Women's Pain and Psychogenic Diagnoses

with Sara Purinton

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(under review)

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Healthcare providers often rely on the following sort of concerning reasoning when encountering patients with difficult-to-diagnose symptoms: in the absence of evidence for a physical cause, the symptoms are presumed to be psychological in origin (O’Leary 2018). In this paper, we take up this concern in the context of chronic pain, with particular attention to how such reasoning disproportionately affects women. We first examine the unwarranted inference from diagnostic uncertainty to psychogenic diagnosis and explore how identity prejudice and diagnostic uncertainty interact in clinical practice. We then consider additional contributors to diagnostic uncertainty: gendered research gaps and male-centered diagnostic paradigms. After outlining the harms associated with psychogenic diagnoses, we consider the objection that such diagnoses might be pragmatically justified. Finally, we conclude by cautioning against using psychogenic diagnoses and call for a more nuanced approach to diagnosing and treating chronic pain.