DSM-IV Pain Disorder: a case against the diagnosis

Pain Disorder has been modified in each of the recent editions of the DSM t o improve its clinical applicability. This diagnosis remains fundamentally flawed because it places medical and psychological causes for pain in oppos ition. It provides neither clear criteria for diagnosis nor clear implicati ons for therapy. All chronic pain problems are grouped together and importa nt medical differences between them are ignored. Pain Disorder shares some problems with the other DSM-IV Somatoform Disorders. Epidemiological studie s support dimensional models of somatization and stronger linkages with aff ective and anxiety disorders than implied in DSM-IV. Distress-related physi cal symptoms such as pain are very common in medical settings. To improve c linical care of these symptoms, we must escape the dualism of psychogenic v ersus somatogenic symptom models. Symptoms do not arise only from defects w ithin bodies or minds.