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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 -
Acta Obstetricia Et Gynecologica... Apr 2021Somatization, defined as a number of medically unexplained physical symptoms for many years, is a resource-intensive condition with much suffering. Adult somatization... (Review)
Review
INTRODUCTION
Somatization, defined as a number of medically unexplained physical symptoms for many years, is a resource-intensive condition with much suffering. Adult somatization has been linked to childhood trauma in both men and women. Among women, sexual trauma affects somatization level to a greater extent than nonsexual trauma. Early diagnosis of a somatization disorder would be of great help for both patients and society. The purpose of this scoping review is to map and summarize the literature on symptoms within somatization in women who have been sexually abused, and investigate if any specific symptom can be linked to previous sexual abuse.
MATERIAL AND METHODS
A scoping review methodology was used. The databases PubMed, PsycINFO, and the Cochrane Library were searched for original qualitative and quantitative research published between 2008 and 2019 that matched the objectives of the review.
RESULTS
The database search identified 195 articles, of which 43 were retrieved in full text. Seven articles were included, involving 2076 women. All studies were quantitative. The included studies were heterogeneous. Four studies showed inconsistent findings regarding a link between sexual abuse and chronic or acute pain. Two studies showed an association between sexual abuse and increased incidence of somatic symptoms. One study showed an association between sexual abuse and symptoms of irritable bowel syndrome. No specific somatic symptoms in somatization were identifiable within the scope of this study.
CONCLUSIONS
This is to our knowledge the first scoping review on sexual abuse and symptoms of somatization. The findings suggest a link between sexual abuse and somatic symptoms, but the identified association with pain and irritable bowel syndrome is inconsistent. No studies have clearly identified specific symptoms within somatization associated with sexual abuse. Qualitative research on the topic was identified as a knowledge gap.
Topics: Chronic Pain; Female; Humans; Irritable Bowel Syndrome; Sex Offenses; Somatoform Disorders
PubMed: 33423277
DOI: 10.1111/aogs.14084 -
Iranian Journal of Psychiatry Apr 2022The study of factors affecting anxiety and depression as the most common emotional disorders has always been at the forefront of psychological research. Among different...
The study of factors affecting anxiety and depression as the most common emotional disorders has always been at the forefront of psychological research. Among different factors, alexithymia and somatization have considerable importance due to their emotional nature with makes them more integrated with anxiety and depression. Several studies have demonstrated a link between these four concepts, but as far as we know, the quality of the relationship has not been addressed yet. The present paper aims to investigate the mediating role of somatization in the structural relationship of alexithymia with anxiety and depression. A total of 334 college students were recruited through cluster sampling and were asked to complete the Toronto Alexithymia Scale (TAS), Beck Depression Inventory - Second Edition (BDI-II), Beck Anxiety Inventory (BAI), and Somatization Subscale from the Symptom Checklist-90-Revised Questionnaire. Data were analyzed using correlational as well as structural equation modeling. Based on the correlation analysis, there was significant relationship between alexithymia, somatization, anxiety, and depression. According to the results of regression weights, there is a moderate relationship between alexithymia and somatization (regression weight = 0.44). The relationship between somatization and depression is at moderate level (regression weight = 0.42) and the relationship of somatization with anxiety is at strong level (regression weight = 0.85). the goodness of fit indices for the hypothetical model showed significant coefficients at P < 0.05 (CFI = 0.98, RMSEA = 0.059). Findings indicated the important and influential role of somatization in explaining the relationship of alexithymia with anxiety and depression. Therefore, it seems that emotional components such as difficulty in identifying and expressing emotions as well as regulating mood states are important in the psychopathology of emotional disorders.
PubMed: 36262762
DOI: 10.18502/ijps.v17i2.8904 -
Archives of Rheumatology Dec 2019This study aims to present two major psychological factors, namely depression and somatization, which may occur with high probability in patients with refractory lateral...
OBJECTIVES
This study aims to present two major psychological factors, namely depression and somatization, which may occur with high probability in patients with refractory lateral epicondylitis (LE).
PATIENTS AND METHODS
This cross-sectional study included 36 patients (11 males, 25 females; mean age 42.6±8.09 years; range 26 to 60 years) diagnosed as refractory LE. Duration of symptoms was >6 months. Each patient completed the Beck Depression Inventory and the Symptom Checklist-90-Revised test evaluating psychosocial status and somatization, respectively.
