Thursday Therapeutic Thought - When Physical Pain Isn't So Physical

Picture courtesy of johnnyalive

A few weeks back, I asked my readership if there were any burning therapy questions they might want answered for one of my Thoughts. Eileen over at A Christian Romance Writer's Journey asked this question:

Is there a term for when someone obsesses over fearing something to the point where physical symptoms, like localized pain, appears?

And the answer is YES. Often, psychological factors can have an major role in the onset, severity, exacerbation or maintenance of pain. This would be called....drum roll please...it's very technical...a Pain Disorder.

Pain Disorder is one of the many Somatoform Disorders (which basically means there is a presence of a physical symptom that would suggest a medical condition but which are not fully explained by a medical condition, direct effects of a substance or by another mental disorder).

What the heck then?

Pain in various anatomical parts of the body can be brought about by more than just aging or car accidents or disease. Psychological factors, such as a reaction to a life stressor or possibly even another disorder like depression or anxiety, can also cause localized or generalized pain.

For someone to fit in this category, the pain has to the predominant focus of the person's presentation in my office and it needs to have been of sufficient severity to warrant clinical attention. It also has to cause significant stress or impairment in the person's life (i.e., inability to attend work or school, frequent use of the health care system, substantial use of medications, relational problems such as marital discord and disruption of the family's normal lifestyle). A therapist would have to judge psychological factors as having a major role in the occurrence and severity of the pain and the pain is not produced intentionally (as there are other disorders for that called Factitious Disorder and Malingering).

Pain Disorder is considered Acute when the duration of the pain is less than 6 months and Chronic is the duration of the pain is longer than 6 months.

Some of the most common causes of Pain Disorder are unemployment, disability and family problems. And there is always the risk that someone with chronic pain will develop a dependence on medication to stop the pain, so usually a substance abuse disorder is also diagnosed for these individuals. Severe depression and terminal illness can cause pain that leaves that individual at an increased risk for suicide. Often, people with pain like this will think some health provider somewhere has the "cure," and will spend inordinate amounts of money searching for a "fix."

Chronic pain is more often associated with Depressive and Anxiety Disorders while Acute pain is more often associated with Anxiety Disorders, so when writing a character who suffers from this remember to lean toward the "anxious" side if your character is going to battle pain for under 6 months.

Females seem to be more perceptible to having Pain Disorders than males, frequently presenting in therapists' offices with migraine and tension-type headaches and musculo-skeletal pain. Pain can occur at any age. It is important to note that the longer a pain is present, the more likely it is to become chronic and persistent.

Important factors to overcome the pain could be various, but I'll include some here so if you do want to include something like this in your character's arc, you'll have an idea where to go. The individual has to acknowledge the pain, not tip-toe around the fact that something's not wrong. They need to give up unproductive efforts to control the pain, which might mean giving up health care providers, who sometimes can unknowingly feed into the person's belief something is wrong. They should participate in regularly scheduled activities like work despite the pain. They should recognize and treat comorbid disorders (disorders that exist at the same time; in conjunction with the pain) and not allow the pain to become the determining factor in their life (i.e. don't live around the pain).