Somatoform disorders carry a number of physical symptoms that are not explained by any medical illness. In addition, they have the characteristic that there are a number of underlying psychological factors that are related to their initiation, maintenance or exacerbation.

In this article we will learn about one of these disorders: pain disorder , in which the main symptom is intense and disabling pain. We will see what its characteristics, types, symptoms, causes and treatments are.

Pain disorder: what is it?

Pain disorder is a disorder that belongs to the DSM-IV-TR category of “somatoform disorders” (APA, 2002). In the DSM-5 (APA, 2013), this category is renamed “disorders of somatic symptoms and related disorders.

In addition, an important change to note is that pain disorder disappears as such in this new edition of the DSM , and becomes a specifier of somatic disorders.

Let’s see what somatoform (or somatomorphic) disorders are, such as pain disorder.

Somatoform disorders

Somatoform or somatomorphic disorders include 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 related to psychological factors, such as traumatic events.

It is important to differentiate somatoform disorders, such as pain disorder, from psychosomatic disorders or diseases. The latter are known and specific organic pathologies or pathophysiological processes, where psychological and psychosocial factors are related to their onset or course.

Characteristics

The pain disorder, which is listed as a diagnosis in the DSM-IV-TR, was previously called “somatoform pain. It was even called “chronic pain,” a term first used by Keefe in 1982.

In terms of its epidemiology, pain disorder is the most prevalent of all somatoform disorders in the clinical setting . It appears more frequently in women than in men, mainly as a symptom related to pain during menstruation.

Symptoms

Let’s look at the main symptoms of pain disorder, which in turn correspond to your diagnostic criteria.

1. Pain

As the name suggests, the main symptom of pain disorder is localized pain in one or more areas of the body . This pain is severe enough to require specific clinical care.

2. Discomfort

Such pain causes the patient significant discomfort . This discomfort can also lead to a deterioration in the 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

In addition, pain disorder is associated with a series of psychological factors that play a determining role in the pain itself ; that is, these factors have an important influence on the initiation, course, maintenance or worsening of the pain symptom.

It is worth mentioning that when pain appears to be associated with a medical illness, this could not be considered a mental disorder.

4. There is no simulation

Finally, the patient does not simulate this pain in any way , nor does he produce it intentionally. This characteristic would differentiate it from the simulation.

Types

In the DSM-IV-TR it is necessary to code the type of pain disorder that the patient manifests, which can be of two types.

1. Psychological factor pain disorder

In this case, there are a number of psychological factors (e.g., anxiety experienced from stressful life events, traumatic experiences, nervousness, etc.) that explain why the pain symptom began, why it was exacerbated, or why it persists over time.

In other words, these factors play an important role in the appearance, maintenance and/or worsening 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 emphasize, these psychological factors must always necessarily exist.

This subtype is more frequent than the previous one.

Specifiers

On the other hand, the DSM-IV-TR also needs to specify whether the pain disorder is acute or chronic.

1. Acute

Acute pain disorder lasts less than 6 months.

2. Chronic

In the case of a diagnosis of chronic pain disorder, the duration of the pain 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 a diagnosis of pain disorder, and that in this classification the persistence of the pain symptom is at least 6 months (a requirement that the DSM-IV-TR does not have).

Causes

The causes of pain disorder, as we have seen, are associated exclusively with psychological factors (which are usually stressful for the person), or psychological factors together with some type of medical illness that the patient suffers from. Psychological factors include stressful or traumatic events for the patient, an accelerated pace of life that causes anxiety, poorly managed grief, the death of a loved one, etc.

But, let’s remember, the pain of pain disorder can never be explained exclusively by a medical illness , because then we wouldn’t be talking about this diagnosis or a mental disorder.

Treatment

The treatment of pain disorder will include a psychological intervention aimed at treating the underlying causes of the pain ; in this case, the psychological factors that explain the symptomatology of the pain. So the therapy will have to be personalized for each patient and adapted to each specific case, since the factors will always vary from one case to another.

Cognitive-behavioral techniques, some kind of systemic, humanistic therapy, etc. can be used. The theoretical orientation of the therapy will depend on the characteristics, needs and preferences of the patient.

On the other hand, anxiolytics and/or antidepressants have also been used to complement psychological intervention, but these should always be considered as specific and supportive “tools”.

Other somatoform disorders

In addition to pain disorder, other disorders belonging to the same category of somatoform disorders are found in DSM-IV-TR.

These are: somatization disorder (which also disappears in DSM-5), undifferentiated somatoform disorder, hypochondria (which in DSM-5 becomes a more global category, “disease anxiety disorder”), body dysmorphic disorder (which in DSM-5 becomes part of obsessive-compulsive disorders), and conversion disorder.

The latter can be of four types: with motor symptoms or deficits, with seizures and convulsions, with sensory symptoms or deficits and of mixed presentation.

In addition, within the somatomorphic disorders we also find the somatomorphic unspecified disorder (different from the somatomorphic undifferentiated disorder).

Bibliographic references:

  • American Psychiatric Association (APA). (2002). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 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 de Psicopatología (2 vols.). Madrid: McGraw Hill.

  • WHO (2000). ICD-10. International Classification of Diseases, Tenth Edition. Madrid. Pan-American.