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Abstract
This is the second in a series of articles that address pain complaints and mental illness. The AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, should not be used if the pain presentation is attributable to mental illness, and the evaluator must distinguish between presentations that should be evaluated using Chapter 18, Pain, and those that should be evaluated using Chapter 14, Mental and Behavioral Disorders. Chapter 14 is unique in its avoidance of numerical impairment ratings but has been praised for its internal consistency and emphasis on following the current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). The only section of Chapter 14 that discusses pain complaints is somatoform pain disorders, which presents several problems, including nomenclature (the phrase somatoform pain disorder is antiquated and disappeared from DSM in 1994, and other forms of mental illness are not somatoform disorders). The DSM is the foundation of the evaluation process, and its discussion of any given mental illness is the gold standard definition of that illness; therefore, any attempt to evaluate pain complaints as a possible manifestation of mental illness must use DSM protocols. The article concludes with a discussion of the components of the evaluation process: awareness of the most prominent diagnostic possibilities; presenting complaints; health history; social history; review of records; family history; collateral interviews; and psychological testing.
- Abstract
- Guidance Provided by Chapter 14
- Issues That Require Clarification by Referring to Other Resources
- The Current Edition of DSM
- Discussion of Somatoform Pain Disorders
- Evaluation Guidelines
- Components of a Thorough Evaluation Process
- The Crucial Importance of the Evaluation Being Done on an Independent Basis
- DSM: The Foundation of the Evaluation
- References
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1.
Brigham CR, Ensalada LH, Talmage JB. The Guides Casebook. 2nd ed. Chicago, Ill: American Medical Association; 2002.
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2.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed, text rev. Washington, DC: American Psychiatric Association; 2000.
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3.
Hales RE, Yudofsky SC. The American Psychiatric Publishing Textbook of Clinical Psychiatry. 4th ed. Washington, DC: American Psychiatric Publishing; 2002.
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4.
Demeter SL, Andersson GBJ. Disability Evaluation. 2nd ed. Chicago, Ill: Mosby-American Medical Association; 2003.
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5.
Levenson JL. Textbook of Psychosomatic Medicine. Washington, DC: American Psychiatric Publishing; 2005.
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6.
Gatchel RJ. Comorbidity of chronic pain and mental health disorders: the biopsy-chosocial perspective. Am Psychol. 2004;59:795–805.
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7.
Greenberg SA, Shurman DW. Irreconcilable conflict between treater and forensic roles. Professional Psychol: Res Pract. 1997;28:50–57.
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8.
Barsky AJ. Forgetting, fabricating, and telescoping: the instability of the medical history. Arch Intern Med. 2002;162: 981–984.
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