Unexplained Pains and Aches: A Case Study

January 21, 2018

The Pain in Perfection


Mr RK, 47 years old businessman, came to the Psychiatrist with a trolley full of investigation reports. An Indian national, he had travelled as far as Germany, UK and the US to get help for his various aches and pains.


He reported a nine year history of spells of chest pain, that was "sharp and shooting". Sometimes he had bouts of shoulder pain that spread towards his hands. This happened more on the left side. He had a frequent pain in his neck. Muscle aches were a common complaint. His pains came and went, often without reason. The only pattern he had deciphered was that the pains were worst when he had some stress in his business.


He said that he was always full of energy. He needed only four hours of sleep. After his short sleep, he was fresh and full of drive in the morning. He was always a very active individual. He mostly ignored his pains when they were mild. He described himself as an "action packed character in the pursuit of perfection." However he had occasional phases where the pains would get out of hand and he then worried a lot about it - and then pursued medical opinions with exceptional zeal.


Other than multiple aches and pains, he reported good health - he was not diabetic, and there was no history of hypertension or dyslipidemia (high cholesterol). He did not smoke or drink, and was a "fitness freak." He is happily married and has two children, both of whom are doing well. His wife described him as a loving husband and father.


Stress was mainly related to his business. He reported repeated spells of intense anger at work. He frequently shouted at his employees. RK stated that his employees "were a bunch on incompetents who needed to be guided on every little thing."


He was frank that he did not hold the medical profession in high esteem.  Pointing at his trolley full of reports, he made his feelings candid "They have made a lot of money out of me. If they were competent, they would have made a proper diagnosis. I came because I am helpless with these pains." He also said that he visiting the psychiatrist after being "hounded" by his physician for more than 3 years. In the beginning he had told the physician "Doctor, I am a tough character. I don't need a 'shrink'. My willpower is strong."


The trolley revealed several medical reports and  investigations - all normal, often repeated several times. Multiple blood and urine tests, treadmill tests, scores of echocardiograms, an angiogram, multiple endoscopies, many X-rays and MRI scans - took the psychiatrist more than half an hour to negotiate through.


The discussion went round to his personality. Mr. RK reported "I am born confident. Perfection is in my blood. I don't mince words. I  If I make up my mind, I create a vision, I work hard and I can achieve anything". He felt he had the vision to create a great business empire - and was well on his way to do it. He had started from scratch and now dealt in tens of millions. Talking high of himself in a matter of fact manner, he said that the only things that were sometimes stopping him from expanding more were "his silly employees and the nuisance of aches and pains."


RK was diagnosed as a case of Pain Disorder. Pain disorder is a condition where pain occurs in the absence of any physical cause. Several investigations and medical evaluations had failed to find a cause in RK's case. RK's personality appeared to contribute to his difficulties. The best way to describe RK's personality was with the term "Hyperthymic Personality". Hyperthymic individuals are full of energy, very positive in their outlook and full of confidence.


RK's aches and pains responded significantly to psychiatric medications. As rapport improved, RK expressed an opinion that he needs to "work on his anger." Regular psychotherapy with the clinical psychologist helped him with this issue. Subsequently, as his anger improved, he was able to set a fresh set of goals for himself and stated that his goal was to become an "energy efficient human being. I have a lot of energy, but I need to get maximal output with minimum energy."

9 months into treatment, RK was almost free of aches and pains. He was also less anger prone and reported that he had made significant changes in the way he handled his staff. He stated "As my anger improved, my employees have begun to contribute more they now make many more millions for me."


RK's condition illustrates the interaction between Personality and Illness. Personality is defined as an individual's repetitive pattern of thinking, feeling and behaving. When personality presents in a form that is maladaptive, we call it a Personality Disorder. RK was a high energy individual, an high achiever - he cannot be diagnosed as having an Personality Disorder - however, his unique personality led to significant levels of stress. He set high standards and aimed for perfection and expected the same from his employees. He had little patience with his employees limitations.
As he became aware of himself and gained insight, he was able to make specific changes in his thinking and  behavior that led to significant positive changes in his life. He continues to be on medication for Pain Disorder.

Please note that the information in this case study should not be considered as medical advice for an individual’s condition. If anyone shows or feel symptoms of a possible medical condition, we strongly encourage you to seek advice from your primary physician or a mental health professional for an evaluation as soon as possible.


The names been changed to protect the privacy of individuals.

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