Objective Previous studies of pain behavior in patients with chronic pain have shown that depressed patients exhibit more pain behavior than nonde-pressed patients. This study sought to extend these findings and to examine the possible causes of the observed differences. Design Patients completed the short form of the Beck Depression Inventory, and their pain behavior was simultaneously rated by themselves and trained observers. Patients Subjects were 37 inpatients in a chronic pain program. Results Both depressed and nondepressed subjects rated themselves as exhibiting more pain behavior than did nurse ratings. While nurses rated pain behaviors as similar among the depressed and the nondepressed groups, patient ratings indicated significantly more pain behavior among depressed than nondepressed patients. Conclusions These results suggest that cognitive factors may influence self-ratings of pain behavior by depressed subjects.