Psychological pain

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This article is about non physical pain. For physical pain caused by psychological factors, see Psychogenic pain.

Psychological pain is an unpleasant feeling (a suffering) of a psychological, non-physical, origin. A pioneer in the field of suicidology, Edwin S. Shneidman, described it as "how much you hurt as a human being. It is mental suffering; mental torment."[1] There is no shortage in the many ways psychological pain is referred to, and using a different word usually reflects an emphasis on a particular aspect of mind life. It may be called mental pain,[2][3] emotional pain,[4] psychic pain,[5][6] social pain,[7] spiritual or soul pain,[8] or suffering.[9][10] It is sometimes also called psychalgia.[11] While these clearly are not equivalent terms, one systematic comparison of theories and models of psychological pain, psychic pain, emotional pain, and suffering concluded that each describe the same profoundly unpleasant feeling.[12] Psychological pain is believed to be an inescapable aspect of human existence.[13]

Other descriptions of psychological pain are "a wide range of subjective experiences characterized as an awareness of negative changes in the self and in its functions accompanied by negative feelings",[14] "a diffuse subjective experience ... differentiated from physical pain which is often localized and associated with noxious physical stimuli",[15] and "a lasting, unsustainable, and unpleasant feeling resulting from negative appraisal of an inability or deficiency of the self."[12]

Etiology

The adjective ‘psychological’ is thought to encompass the functions of beliefs, thoughts, feelings, and behaviors,[16] which may be seen as an indication for the many sources of psychological pain. One way of grouping these different sources of pain was offered by Shneidman, who stated that psychological pain is caused by frustrated psychological needs.[1] For example, the need for love, autonomy, affiliation, and achievement, or the need to avoid harm, shame, and embarrassment. Psychological needs were originally described by Henry Murray in 1938 as needs that motivate human behavior.[17] Shneidman maintained that people rate the importance of each need differently, which explains why people's level of psychological pain differs when confronted with the same frustrated need. This needs perspective coincides with Patrick David Wall’s description of physical pain that says that physical pain indicates a need state much more than a sensory experience.[18]

In the fields of social psychology and personality psychology, the term social pain is used to denote psychological pain caused by harm or threat to social connection; bereavement, embarrassment, shame and hurt feelings are subtypes of social pain.[19] Just like physical pain, social pain is thought to serve a function of adaptation and avoidance from what caused the pain.[7] From an evolutionary perspective, psychological pain forces the assessment of actual or potential social problems that might reduce the individual’s fitness for survival.[20] The way we display our psychological pain socially (for example, crying, shouting, moaning) serves the purpose of indicating that we are in need.

Neural mechanisms

Research suggests that physical pain and psychological pain may share some underlying neurological mechanisms.[21][22][23][24] Brain regions that were consistently found to be implicated in both types of pain are the anterior cingulate cortex and prefrontal cortex (some subregions more than others), and may extend to other regions as well. Brain regions that were also found to be involved in psychological pain include the insular cortex, posterior cingulate cortex, thalamus, parahippocampal gyrus, basal ganglia, and cerebellum. Some advocate that, because similar brain regions are involved in both physical pain and psychological pain, we should see pain as a continuum that ranges from purely physical to purely psychological.[25] Moreover, many sources mention the fact that we use methaphors of physical pain to refer to psychological pain experiences.[7][12][26]

Treatment

Research has shown that use of analgesic paracetamol for several weeks reduces neural response to meaning threats, such as thinking about death,[27] and reduces the agitation of people with dementia.[28][29] However use of paracetamol for more general psychological pain remains disputed.[30]

