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Skin Health and Disease Dec 2022Medically unexplained dermatologic symptoms, such as pruritus, numbness and burning are known as somatization. These cutaneous symptoms can be very difficult to treat... (Review)
Review
Medically unexplained dermatologic symptoms, such as pruritus, numbness and burning are known as somatization. These cutaneous symptoms can be very difficult to treat because of an absence of an objective explanation and they may not fit neatly into any known dermatological or psychiatric condition. These disorders are more commonly encountered in primary care and in dermatology, rather than in psychiatry. Certain skin disorders, for example, pruritus, could be a manifestation of somatization and others may predispose to somatic symptoms, for example, atopic dermatitis and psoriasis. Although there has been increasing research in the interconnection between psychiatry and dermatology, psychodermatology is a relatively new crossover discipline in clinical practice and recognition of psychodermatological conditions, such as cutaneous somatic disorders, can be difficult. Somatization may occur with or without the existence of a dermatological disease. When a dermatological disorder is present, somatization should be considered when the patient is worrying too much about their skin, spending too much time and energy on it and especially if the patient also complains of many non-cutaneous symptoms. Purely cutaneous somatic conditions include for example, the genital pain syndromes or Gardner-Diamond syndrome, characterized by unexplained bruising, which usually affects women. Effective management tools may include mindfulness therapies, pharmacotherapy with selective serotonin reuptake inhibitors, tricyclic antidepressants and cognitive conduct therapy. Electroconvulsive therapy can also be considered in extremely rare cases for treatment of severe somatization on a background of mood disorders. This paper discusses somatization, its relationship to immunodermatoses and its relevance to clinical practice.
PubMed: 36479272
DOI: 10.1002/ski2.164 -
American Journal of Psychoanalysis Sep 2023This paper attempts to deal with a specific kind of pathological identification-"raw object identification"-which tends to appear as concrete physiological phenomena,...
This paper attempts to deal with a specific kind of pathological identification-"raw object identification"-which tends to appear as concrete physiological phenomena, trying to escape meaning and integration. These somatic manifestations stem from early traumatic experiences with a meaningful object and entrap-as revealed through analysis-specific significant qualities of that object. A massive splitting ensues between body and mind, self and object, relation and identification. Certain properties of the object are then experienced as a foreign body in the subject and are defensively identified with. Thus, raw object identification is often manifested in stubborn bodily symptoms.
Topics: Humans; Unconscious, Psychology; Transference, Psychology; Mental Disorders; Object Attachment; Psychoanalytic Therapy
PubMed: 37528215
DOI: 10.1057/s11231-023-09416-8 -
Maedica Jun 2021Somatization is a common symptom among patients with comorbid anxiety and depression. It is associated with poorer outcome, long-term evolution, worse sleep patterns...
Somatization is a common symptom among patients with comorbid anxiety and depression. It is associated with poorer outcome, long-term evolution, worse sleep patterns and an overall lower quality of life. Previous studies suggest that sleep disturbances exacerbate somatization, which in turn negatively affects sleep. The purpose of this study was to determine the correlation between anxiety/depression and somatization/sleep quality in hospitalized psychiatric patients. Participants comprised 103 hospitalized patients with somatic symptoms disorder as major diagnosis and anxiety and depression disorders as comorbid diagnoses. All subjects were given SOMS-2 and SOMS-7 (Screening for Somatoform Symptoms) for somatization symptoms, HAM-A (Hamilton Anxiety Rating Scale) for anxiety, HAM-D 17 (Hamilton Depression Rating Scale) for depression and PSQI (Pittsburgh Sleep Quality Index) for sleep quality. The Somatic Symptom Disorder-B criteria scale (SSD-12) has been also used for the psychological impact of somatization. The same scales were administered to a control group of 77 participants by trained physicians. There was a negative correlation between the scores of HAM-A/HAM-D scales and those of SSD-12. Also, positive associations between the scores of anxiety and depression scales in patients with sleep disturbances were found. Sleep scores being assessed with PSQI were significantly higher after hospitalization in 80% of participants and did not correlate with neither anxiety/depression nor somatization. In the participant group, SOMS-2 results were not correlated with any social and demographic variables. All scales scores were worse in the study group than the control group. Anxiety and depression symptoms may be associated with higher somatization symptoms but not with the psychological impact of somatization. Also, somatization may not directly impact sleep quality scores. Further approaches are needed to better understand the relationship between sleep quality and somatization, on one hand, and its modulation by comorbid psychiatric disorders, on the other hand.