RESULTS
Depression was found in 24 (66.6%) (moderate in 15 [41.7%] and mild in 9 [25%]) and somatization was found in 28 (77.8%) patients. Depression and somatization were significantly more common in females than males (p=0.02 and p=0.04, respectively).
CONCLUSION
Depression and somatization may occur frequently in refractory LE patients, particularly in females. Both physical and psychological assessment tools should be incorporated into the clinical evaluation while psychological support should be included in the treatment of refractory LE.
PubMed: 32010884
DOI: 10.5606/ArchRheumatol.2019.7139 -
Therapeutic Advances in Gastroenterology 2022Irritable bowel syndrome (IBS) is characterized by abdominal pain and altered bowel habits. Further, IBS patients experience a high degree of extraintestinal symptoms. (Review)
Review
BACKGROUND
Irritable bowel syndrome (IBS) is characterized by abdominal pain and altered bowel habits. Further, IBS patients experience a high degree of extraintestinal symptoms.
OBJECTIVES
The aim of this review was to describe the relation between IBS and extraintestinal manifestations and mechanisms and treatments of these extraintestinal manifestations.
DESIGN
The study was performed as a systematic review.
DATA SOURCES AND METHODS
Search terms including extraintestinal manifestations or somatization and IBS were used to scrutinize for publications in Pubmed. In total, 630 publications were identified and 80 were finally included in this review.
RESULTS
About 50% of all IBS patients have extraintestinal manifestations in addition to gastrointestinal symptoms. Somatic pain, fatigue, and sleeping disturbances are most common, and most often described in women. Both extraintestinal manifestations and psychological distress are associated with exaggerated gastrointestinal symptoms, impaired quality of life, and difficulties to treat IBS symptoms. The extraintestinal manifestations render an excess of healthcare costs. Varying etiology and pathophysiology to IBS are discussed, and many patients express a general hypersensitivity. Extraintestinal symptoms are seldom documented at clinical healthcare or included in the assessment of treatment outcomes. A good patient-physician relationship and strengthening of coping mechanisms have rendered less gastrointestinal symptoms, psychological distress, and somatization. Altered lifestyle habits may improve both gastrointestinal and extraintestinal symptoms. Pharmacological treatment, including antidepressant drugs, should be considered when lifestyle advice fails. Teamwork between different specialists and healthcare providers may be of importance in the wide range of symptoms and extraintestinal manifestations.
CONCLUSION
Extraintestinal manifestations are common in IBS patients and is associated with worse suffering and difficulties to treat symptoms. Evaluation and treatment of IBS patients should consider also extraintestinal manifestations and their treatment outcome. Establishment of good relationship, strengthening of coping mechanisms, and education in healthier lifestyle habits are crucial in the management of these patients.
PubMed: 35967918
DOI: 10.1177/17562848221114558 -
Journal of Clinical Medicine Oct 2023Chronic tinnitus, the perception of sound without an external source, can significantly affect individuals' well-being. As an often medically unexplained symptom,... (Review)
Review
Chronic tinnitus, the perception of sound without an external source, can significantly affect individuals' well-being. As an often medically unexplained symptom, chronic tinnitus can present as a "somatoform" or "functional" difficulty. Some evidence has pointed to alexithymia as a transdiagnostically relevant risk factor for both symptom clusters. Using a two-part rapid review-searching within EBSCO, Embase by Ovid, PubMed, Web of Science-we summarize psychological studies regarding alexithymia, i.e., difficulties in recognizing and expressing emotions and (1) somatoform conditions and (2) chronic tinnitus. For the former (inclusion criteria: (1) adult human beings with different kinds of somatization, (2) longitudinal study designs, (3) publication between 2001 and 2021, (4) full-text in English or German) we identified eight studies that revealed significant links between alexithymia and somatoform conditions. Psychotherapy improved alexithymia in most studies. Additionally, alexithymia was associated with broader treatment outcomes such as improvements in pain intensity, gastrointestinal symptoms, and patient-therapist alliance. The 'Risk Of Bias In Non-randomized Studies-of Interventions' tool (ROBINS-I) and 'Revised Cochrane risk-of-bias tool for randomized trials' (RoB 2) were used for risk of bias assessment. Summarizing all available studies on alexithymia and chronic tinnitus, we identified three studies. Inclusion criteria were: (1) adult human beings with chronic tinnitus, (2) publication between 2001 and 2021, (3) full-text in English or German. Risk of bias was assessed by the 'JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies'. The available studies suggested a high rate of alexithymia (65.7%) in patients with chronic tinnitus. Tinnitus-related distress was significantly associated with alexithymia in two studies, one of which, however, found no differences in alexithymia between patients with bothersome versus non-bothersome tinnitus. Conversely, one study reported high levels of alexithymia in patients with low levels of tinnitus-related distress. Overall, alexithymia may be a transdiagnostic psychological indicator of somatization phenomena, which might include some chronic tinnitus presentations. Psychotherapy likely improves alexithymia as well as somatoform symptom presentations.
