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TMD and Psychological Characteristics

Previous literature has suggested that psychological features could reflect an adaptive response to chronic pain, rather than being the cause itself. This study investigated this role of psychological factors by comparing two groups of patients with temporomandibular joint disorders (TMD)—those with myofascial pain and those with articular dysfunction.

To evaluate the patients' psychological standing, the researchers administered the MMPI, which is a questionnaire of 300 true/false questions that is organized to clinically assess particular psychological aspects. The 50 TMD patients expressed "neurotic" characteristics in percentages higher and more frequent than the general population. As well, the patients displayed hysterical features and depression which proved to contribute to inhibiting treatment. Of the 50, 36% were classified as "normal" with appropriate coping methods and adaptive personalities.

The researchers found little difference between the "myofascial" and the "articular" patients, and reasoned the qualities were shared since both were chronic pain patients. The authors comment that their study in conjunction with the previous literature, "justifies the necessity for psychological screening in order to evaluate the tendency toward depression and somatic worry which could influence the treatment."

The authors suggest chronic pain patients with high levels of pain disorders should receive two diagnoses: a medical/dental evaluation and psychosocial behavioral diagnosis. As well, the treatment should incorporate both, with an emphasis on the psychological factors:

"The analysis of the psychological profile indicates the necessity of a psychological treatment together with a dysfunctional traditional treatment. The patients should therefore become aware of the stressful life problems and should learn methods to improve their ability to cope with their pain and stress problems."

Michelotti A, Martina R, Russo M, and Romeo R. Personality characteristics of temporomandibular disorder patients using M.M.P.I. Journal of Craniomandibular Practice 1998;16(2):119-125.