Table 1.

Description of patients' self-identified most significant image, with associated triggers, affect, meaning, and avoidance pattern

N°	Triggers	Content of Image	Associated Affect	Associated Meaning	Avoidance/Functional Impact
1.	Pain, sex, sleep.	I am being raped.	Repulsed, guilty, frightened, sick	A metaphor for the loss of control due to the pain.	Avoidance of triggers. I want to be a little girl, be looked after.
2.	Pain, thinking and talking about pain.	Malicious demons play around my pelvis, pushing, pulling and scratching.	Bitterly amused	Pain is malicious, out to get me.	Avoidance of physical activity.
3.	Pain, talking about pain.	Bright operating room lights.	Terrorized	I'm going to die.	Avoidance by filling mind with a substitution image (see text).
4.	Pain, anxiety.	I see myself as a small curled up figure in a red pit, grasping upwards.	Sad, helpless, anxious, tense	Something is wrong with me, and I cannot fix it.	Avoidance of many activities. I want to curl up and die.
5.	Pain, babies.	In the hospital room, I see and hear being told I need a caesarean.	Helpless and anxious	Could this difficult delivery explain the pain?	I cannot avoid the triggers.
6.	Pain, reminders of surgery or of menstruation, exercise.	A gaping hole in my abdomen, where my uterus and ovaries were. It is much bigger than it can be in reality and impenetrable.	Always sad, and at times angry or hopeful	This hole is keeping the space open for my organs to come back. I have not accepted my surgery.	Avoidance of triggers, restricting shopping and social interactions.
7.	Pain.	A little man jumping on my lower abdomen. He is the pain.	Helpless	The pain is winning.	Avoidance of many activities. Avoidance by filling mind with image of a number.
8.	Pain, social gatherings.	My children are crying.	Panicky, anxious and guilty	I am not giving my children a nice childhood. I am disappointing them.	Avoidance of triggers and activities with children.
9.	Pain.	Different things that could be happening inside me (e.g., my intestine is tearing or unzipping, there are ulcers in the bowel, my fallopian tubes are twisting).	Panicky while pain increases, then fed up.	They might have missed something. My pain is too important to be explained by my diagnosis.	Avoidance of many activities.
10.	Pain, movement.	There's a heavy, grey lead ball where it hurts. The weight is surprising, given its size. It's dragging down, as if it was going to fall out of me, taking my insides out.	Disgusted, horrified, revulsion	Something is wrong. This gives a meaning to the pain.	It brings up all my worries. I want to curl up in bed.