Pain is a complicated thing as symptoms cannot always be fully attributed to an organic origin for those suffering from depression. Dirk Frieser, psychologist at the Institute of Psychology at Johannes Gutenberg University Mainz, notes in a recent Science Daily report that women are more frequently affected by depression and by the so-called somatoform pain disorder. Somatoform symptoms are those that cannot by fully explained in medical terms. Surprisingly, this is a widespread phenomenon. Frieser noted, "up to 80 percent of the symptoms reported in GP practices are somatoform. However, this does not mean that patients are simply 'imagining' that they have these symptoms." For patients, these symptoms are very real and impair their quality of life. They often include pain symptoms in addition to other symptoms such as dizziness, sensations of hypersensitivity in various regions of the body, and even fatigue or exhaustion. The symptoms can also cause clinically relevant disorders requiring psychological treatment, including cognitive behavioral therapy. The results of this study indicate there is a significantly higher occurrence of somatoform pain in various body regions in patients with existing depression or those who have suffered depression in the previous 12 months. As a result, it is very possible that those patients who report multiple pain symptoms to their doctors that cannot be explained in clinical terms are in fact suffering from a depressive disorder requiring treatment. When major depression is present, affected patients often exhibit dejection, despair, swings in appetite and body weight, insomnia or an increased need for sleep, tiredness, lack of energy and psychomotor disturbances. Suicide has also been considered by these patients, sometimes quite frequently. As a result of this research, it has been determined that general practitioners identified pain was somatoform in 73 percent of cases and could only be fully explained in medical terms in 27 percent of cases.