Somatomorphic disorders involve a number of physical symptoms that cannot be explained by any medical illness. In addition, they have the characteristic that there are a number of basic psychological factors associated with their appearance, maintenance or exacerbation.
In this article, we’re going to learn more about one of these disorders: Pain Disorder, In which the main symptom is severe and debilitating pain. We will see what are their characteristics, types, symptoms, causes and treatments.
Painful disorder: what is it?
Pain disorder is a disorder that belongs to the category of “somatomorphic disorders” inherent in DSM-IV-TR (APA, 2002). In the DSM-5 (APA, 2013), this category changes its name to “somatic symptom disorders and associated disorders”.
Outraged, an important change to note is that the pain disorder disappears as such in this new edition of the DSM, And becomes a specifier of somatic disorders.
Let’s see what somatomorphic (or somatomorphic) disorders are, what a pain disorder would look like.
Somatoform or somatomorphic disorders encompass a group of mental disorders characterized by the appearance of a series of physical symptoms that are not explained by any medical condition; however, these symptoms are linked to psychological factors, such as traumatic events.
It is important to differentiate between somatoform disorders, such as pain disorders, psychosomatic disorders or diseases. The latter are organic pathologies or known and specific physiopathological processes, where psychological and psychosocial factors are linked to their appearance or evolution.
The pain disorder, listed as a diagnosis in the DSM-IV-TR, was previously referred to as “somatoform pain”. It has even been called “chronic pain,” a term Keefe first used in 1982.
As for its epidemiology, the pain disorder is the most common of all somatomorphic disorders in the clinical setting. It occurs more frequently in women than in men, especially as symptoms of period pain.
Let’s take a look at the main symptoms of pain disorder, which in turn meet your diagnostic criteria.
As indicated by his name, the main symptom of the pain disorder is pain that is localized in one or more areas of the body. This pain is severe enough to require specific clinical attention.
This pain causes significant discomfort for the patient. This discomfort can also lead to a deterioration in a person’s life and is also clinically relevant. In other words, it is significant and not reduced to a simple feeling of discomfort.
3. Psychological factors
Outraged, Pain disorder is associated with a number of psychological factors that play a key role in the pain itself; that is, these factors significantly influence the onset, course, maintenance or worsening of the pain symptom.
It should be mentioned that when the pain appears to be associated with a medical illness, it cannot be considered a mental disorder.
4. There is no simulation
Finally, the patient does not in any way simulate this painNeither does it intentionally produce it. This characteristic would differentiate it from simulation.
In the DSM-IV-TR, it is necessary to codify the type of pain disorder that the patient manifests, which can be of two types.
1. Pain disorder associated with psychological factors
In this case, there are a number of psychological factors (for example, anxiety experienced by stressful life events, traumatic experiences, nervousness, etc.) that explain why the pain symptom started, why it was exacerbated or why is maintained over time.
In other words, these factors play an important role in the onset, maintenance and / or aggravation of pain.
2. Pain disorder associated with psychological factors and medical illness
In this second type of pain disorder, in addition to the psychological factors mentioned, there is also a basic medical illness; although, we note, there must always be these psychological factors, necessarily.
This subtype is more common than the previous one.
On the other hand, in the DSM-IV-TR it is also necessary to specify whether the pain disorder is acute or chronic.
The acute pain disorder lasts less than 6 months.
In the case of the diagnosis of a chronic pain disorder, its duration is equal to or greater than 6 months.
It should be noted that in the WHO classification (ICD-10, International Classification of Diseases), there is also the diagnosis of pain disorder, and in this classification the persistence of the pain symptom is at least 6 months (requirement not fulfilled). by DSM-IV-TR).
The causes of the pain disorder, as we have seen, are associated exclusively with psychological factors (which are usually stressful for the person), or with psychological factors alongside a certain type of medical illness from which the patient suffers. Psychological factors include stressful or traumatic events for the patient, an accelerated pace of life that causes anxiety, a poorly managed duel, the death of a loved one, etc.
But, remember, the pain of pain disorder can never be explained exclusively by medical illness., Because then we wouldn’t be talking about that diagnosis or a mental disorder.
Treatment for the pain disorder will include psychological intervention to address the underlying causes.; in this case, the psychological factors that explain the symptomatology of pain. Therapy should therefore be personalized for each patient and adapted to each specific case, as factors will always vary from case to case.
Cognitive-behavioral techniques, a certain type of systemic, humanistic therapy, etc. can be used. The theoretical direction of therapy will depend on the characteristics, needs and preferences of the patient.
On the other hand, anxiolytics and / or antidepressants complementary to psychological intervention have also been used, but these must always be considered as ad hoc and supportive “tools”.
Other somatomorphic disorders
In addition to the pain disorder, in the DSM-IV-TR we find other disorders belonging to the same category of somatomorphic disorders.
These are: somatization disorder (which also disappears in DSM-5), undifferentiated somatomorphic disorder, hypochondria (which in DSM-5 becomes a more comprehensive category, “disease anxiety disorder”), body dysmorphic disorder (which in DSM -5 is part of obsessive-compulsive disorder) and conversion disorder.
These can be of four types: with motor symptoms or deficits, with convulsions and convulsions, with symptoms or deficits in sensory or mixed presentation.
In addition, in somatomorphic disorder we also find unspecified somatomorphic disorder (different from undifferentiated somatomorphic disorder).
American Psychiatric Association (APA). (2002). DSM-IV-TR Diagnostic and Statistical Manual. Barcelona: Masson.
American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Panamericana.
Belloch, A., Sandín, B. and Ramos, F. (Eds.) (1995). Manual of psychopathology (2 vol.). Madrid: McGraw Hill.
WHO (2000). CIE-10. International Classification of Diseases, tenth edition. Madrid. Panamericana.