Psychalgic depressive disorder: a descriptive and comparative study.

In this study 35 consecutive patients diagnosed as having psychalgic depressive disorder (PDD) who lacked sadness but presented with chronic pain have been described. The patients were mainly female, middle-aged and from an urban background. Pain, usually at multiple sites, was reported to be severe by most patients. Predominant depressive symptoms were lack of interest in surroundings (97%), although this was not directly reported, early morning awakening (91%), loss of appetite (100%), and suicidal ideas (66%). None had marked sadness or weeping spells. Lack of reactivity of mood was present in only 2 cases. These psychalgic depression cases were compared with a group of 30 patients diagnosed as having psychogenic pain disorder. PDD cases were significantly more often female, married, less educated, and from an urban background. Pain was significantly more intense and at multiple sites, as compared with the psychogenic pain disorder cases. Clinical outcome was better for PDD cases.