.01 0.035 0.009 0.13 0.897\nIgnoring Pain Sensations –0.08 0.053 –0.129 –1.41 0.161\nPraying and Hoping 0.17 0.037 0.308 4.50 < 0.001\nCoping Self-Statements 0.07 0.047 0.134 1.53 0.126\nIncreased Behavioral Activity 0.04 0.054 0.065 0.79 0.431\nProfit\nF(8;256) = 3.50; \np < 0.001; R\n2 adj. \n= 0.070\n(Constant) 1.53 0.258 5.94 < 0.001\nSelf-compassion 0.15 0.066 0.157 2.22 0.027\nDiverting Attention 0.01 0.045 0.019 0.22 0.830\nReinterpreting Pain Sensations 0.14 0.052 0.218 2.66 0.008\nCatastrophizing 0.03 0.034 0.063 0.86 0.392\nIgnoring Pain Sensations 0.01 0.052 0.016 0.17 0.868\nPraying and Hoping 0.04 0.036 0.076 1.06 0.291\nCoping Self-Statements –0.12 0.046 –0.242 –2.63 0.009\nIncreased Behavioral Activity –0.00 0.052 –0.005 –0.06 0.953\nB – unstandardized regression coefficient, SE – standard error, β  – standardized regression coefficient, t – result of the t-test, F – result of \nthe analysis of variance, R²adj. – adjusted R-squared.\nTable II. Cont.\n\nMałgorzata Puchalska-Wasyl, Katarzyna Wikiera\n6 Arch Med Sci\ncoping self-statements were negatively associated \nwith, the perception of illness as profit, explaining \n7% of the variance. The first two predictors over -\nlap in the perception of illness as value and profit, \nsuggesting that the perception of benefits from ill-\nness may be related to positive reinterpretation of \npain sensations and understanding one’s suffer -\ning as a communal experience. Additionally, pray-\ning and hoping was associated with the percep-\ntion of illness as value. Finally, interpreting illness \nas a  challenge was associated with the praying \nand hoping strategy (R² = 16%). \nDiscussion\nThe study aimed to investigate whether \nself-compassion and pain-coping strategies were \nassociated with distinct categories of illness per -\nception in women with endometriosis. Regression \nresults showed that self-care and emotional and \ncognitive responses to pain were significantly \nassociated with how the illness is perceived, in \nboth negative and positive terms. In addition to \nself-compassion, the pain-coping strategies asso-\nciated with illness perception included reinterpret-\ning pain sensations, praying and hoping, coping \nself-statements, and catastrophizing. This is con-\nsistent with previous studies [29, 40, 41] suggest-\ning that women with endometriosis employ both \nadaptive and maladaptive coping strategies in \ntheir daily lives.\nPerceiving illness in negative terms – as an ob-\nstacle/loss, threat, or harm – was associated with \na catastrophizing strategy. This finding can be in-\nterpreted within the Fear-Avoidance Model, which \nfocuses on the impact of cognitive interpretations \nof pain on patients’ emotional and behavioral re-\nsponses [42]. According to this model, catastrophic \ninterpretations of pain – including negative beliefs \nabout its intensity, duration, and lack of control \nover the suffering experienced – may contribute \nto increased fear of pain. As a result, pain begins \nto be perceived as a signal of danger and poten-\ntial damage to the body, which can contribute to \nfeelings of helplessness and ineffectiveness [43]. \nConsequently, fear of pain may trigger avoidance \nstrategies and lead to reduced physical activity, \nwhile also reinforcing excessive focus on somatic \nsymptoms, creating a vicious circle of increasing \npain and dysfunction [44]. This may lead individu-\nals to avoid pain stimuli and focus excessively on \nthem, potentially triggering greater stress. Empir -\nical research has shown that catastrophizing, fear \nof pain, and pain vigilance are associated with \nnegative affect, anxiety, depression, pain-related \ndisability, and pain intensity in patients with vari-\nous chronic pain conditions [45]. In the case of en-\ndometriosis, which is commonly associated with \nchronic pain, this mechanism contributes to per -\nceiving the disease as an obstacle/loss, a threat, or \nharm – that is, as an illness that may be perceived \nas highly debilitating for everyday functioning. \nPoor control over thoughts, dichotomous thinking, \nand impaired emotion regulation may contribute \nto elevated stress and reduced quality of life [44]. \nWomen may become preoccupied with the losses \nand limitations imposed by the illness, which may \nreinforce beliefs about its negative impact on their \nactivities and socio-professional life. This way of \ninterpreting health experiences hinders the pro-\ncess of adaptation to and acceptance of the dis-\nease and may lead to denial of its significance in \nthe patient’s life.\nNegative perceptions of illness, such as threat \nand harm, were also linked to lower levels of \nself-compassion, which is defined as kindness and \nunderstanding toward oneself and acceptance of \ndifficult experiences [46]. Self-compassion may be \nbeneficial for individuals facing illness by poten-\ntially facilitating stress management, enhancing \nquality of life in chronic conditions [26], and im-\nproving emotion regulation in chronic pain, there-\nby being associated with reductions in depressive \nand anxiety symptoms as well as catastrophic \nthinking [25]. Thus, it is conceivable that self-com-\npassion may also be positively associated with \nboth the primary and secondary appraisal of ill-\nness, in line with the transactional model of stress \nand coping [10]. Therefore, self-compassion may \nrepresent a potentially relevant target for further \ntherapeutic research aimed at helping patients \nreframe their experiences and reduce the psycho-\nlogical burden of chronic illness. \nWomen may perceive endometriosis not only \nnegatively but also positively, in terms of value (re-\nferring to intangible and spiritual aspects) or profit \n(referring to material or social gains). In such cas-\nes, self-compassion, combined with cognitive