Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

The Drug Conundrum

Psychosomatic refers to one or more psychological or behavioral factors that affect an individuals general medical condition. These psychological or behavioral factors may contribute to the development of a medical condition, they may exacerbate the condition or they may delay recovery from a medical condition.

The diagnostic code for this is 316.0 Psychological Factor Affecting Medical Condition and is a frequent diagnosis with injured workers.

Allow me to cover three of these now, and I’ll cover the remaining three next week:

1. First we have cases in which Mental Disorder Affects Work-Related (e.g. orthopedic) Injury – This occurs when a diagnosed clinical disorder (e.g. Major Depressive Disorder) or a diagnosed personality disorder (e.g.Dependent Personality Disorder) complicates the course of treatment for the injury. For example, the individual is so depressed that he/she fails to follow-through with physical therapy or does not consistently take medication or remains in bed all day and becomes further de-conditioned.

2. Secondly, we have cases in which Psychological Symptoms Affects Work-Related Injury. These patients do not have symptoms sufficient for the diagnosis of a mental disorder. But they may have some symptoms of depression, some indications of anger, observable levels of resentment or distrust. These symptoms, in turn, keeps them agitated, tense and affects their level of muscle tension/spasm, capacity to effectively use pain management strategies or effect the course of recovery from surgery.

3. Thirdly, we have cases in which Personality Traits or Coping Style Affect Work-Related Injury. These patients may have an enduring pattern of behavior which is not sufficiently severe to be diagnosed as a personality disorder but severe enough to complicate recovery. Examples include the passive-aggressive style that results in non-compliance with prescribed care and leads to worsening of their condition. There is also the driven, compulsive and demanding (of self and others) coping style that may impact the ability to accurately process pain symptoms.

The most important thing to keep in mind is that psychosomatic does not mean “imaginary.” The person is not believing they are in pain when they are not. In fact, there are psychological and behavioral factors which are making their pain worse along with less capacity to deal with pain.

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