See also

References

  1. ↑ 1.0 1.1 Shneidman ES. The Suicidal Mind. Oxford University Press; 1996. Appendix A Psychological Pain Survey. p. 173.
  2. ↑ Weiss E. Bodily pain and mental pain. The International Journal of Psychoanalysis,. 1934;15:1-13.
  3. ↑ Orbach I, Mikulincer M, Gilboa-Schechtman E, Sirota P. Mental pain and its relationship to suicidality and life meaning. Suicide and Life-Threatening Behavior,. 2003;33(3):231-41. doi:10.1521/suli.33.3.231.23213.
  4. ↑ Bolger EA. Grounded theory analysis of emotional pain. Psychotherapy Research,. 1999;9(3):342-62. doi:10.1080/10503309912331332801.
  5. ↑ Joffe WG, Sandler J. On the concept of pain, with special reference to depression and psychogenic pain. Journal of Psychosomatic Research. 1967;11(1):69-75.
  6. ↑ Shattell MM. Why does "pain management" exclude psychic pain?. Issues in Mental Health Nursing. 2009;30(5):344. doi:10.1080/01612840902844890.
  7. ↑ 7.0 7.1 7.2 Macdonald G, Leary MR.. Why does social exclusion hurt? The relationship between social and physical pain. Psychological Bulletin. 2005;131(2):202-23. doi:10.1037/0033-2909.131.2.202. PMID 15740417.
  8. ↑ Spiritual pain: 60,000 Google results. Soul pain: 237,000 Google results.
  9. ↑ Morse JM. Toward a praxis theory of suffering. ANS. Advances in Nursing Science. 2001;24(1):47-59.
  10. ↑ Rehnsfeldt A, Eriksson K. The progression of suffering implies alleviated suffering. Scandinavian Journal of Caring Sciences. 2004;18(3):264-72. doi:10.1111/j.1471-6712.2004.00281.x.
  11. ↑ Psychalgia: mental distress. Merriam-Webster's Medical Dictionary. But see also psychalgia in the sense of psychogenic pain.
  12. ↑ 12.0 12.1 12.2 Meerwijk EL, Weiss SJ. Toward a unifying definition of psychological pain. Journal of Loss & Trauma. 2011;16(5):402-12. doi:10.1080/15325024.2011.572044.
  13. ↑ Wille RSG.. On the capacity to endure psychic pain. The Scandinavian Psychoanalytic Review. 2011;34:23-30.
  14. ↑ Orbach I, Mikulincer M, Sirota P, Gilboa-Schechtman E. Mental pain: A multidimensional operationalization and definition. Suicide and Life-Threatening Behavior. 2003;33(3):219-30. doi:10.1521/suli.33.3.219.23219.
  15. ↑ Mee S, Bunney BG, Reist C, Potkin SG, Bunney WE. Psychological pain: a review of evidence. Journal of Psychiatric Research. 2006;40(8):680-90. doi:10.1016/j.jpsychires.2006.03.003.
  16. ↑ Covington EC. Psychogenic pain--What it means, why it does not exist, and how to diagnose it. Pain Medicine. 2000;1(4):287-94.
  17. ↑ Murray HA (2008). Explorations in personality (70 ed.). New York, NY: Oxford University Press. ISBN 978-0-19-530506-7. 
  18. ↑ Wall PD.. On the relation of injury to pain. Pain. 1979;6:253-64.
  19. ↑ MacDonald, Geoff (2009). "Social Pain and Hurt Feelings". In Corr, Philip J.; Matthews, Gerald. Cambridge Handbook of Personality Psychology. Cambridge UK: Cambridge University Press. ISBN 0-521-68051-4, 9780521680516 Check |isbn= value (help). 
  20. ↑ Thornhill R, Wilmsen Thornhill N. (1989). "The Evolution of Psychological Pain". In Bell, RW; Bell, NJ. Sociobiology and the Social Sciences. Lubbock, Texas: Texas Tech University Press. ISBN 0-89672-161-2. 
  21. ↑ http://europepmc.org/articles/PMC3273616
  22. ↑ Mee, S, Bunney, BG, Reist, C, Potkin, SG, & Bunney, WE.. Psychological pain: a review of evidence. Journal of Psychiatric Research. 2006;40(8):680-90. doi:10.1016/j.jpsychires.2006.03.003.
  23. ↑ Eisenberger, Naomi I.; Lieberman, Matthew D. (Jul 2004). "Why rejection hurts: a common neural alarm system for physical and social pain". Trends Cogn Sci. 8 (7): 294–300. doi:10.1016/j.tics.2004.05.010. PMID 15242688. 
  24. ↑ Meerwijk, EL, Ford, JM, & Weiss, SJ.. Brain regions associated with psychological pain: implications for a neural network and its relationship to physical pain. Brain Imaging Behav. 2012. doi:10.1007/s11682-012-9179-y.
  25. ↑ Biro D.. Is there such a thing as psychological pain? and why It matters. Culture, Medicine and Psychiatry. 2010;34(4):658-67. doi:10.1007/s11013-010-9190-y.
  26. ↑ Flaskerud JH.. Heartbreak and physical pain linked in brain. Issues in Mental Health Nursing. 2011;32:789-91. doi:10.3109/01612840.2011.583714.
  27. ↑ http://pss.sagepub.com/content/early/2013/04/11/0956797612464786.abstract
  28. ↑ http://www.bmj.com/content/343/bmj.d4065
  29. ↑ http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1713&pageNumber=3
  30. ↑ http://www.nhs.uk/news/2013/04April/Pages/paracetamol-not-recommended-for-painful-emotions.aspx
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