Differential Diagnosis
Pain symptoms are included in the diagnostic criteria for Somatization Disorder. If the pain associated with psychological factors occurs exclusively during the course of Somatization Disorder, an additional diagnosis of Pain Disorder Associated With Psychological Factors is not made. Similarly, if the pain presentation meets criteria for Dyspareunia (i.e., pain associated with sexual intercourse), an additional diagnosis of Pain Disorder is not given. Pain complaints may be prominent in individuals with Conversion Disorder, but by definition, Conversion Disorder is not limited to pain symptoms. Pain symptoms are common associated features of other mental disorders (e.g., Depressive Disorders, Anxiety Disorders, Psychotic Disorders). An additional diagnosis of Pain Disorder should be considered only if the pain is an independent focus of clinical attention, leads to clinically significant distress or impairment, and is in excess of that usually associated with the other mental disorder.
Pain symptoms may be intentionally produced or feigned in Factitious Disorder or Malingering. In Factitious Disorder, the motivation is to assume the sick role and to obtain medical evaluation and treatment, whereas more obvious goals such as financial compensation, avoidance of duties related to military service or incarceration, evasion of criminal prosecution, or obtaining drugs are apparent in Malingering.
Relationship to the Taxonomy Proposed by The International Association for the Study of Pain
The Subcommittee on Taxonomy of The International Association for the Study of Pain proposed a five-axis system for categorizing chronic pain according to I) anatomical region, II) organ system, III) temporal characteristics of pain and pattern of occurrence, IV) patient’s statement of intensity and time since onset of pain, and V) etiology. This five-axis system focuses primarily on the physical manifestations of pain. It provides for comments on psychological factors on both the second axis where the involvement of a mental disorder can be coded and the fifth axis where possible etiologies include “psychophysiological” and “psychological.”