re-\nappraisal of pain experiences, may be associated \nwith more adaptive functioning. Recent research \ndemonstrates that higher levels of self-compas-\nsion and mindfulness are associated with better \npsychological well-being, lower psychological dis-\ntress, and improved quality of life among women \nwith endometriosis [47, 48]. \nIn the context of findings highlighting the neg-\native role of catastrophizing and the positive role \nof self-compassion and strategies involving the \nreinterpretation of pain sensations, Acceptance \nand Commitment Therapy (ACT) appears to pro-\nvide a  theoretical framework that may be rele-\nvant to promoting adaptive functioning in women \nexperiencing chronic pain due to endometriosis. \nWithin this approach, self-compassion may play \nan important role by facilitating the acceptance of \npain-related thoughts and emotions without ex-\ncessive self-criticism, potentially allowing individ-\nuals to disengage from experiential avoidance and \n\nIllness perception, pain coping, and self-compassion: a cross-sectional study of Polish women with endometriosis\nArch Med Sci 7\npain catastrophizing. Moreover, ACT emphasizes \ncognitive reappraisal of pain sensations, helping \npatients reinterpret them as transient internal ex-\nperiences rather than threats. This combination \nof acceptance, self-compassion, and reinterpre-\ntation enables engagement in valued life activi-\nties despite ongoing symptoms [49, 50]. Such an \nACT-consistent approach may be particularly rel-\nevant for women with endometriosis, for whom \ncomplete elimination of pain is often unattainable.\nIn a positive perception of illness, the strategy \nof praying and hoping also appears to be relevant. \nWhen the illness is perceived as a value, personal \nprayer may be associated with inner peace, reflec-\ntion on life’s meaning, and a sense of value in suf-\nfering. When the disease is seen as a challenge, \nprayer may also promote hope and provide sup-\nport through the belief that God has control over \none’s illness [51]. Moreover, frequent prayer and \nplacing hope in God may reflect viewing the ill-\nness not only as a challenge to one’s coping capa-\nbilities but also as a test of faith – one believed to \nbe surmountable through prayer and trust in God.\nUnderstanding the determinants of illness per-\nception, such as self-compassion and pain-coping \nstrategies, can help clarify factors associated with \na  more positive perception of endometriosis. In \nparticular, developing self-compassion and replac-\ning catastrophizing with cognitive reinterpretation \nof pain sensations may be relevant to therapeutic \ninterventions aimed at supporting women in cop-\ning with their chronic condition.\nThe findings have important implications for \nthe comprehensive care of women with endome-\ntriosis. Given the interconnections between illness \nperception, pain-coping strategies, self-compas-\nsion, and psychological well-being, routine psy-\nchological assessment may be a useful component \nof treatment. Regular screening for maladaptive \nillness beliefs, pain catastrophizing, and anxiety \nmay facilitate early identification of patients at \nrisk of psychological distress and reduced quality \nof life, potentially supporting timely intervention.\nFurthermore, access to psychological counsel-\ning may be beneficial for women with endome-\ntriosis. Interventions based on cognitive-behav-\nioral therapy, acceptance-based approaches, and \ncompassion-focused therapy have been asso-\nciated with reductions in pain catastrophizing, \nbetter emotional regulation, and more adaptive \ncoping in patients with chronic pain [46, 52, 53]. \nFor women with endometriosis, interventions \npromoting self-compassion and cognitive rein-\nterpretation of pain, instead of catastrophizing, \nmay be relevant to addressing maladaptive illness \nperceptions, psychological distress, and resilience \n[5]. Integrating psychological support into stan-\ndard gynecological care may contribute to more \npatient-centered care and potentially better long-\nterm outcomes [54].\nThe study has several limitations that may \naffect the interpretation of the results. First, its \nonline design limited control over the reliability \nof responses, and the considerable number of re-\nflective questions may have reduced participants’ \nattentiveness. Future research should monitor \ncompletion time or include attention-check ques-\ntions. Second, the cross-sectional design makes it \ndifficult to draw causal conclusions. The observed \nassociations may be bidirectional, highlighting the \nneed for replication in longitudinal studies to bet-\nter understand the mechanisms underlying illness \nperception and coping. Third, for some regression \nmodels, such as the one for profit, R\n2 values were \nrelatively low, indicating limited explained vari-\nance. Combined with a relatively large number of \npredictors, this may increase the risk of overfitting. \nConsequently, these results should be interpreted \nwith caution, considering the limited statistical \npower and potential risk of Type I errors. Fourth, \nclinical variables such as pain intensity, disease \nduration, and parental status were not included \nin the analyses, although they may be associat-\ned with pain-coping strategies, illness perception, \nand adaptation. Additionally, the lack of data on \nthe mental health history of participants and their \nfamilies (e.g., previous therapies, hospitalizations) \nlimits a full understanding of the relationships un-\nder study. Therefore, future research should take \nthese factors into account.\nFunding\nNo external funding.\nEthical approval\nThe procedure was approved by the Research \nEthics Committee at the first author’s university \n(approval no. 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