PubMed: 37959295
DOI: 10.3390/jcm12216828 -
Indian Journal of Community Medicine :... Oct 2019Common mental disorders (CMDs) such as somatization and anxiety are prevalent in general practice. These are twice more common in women.
BACKGROUND
Common mental disorders (CMDs) such as somatization and anxiety are prevalent in general practice. These are twice more common in women.
OBJECTIVES
The objective of this study is to estimate the prevalence and determinants of somatization and anxiety among adult women in an urban population of Kochi.
MATERIALS AND METHODS
A cross-sectional study was conducted among 1210 adult women of Kochi in 2016-2017. The Patient Health Questionnaire-15; the Generalized Anxiety Disorder-7 questionnaire; the Hurt, Insult, Threaten, and Scream tool; and a semi-structured questionnaire were used to estimate the prevalence of somatization and anxiety. Descriptive statistics and univariate and multivariate analysis were done for factors associated with CMDs.
RESULTS
Most of the respondents were married (77.7%), with a mean age of 45.24 ± 15.59. In the current study, 40.8% (95% confidence interval [CI] =38.09-43.62) had somatization and 23.9% (95% CI = 21.57-26.37) had anxiety disorders. In the final logistic regression model, hypertension, perception of illness, positive family history of mental illness, and arthritis were the four determinants common to somatization and anxiety. Menstrual problems (odds ratio [OR] =3.19; 95% CI = 1.12-5.9), cardiac illness (OR = 2.31; 95% CI = 1.08-4.9), and history of major surgeries (OR = 1.62; 95% CI = 1.14-2.41) were independent determinants of somatization. The status of being single (OR = 1.71; 95% CI = 1.25-2.32), adverse life circumstances (OR = 5.85; 95% CI = 3.98-8.6), diabetes (OR = 2.04; 95% CI = 1.25-3.34), sleep problems (OR = 1.64; 95% CI = 1.77-2.91), and history of drug use (OR = 4.89; 95% CI = 1.92-12.46) were independent determinants of anxiety.
CONCLUSION
Mental health services for urban women deserve immediate attention as the prevalence of somatization and anxiety is high. Hence, it is important to screen for somatization and anxiety among women with noncommunicable diseases.
PubMed: 31728095
DOI: 10.4103/ijcm.IJCM_55_19 -
The Primary Care Companion For CNS... May 2021To review the published literature over the last 10 years for the efficacy of electroconvulsive therapy (ECT) in refractory somatization disorder. (Review)
Review
OBJECTIVE
To review the published literature over the last 10 years for the efficacy of electroconvulsive therapy (ECT) in refractory somatization disorder.
DATA SOURCES
A comprehensive evidence search of the published literature in the last 10 years (2010-2020) was conducted using the search terms ECT, electroconvulsive therapy, efficacy, effectiveness, use of ECT, chronic pain, somatoform disorders, somatoform pain, somatic symptom disorder, and somatization disorder. The review was limited to articles written in the English language. Databases searched included PsycInfo, MEDLINE, PubMed, Embase, and Google Scholar. A supplementary citation search was also conducted by analyzing the reference lists of identified sources.
STUDY SELECTION
The initial search revealed 31 articles of potential relevance.
DATA EXTRACTION
The studies were analyzed by both authors to obtain clinical information relevant to meeting the objectives of the review.
DATA SYNTHESIS
Five single case studies, 1 case series, and 1 open trial focusing on the use of ECT in somatization disorder were identified for inclusion in the review. There were no controlled trials or systematic reviews, and the evidence collated was of low quality.
CONCLUSIONS
This review indicates that ECT may be an effective treatment option for severe and refractory manifestations of somatization disorder. However, further research is required in the assessment of the efficacy, safety, and tolerability of ECT in somatization disorder.