PubMed: 34621347
DOI: 10.26574/maedica.2021.16.2.246 -
Brain Sciences Feb 2022(1) To determine which psychosocial aspects predict tinnitus-related distress in a large self-reported dataset of patients with chronic tinnitus, and (2) to identify...
OBJECTIVES
(1) To determine which psychosocial aspects predict tinnitus-related distress in a large self-reported dataset of patients with chronic tinnitus, and (2) to identify underlying constructs by means of factor analysis.
METHODS
A cohort of 1958 patients of the Charité Tinnitus Center, Berlin completed a large questionnaire battery that comprised sociodemographic data, tinnitus-related distress, general psychological stress experience, emotional symptoms, and somatic complaints. To identify a construct of "tinnitus-related distress", significant predictive items were grouped using factor analysis.
RESULTS
For the prediction of tinnitus-related distress (linear regression model with R = 0.7), depressive fatigue symptoms (concentration, sleep, rumination, joy decreased), the experience of emotional strain, somatization tendencies (pain experience, doctor contacts), and age appeared to play a role. The factor analysis revealed five factors: "stress", "pain experience", "fatigue", "autonomy", and low "educational level".
CONCLUSIONS
Tinnitus-related distress is predicted by psychological and sociodemographic indices. Relevant factors seem to be depressive exhaustion with somatic expressions such as sleep and concentration problems, somatization, general psychological stress, and reduced activity, in addition to higher age.
PubMed: 35204037
DOI: 10.3390/brainsci12020275 -
Journal of Psychosomatic Research Oct 2023We investigated the differences in fatigue and somatization between shift and non-shift workers and explored the effects of sleep and depression on fatigue and...
OBJECTIVE
We investigated the differences in fatigue and somatization between shift and non-shift workers and explored the effects of sleep and depression on fatigue and somatization in shift workers.
METHODS
In total, 4543 shift workers and 2089 non-shift workers completed self-reported questionnaires. The Center for Epidemiologic Studies Depression Scale (CESD), Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), and Somatization subscale of the Symptom Checklist 90-item version (SCL-SOM) were used to measure depression, sleep quality, fatigue, and somatization, respectively. Fatigue and somatization were compared between shift and non-shift workers after controlling for different sets of covariates.
RESULTS
Compared to non-shift workers, shift workers reported higher FSS (mean difference: 2.19 ± 0.30, p < 0.01) and SCL-SOM (mean difference: 1.77 ± 0.21, p < 0.01) scores after controlling for age, gender, presence of medical illness, occupational category, monthly income, length of service, and weekly working hours. The between-group difference in FSS score was no longer significant after additionally controlling for CES-D (p = 0.15) or PSQI (p = 0.18). The between-group difference in SCL-SOM score showed only non-significant trends after additionally controlling for CES-D (p = 0.09) or PSQI (p = 0.07). The group difference in SCL-SOM scores disappeared after controlling for both CES-D and PSQI scores (p = 0.99).
CONCLUSIONS
Shift workers had higher fatigue and somatization levels than non-shift workers and the group difference was associated with disturbed sleep and depressed mood in shift workers.
Topics: Humans; Depression; Sleep; Fatigue; Sleep Wake Disorders; Surveys and Questionnaires
PubMed: 37619432
DOI: 10.1016/j.jpsychores.2023.111467 -
JAMA Network Open Jul 2023Different types of traumatic life events have varying impacts on symptoms of depression, anxiety, and somatization. For women from areas of the world experiencing war...
IMPORTANCE
Different types of traumatic life events have varying impacts on symptoms of depression, anxiety, and somatization. For women from areas of the world experiencing war and humanitarian crises, who have experienced cumulative trauma exposure during war and forced migration, it is not known whether cumulative trauma or particular events have the greatest impact on symptoms.
OBJECTIVE
To examine which traumatic life events are associated with depression, anxiety, and somatization symptoms, compared with the cumulative amount, in a sample of female refugees.
DESIGN, SETTING, AND PARTICIPANTS
For this cross-sectional study, data were collected in 2016 as a part of The Study on Female Refugees. The current analysis was conducted in 2022 to 2023. This multicenter study covered 5 provinces in Germany. Participants were recruited at reception centers for refugees. Women volunteered to participate and to be interviewed after information seminars at the different centers.
EXPOSURE
Traumatic life events experienced by refugees from areas of the world experiencing war and humanitarian crises.
MAIN OUTCOMES AND MEASURES
Demographic variables (age, country of origin, religion, education, relationship status, and children), traumatic and adverse life events, and self-reported depression, anxiety, and somatization symptoms were measured. Random forest regressions simultaneously examined the importance of these variables on symptom scores. Follow-up exploratory mediation models tested potential associative pathways between the identified variables of importance.
RESULTS
For the final sample of 620 refugee women (mean [SD] age, 32.34 [10.35] years), family violence was most associated with depression (mean [SD] variable of importance [VIM], 2.93 [0.09]), anxiety (mean [SD] VIM, 4.15 [0.11]), and somatization (mean [SD] VIM, 3.99 [0.15]), even though it was less common than other traumatic experiences, including war, accidents, hunger, or lack of housing. Other factors, such as childhood sexual abuse, injury, near-death experiences, and lack of access to health care, were also important. Follow-up analyses showed partial mediation effects between these factors in their association with symptoms, supporting the unique importance of family violence in understanding mental health.
CONCLUSIONS AND RELEVANCE
The findings of this cross-sectional study of refugee women who experienced multiple severe traumas related to war in their home countries and danger encountered during their migration suggest that family violence was key to their current mental health problems. Culturally sensitive assessment and treatment need to place special emphasis on these family dynamics.
Topics: Child; Female; Humans; Adult; Refugees; Depression; Stress Disorders, Post-Traumatic; Cross-Sectional Studies; Anxiety
PubMed: 37471088
DOI: 10.1001/jamanetworkopen.2023.24511 -
Journal of General Internal Medicine Jan 2023The mechanism of symptom amplification, developed in the study of somatization, may be helpful in caring for patients with symptoms that, while they have a demonstrable... (Review)
Review
The mechanism of symptom amplification, developed in the study of somatization, may be helpful in caring for patients with symptoms that, while they have a demonstrable medical basis, are nonetheless disproportionately severe and distressing. Amplified medical symptoms are marked by disproportionate physical suffering, unduly negative thoughts and concerns about them, and elevated levels of health-related anxiety. They are accompanied by extensive and sustained illness behaviors, disproportionate difficulty compartmentalizing them and circumscribing their impact, and consequent problems and dissatisfaction with their medical care. A distinction has long been made between "medically explained" and "medically unexplained" symptoms. However, a more comprehensive view of symptom phenomenology undermines this distinction and places all symptoms along a smooth continuum regardless of cause: Recent findings in cognitive neuroscience suggest that all symptoms-regardless of origin-are processed through convergent pathways. The complete conscious experience of both medically "explained" and "unexplained" symptoms is an amalgam of a viscerosomatic sensation fused with its ascribed salience and the patient's ideas, expectations, and concerns about the sensation. This emerging empirical evidence furnishes a basis for viewing persistent, disproportionately distressing symptoms of demonstrable disease along a continuum with medically unexplained symptoms. Thus, therapeutic modalities developed for somatization and medically unexplained symptoms can be helpful in the care of seriously ill medical patients with amplified symptoms. These interventions include educational groups for coping with chronic illness, cognitive therapies for dysfunctional thoughts, behavioral strategies for maladaptive illness behaviors, psychotherapy for associated emotional distress, and consultation with mental health professionals to assist the primary care physician with difficulties in medical management.
Topics: Humans; Somatoform Disorders; Medically Unexplained Symptoms; Anxiety Disorders; Anxiety; Psychotherapy
PubMed: 35829874
DOI: 10.1007/s11606-022-07699-8 -
Journal of Neurology, Neurosurgery, and... May 2022Phantom limb pain (PLP) impacts the majority of individuals who undergo limb amputation. The PLP experience is highly heterogenous in its quality, intensity, frequency... (Review)
Review
Phantom limb pain (PLP) impacts the majority of individuals who undergo limb amputation. The PLP experience is highly heterogenous in its quality, intensity, frequency and severity. This heterogeneity, combined with the low prevalence of amputation in the general population, has made it difficult to accumulate reliable data on PLP. Consequently, we lack consensus on PLP mechanisms, as well as effective treatment options. However, the wealth of new PLP research, over the past decade, provides a unique opportunity to re-evaluate some of the core assumptions underlying what we know about PLP and the rationale behind PLP treatments. The goal of this review is to help generate consensus in the field on how best to research PLP, from phenomenology to treatment. We highlight conceptual and methodological challenges in studying PLP, which have hindered progress on the topic and spawned disagreement in the field, and offer potential solutions to overcome these challenges. Our hope is that a constructive evaluation of the foundational knowledge underlying PLP research practices will enable more informed decisions when testing the efficacy of existing interventions and will guide the development of the next generation of PLP treatments.
