رفتار بیماری در درد مزمن: پریشانی و یا تمارض؟ مشکلات مفهومی در ارزیابی پزشکی-قانونی ادعای آسیب دیدگی شخصی

In personal injury (PI) litigation involving musculoskeletal incapacity, the terms 'functional overlay' and 'illness behaviour' are frequently adduced to explain the persistence of pain (and associated incapacity) following injury, particularly where the physical findings are inconclusive. They are often diagnosed 'by exclusion' based on the absence of conclusive physical findings rather then the presence of alternative explanations, such as psychological reactions to injury and incapacity. As such they are frequently employed as 'pseudopsychological diagnoses'. The purposes of this article are to highlight the difference between clinical and medico-legal assessment, to examine specifically the task confronting the psychologist or psychiatrist as an expert witness in cases of PI involving musculoskeletal incapacity, and to clarify some of the ambiguities inherent in the use of terms such as 'functional overlay' and 'illness behaviour'.