Topics: Electroconvulsive Therapy; Humans; Somatoform Disorders; Treatment Outcome
PubMed: 34015195
DOI: 10.4088/PCC.20r02807 -
Frontiers in Psychiatry 2021The global dissemination of COVID-19 creates confusion and ambiguity in nearly every aspect of life, including fear of contagion, heightened awareness of the mortality...
The global dissemination of COVID-19 creates confusion and ambiguity in nearly every aspect of life, including fear of contagion, heightened awareness of the mortality of self and family members, lack of power, and distrust of experts and decision-makers. In this stressful situation, the question arises as to what mechanisms distinguish between adaptive and maladaptive self-regulation. The theory of Motivated Cue-Integration (MCI) is a novel theory of self-regulation that provides a new perspective on the effect of COVID-19 on self-regulation deficiency as an example of psychological distress. Inspired by predictive coding, social cognition, embodied cognition, and experiential approach, MCI suggests that self-regulation is based on interaction between (1) high-level values and goals, (2) low-level interoceptive and exteroceptive signals, and (3) trust in epistemic authority or a significant other. Motivated Cue-Integration posits that individuals create meaning by making moment-to-moment predictions that affect their interpretation of the experience of ambiguity influenced by their relationship with epistemic authority. According to MCI, deficiency in self-regulation during COVID-19 could result either from over-sensitivity or under-sensitivity to low-level interoceptive and exteroceptive cues; rigidity or ambiguity of high-level goals, poor integration between the two levels of processing as well as distrust in epistemic authority. According to MCI, variations of these deficiencies may occur in various clinical phenomena such as alexithymia and somatization, as well as in social phenomena such as goal radicalization. Based on this reasoning, MCI claims that the mentalization of the relationship between interoceptive cues, exteroceptive cues, goals, and psychological needs of the person, as well as the improvement of confidence in epistemic authority, can promote adaptive self-regulation. Psychological intervention can foster trust in epistemic authority, increase the mentalization of interoceptive and exteroceptive cues, and their association with adaptive goals. As such, the integration of these elements in a way that facilitates incentives pathways and insight fosters a more integrated subjective experience, higher clarity of emotion, and positive internal dialogue which promotes action tendency.
PubMed: 34177640
DOI: 10.3389/fpsyt.2021.631758 -
Journal of Preventive Medicine and... Dec 2019Today mental disorders are important concerns of health care system in all countries. Among different mental disorders; depression, anxiety, and somatization are more...
INTRODUCTION
Today mental disorders are important concerns of health care system in all countries. Among different mental disorders; depression, anxiety, and somatization are more frequent. This manuscript was conducted to evaluate the frequency of somatization symptoms, its related factors and the correlation between somatization symptoms and anxiety and depression disorders in Iranian population.
METHODS
The cross-sectional study was conducted in Kerman, Iran, 2017. Participants were selected from patients who referred to the Clinics of Educational Hospitals using convenience sampling method. The PHQ-15 and HADS questionnaire were used to assess the somatization and depression and anxiety, respectively. The univariate and multivariate logistic regression was used to determine the predictive factors of somatization symptoms. The correlations between each PHQ-15 item score and anxiety and depression score were expressed.
RESULTS
The frequency of mild, moderate and severe levels of somatization was 66.3%, 20.5% and 13.1%, respectively. Considering multivariate logistic regression analysis; age was associated with somatic symptoms, significantly. The risk of somatic symptoms was 3.4 times more in Divorced/Widowed participants than single ones (p-value: 0.035). There were significant positive correlations between anxiety and depression scores. Each additional score of anxiety and depression were associated with 1.14 times more likely (p-value: < 0.001) and 1.11 times less likely (p-value: 0.003) of having somatic symptoms, respectively.
CONCLUSION
The burden of somatization, depression and anxiety is high in Iranian population. Psychologists and policy-makers should consider these predictive factors for primary prevention of somatization at the personal and community level, respectively.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Anxiety; Child; Cross-Sectional Studies; Depression; Divorce; Female; Humans; Iran; Logistic Models; Male; Marital Status; Middle Aged; Multivariate Analysis; Patient Health Questionnaire; Prevalence; Risk Factors; Somatoform Disorders; Widowhood; Young Adult
PubMed: 31967099
DOI: 10.15167/2421-4248/jpmh2019.60.4.1006