PubMed: 35609964
DOI: 10.1136/jnnp-2021-328428 -
Journal of Clinical Medicine Apr 2022The present study aimed to investigate alexithymia and psychopathological manifestations centered on the body in a sample of adolescents with somatizing and/or...
The present study aimed to investigate alexithymia and psychopathological manifestations centered on the body in a sample of adolescents with somatizing and/or self-harming issues to analyze the phenomenon of NSSI linked to Somatic Symptom Disorders (SSD). A sample of 184 adolescents between 12 and 19 years of age, was divided into three groups, one with NSSI ( = 49) and the second group with SSD ( = 57), comparing them with a third group of adolescents with SSD and NSSI ( = 78) to investigate their differences and similarities in psychopathological correlates and to analyze the mediation role of alexithymia and emotional dysregulation in NSSI and SSD related to internalizing problems. The battery of tests included the Toronto Alexithymia Scale (TAS-20) and the Youth Self-Report 11-18 (YSR). The NSSI + SSD group scored higher than the other two groups on all the YSR scales. The affective syndromes were the only clinical condition that discriminated between the three groups. On all the other syndrome scales, the NSSI + SSD group differed from the other two groups, while there were no differences between the NSSI group and the SSD group. The NSSI + SSD group revealed a more severely deficient emotional self-regulation. Difficulty identifying feelings was a trait shared by adolescents with SSD and those engaging in NSSI, a more complex overall alexithymia profile was associated with the combination of self-harming behavior and somatization. Alexithymia and emotional dysregulation played a mediating role in the relationship between internalizing problems and somatization. We did not find a mediating role in alexithymia and emotional dysregulation in the relationship between internalizing problems and self-injurious behavior. The combination of NSSI and SSD gave rise to more severe psychopathological correlates, clinical levels of alexithymia, and more severe deficient emotional self-regulation. Results of mediation role indicated a link between alexithymia, emotional dysregulation, and somatization.
PubMed: 35456311
DOI: 10.3390/jcm11082220 -
Epilepsy & Behavior : E&B Oct 2020There is no clear understanding of what causes and maintains nonepileptic attack (NEA) disorder (NEAD), or which psychological therapies may be helpful. The... (Review)
Review
BACKGROUND
There is no clear understanding of what causes and maintains nonepileptic attack (NEA) disorder (NEAD), or which psychological therapies may be helpful. The relationships between variables of psychological inflexibility: experiential avoidance (EA), cognitive fusion (CF), mindfulness, and key outcome variables in NEAD: somatization, impact upon life, and NEA frequency were investigated.
METHOD
Two hundred eighty-five individuals with NEAD completed validated measures online. Linear regression was used to explore which variables predicted somatization and impact upon life. Ordinal regression was used to explore variables of interest in regard to NEA frequency.
RESULTS
Mindfulness, EA, CF, somatization, and impact upon life were all significantly correlated. Mindfulness uniquely predicted somatization when considered in a model with EA and CF. Higher levels of somatization increased the odds of experiencing more NEAs. Individuals who perceived NEAD as having a more significant impact upon their lives had more NEAs, more somatic complaints, and more EA.
CONCLUSIONS
Higher levels of CF and EA appear to be related to lower levels of mindfulness. Lower levels of mindfulness predicted greater levels of somatization, and somatization predicted NEA frequency. Interventions that tackle avoidance and increase mindfulness, such as, acceptance and commitment therapy, may be beneficial for individuals with NEAD. Future directions for research are suggested as the results indicate more research is needed.
Topics: Acceptance and Commitment Therapy; Humans; Mindfulness; Psychophysiologic Disorders; Seizures; Somatoform Disorders
PubMed: 32563053
DOI: 10.1016/j.yebeh.2020.107155