DSM-IV Pain Disorder: a case against the diagnosis

Abstract

Pain Disorder has been modified in each of the recent editions of the DSM to improve its clinical applicability. This diagnosis remains fundamentally flawed because it places medical and psychological causes for pain in opposition. It provides neither clear criteria for diagnosis nor clear implications for therapy. All chronic pain problems are grouped together and important medical differences between them are ignored. Pain Disorder shares some problems with the other DSM-IV Somatoform Disorders. Epidemiological studies support dimensional models of somatization and stronger linkages with affective and anxiety disorders than implied in DSM-IV. Distress related physical symptoms such as pain are very common in medical settings. To improve clinical care of these symptoms, we must escape the dualism of psychogenic versus somatogenic symptom models. Symptoms do not arise only from defects within bodies or minds.