How could the validity of the DSM-IV pain disorder be improved in reference to the concept that it is supposed to identify?
This article examines the dilemmas inherent in psychiatry's attempts to incorporate pain disorders into the standard psychiatric nomenclature. Each succeeding Diagnostic and Statistical Manual has broadened the concept of pain disorders, and, gradually, the diagnosis has become increasingly removed from the original idea of "psychogenic pain." The advantage of this broadening has been the increased use of the diagnosis in clinical settings. However, there remains a problem of validity, as the disorder continues to imply a mind-body dualism, and clinicians are asked to determine the relative contribution of both to the overall picture of pain. After examining this problem, the article looks at some alternative models, and offers some generalizations regarding the dimensions of the pain experience. The article ends by tentatively offering some suggestions for future approaches to pain diagnoses in psychiatry.
Boland
Robert J
RJ
Department of Psychiatry, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906, USA. robert_boland_1@brown.edu
D006801:Humans; D011581:Psychological Tests; D015203:Reproducibility of Results; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000523:psychology*