ABSTRACT
Pain disorders that are primarily associated with psychological factors are of great clinical concern, but they are difficult to study because of the inability to make valid or reliable diagnoses by structured interview alone. The authors confront this difficulty by using an injured subject population that had extensive psychiatric and medical evaluations. Those who developed somatoform pain disorder (SPD) were compared with a control group who did not. The SPD group had distinctive associated factors: more sites of pain, spread of pain beyond area of original injury, and substantially more opiate and benzodiazepine use. Compensation/litigation influenced symptoms more in the SPD group. Psychotherapists often supported the patient's viewpoint that the pain was physical and to be endured.
Subject(s)
Pain/psychology , Somatoform Disorders/psychology , Wounds and Injuries/psychology , Accidents, Traffic/psychology , Adult , Chronic Disease , Comorbidity , Female , Follow-Up Studies , Humans , Male , Mental Disorders/psychology , Middle Aged , Motivation , Psychiatric Status Rating Scales , Workers' CompensationABSTRACT
Twenty-six cases of workers' compensation "stress" claims were examined to delineate the nature and causes of psychiatric illness in relation to psychological stress in the workplace. Correlations were made among demographic data, psychiatric diagnoses, categories of complaints, psychological themes, and role of litigation. Findings showed that most subjects sorted into two major groups. For the largest group (56%), symptoms were precipitated by interpersonal issues. Within this group, 86% of subjects believed that unfair treatment caused their symptoms, 79% fulfilled criteria for a personality disorder diagnosis, and 71% were more focused on issues related to their claim than on symptom relief. A smaller group (24%) encountered significant stress at work. This group had more severe psychiatric illness and fewer personality disorders.
