For years I’ve taken a stance that chronic pain is not a psychiatric disorder. Yes, it’s associated with depression, anxiety and a host of other problems, but in itself it’s not primarily a mental health problem.
I have met more people with psychological problems after they’ve developed chronic pain, rather than chronic pain initiated through psychological stress.
My stance on stress and chronic pain is that having chronic pain is extremely stressful. When a person experiences pain it disrupts and interferes with usual bodily experience during movement and rest.
There’s no doubt that for some people, the demoralising effect of trying time after time for a diagnosis, and the search for effective treatment is stressful enough to produce depression and/or anxiety, and certainly a sense of hopelessness and helplessness.
By labeling chronic pain a psychiatric disorder, the person being thus labelled experiences a double-whammy:
- Their pain may be real but not acknowledged,
- their suffering may be acknowledged but labelled a psychiatric problem.
A person given a diagnosis of “somatic symptom and related disorder” (according to DSM 5) is meant to mean they have “somatic symptoms associated with significant distress and impairment.”
The diagnosis is to be made “on the basis of positive symptoms and signs (distressing somatic symptoms plus abnormal thoughts, feelings, and behaviors in response to these symptoms) rather than the absence of a medical explanation for somatic complaints.” (See DSM-5, p. 309.)
I wonder, what are “abnormal” thoughts, feelings and behaviours in response to pain?
How is this judged? Who does the judging? What’s normal?
Simply having pain that no-one can explain is, in itself, distressing. I’d have thought this was a pretty normal response.
In DSM-5, some individuals with chronic pain would be appropriately diagnosed as having somatic symptom disorder, with predominant pain. For others, psychological factors affecting other medical conditions or an adjustment disorder would be more appropriate.”(click here for the document)
But I think it’s a clumsy way of addressing the underlying issue that means insurers and legislators STILL believe there has to be tissue damage, or something we can “see” before a person can have real pain.
Read the full article at
Or check out some of Bronnie’s other posts: