[Depressive symptoms in psychosomatic pain syndromes]

Two groups of patients with psychogenic pain syndromes were compared: in one group, pain was the sole major clinical complaint; in the other symptoms of depression also presented in addition to the pain. In both groups, the patient considers himself to be physically ill, despite the absence of organic findings. On the basis of the clinical examples, the psychodynamics of chronic pain is discussed with respect to primary and secondary epinosic gain, conscious and unconscious processes involving personal loss, proffered offences, desires and affects. In the absence of depressive symptoms, the psychological organization of pain can be understood as a substitution. Such a situation leads to a "stabilization" of the symptom and more prolonged chronicity than when depression presents at the same time, since in these patients, referral for psychotherapy is delayed.