Ambivalence over emotional expression and symptom attribution are associated with self‐reported somatic symptoms in Singaporean school adolescents

Although somatization is common across cultures, its meanings may differ as culture shapes emotional experience. Thus, instead of treating somatization as a form of psychopathology, it is more useful to conceptualize it as an idiom of distress, and how complaints of somatic symptoms are related to social relationships, patterns of emotional expression and symptom attribution in a cultural context. This study seeks to explore whether ambivalence over emotional expression and causal attribution would shed light on the meanings of somatization among Asian adolescents. Three hundred secondary school adolescents in Singapore participated in this study. The main results show that emotional ambivalence, biomedical and Traditional Chinese Medicinal causal beliefs, and magical attribution contributed to additional variance in somatic symptoms over and above the variance explained by emotional distress. These findings are discussed from both psychological and cultural perspectives.     

The health preoccupation diagnostic interview: inter-rater reliability of a structured interview for diagnostic assessment of DSM-5 somatic symptom disorder and illness anxiety disorder

Somatic symptom disorder (SSD) and illness anxiety disorder (IAD) are two new diagnoses introduced in the DSM-5. There is a need for reliable instruments to facilitate the assessment of these disorders. We therefore developed a structured diagnostic interview, the Health Preoccupation Diagnostic Interview (HPDI), which we hypothesized would reliably differentiate between SSD, IAD, and no diagnosis. Persons with clinically significant health anxiety (n = 52) and healthy controls (n = 52) were interviewed using the HPDI. Diagnoses were then compared with those made by an independent assessor, who listened to audio recordings of the interviews. Ratings generally indicated moderate to almost perfect inter-rater agreement, as illustrated by an overall Cohen’s κ of .85. Disagreements primarily concerned (a) the severity of somatic symptoms, (b) the differential diagnosis of panic disorder, and (c) SSD specifiers. We conclude that the HPDI can be used to reliably diagnose DSM-5 SSD and IAD.     

Relationship satisfaction determines the association between Epstein–Barr virus latency and somatic symptoms after the loss of a spouse

The loss of a spouse is associated with a host of negative health outcomes. While bereaved individuals commonly report somatic symptoms, no investigations exist of the association between reactivation of latent Epstein–Barr virus (EBV) and somatic symptoms among this population. Further, how an individual perceives the quality of their lost relationship in retrospect may impact loss outcomes. Among 99 bereaved spouses, elevated EBV antibody titers were associated with somatic symptoms for those who retrospectively reported high or mean levels of relationship satisfaction (RS), but not among those less satisfied. Further, higher RS was associated with greater grief symptoms. This study identifies higher retrospective RS as a possible risk factor for negative physical and mental health outcomes during bereavement.     

The development of a brief group intervention (Dynamic Interpersonal Therapy) for patients with medically unexplained somatic symptoms: a pilot study

The primary aim of this equivalence study was to compare the outcome of a brief group therapeutic intervention, based on the principles of dynamic interpersonal therapy (DIT) with an intervention based on cognitive behavioural therapy (CBT) in patients suffering from medically unexplained somatic symptoms (MUSS). Participants were 89 patients (aged 18 to 62) who were offered 20 sessions of either DIT or CBT, as central part of a treatment package, consisting of art therapy, psychomotor therapy, social therapy and physical therapy. Measurements were conducted at baseline, 10 weeks and 20 weeks, using self-rating scales measuring the level of anxiety and depression, the severity of medically unexplained symptoms and quality of life. Results showed that CBT and DIT were comparable. The conclusion was that it is recommended to design a larger scale randomised controlled trial to further elaborate the short-term and long-term effects of this novel psychodynamic group therapy for MUSS patients.     

Health anxiety and hypochondriasis in the light of DSM-5

Background: In the DSM-5, the diagnosis of hypochondriasis was replaced by two new diagnositic entities: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). Both diagnoses share high health anxiety as a common criterion, but additonal somatic symptoms are only required for SSD but not IAD. Design: Our aim was to provide empirical evidence for the validity of these new diagnoses using data from a case–control study of highly health-anxious (n = 96), depressed (n = 52), and healthy (n = 52) individuals. Results: The individuals originally diagnosed as DSM-IV hypochondriasis predominantly met criteria for SSD (74%) and rarely for IAD (26%). Individuals with SSD were more impaired, had more often comorbid panic and generalized anxiety disorders, and had more medical consultations as those with IAD. Yet, no significant differences were found between SSD and IAD with regard to levels of health anxiety, other hypochondriacial characteristics, illness behavior, somatic symptom attributions, and physical concerns, whereas both groups differed significantly from clinical and healthy controls in all of these variables. Conclusion: These results do not support the proposed splitting of health anxiety/hypochondriasis into two diagnoses. Further validation studies with larger samples and additional control groups are warranted to prove the validity of the new diagnoses.     

The state,the institution,and the patient: A three-way collison at the crossroads as a hospital fights closure

This paper recounts the story of a National Health Service hospital which was almost closed for financial reasons in 1990. After a political campaign carried out in the full glare of publicity, the Hospital was reprieved. The account is based on the author's conversations with members of staff. The story of the staff, the patients, the Hospital, and the political struggle are woven together by common themes which are highlighted by reference to the Oedipus myth.     

Associations between miscellaneous symptoms and symptom dimensions: an examination of pediatric obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) in children and adults is a heterogeneous disorder associated with significant psychosocial impairment. Although factor analytic studies have identified symptom dimensions, these analyses do not capture the varied miscellaneous symptoms that fail to load on a specific dimension despite being functionally related. The present study sought to extend the findings of previous research in adults to a sample of youth with OCD (n=131). Logistic regression analyses were used to examine the predictive value of each of the four symptom factors (contamination symptoms, obsessions and checking, symmetry and ordering, and hoarding) to the miscellaneous OCD symptoms. The vast majority of miscellaneous symptoms (17 of the 18 symptoms) were associated with one or more symptoms factors (i.e., contamination symptoms, obsessions and checking, symmetry, and ordering). Hoarding was not related to any miscellaneous symptom. In addition to improving our understanding about the clinical presentation of pediatric OCD, findings also have important assessment (e.g., understanding which miscellaneous symptoms relate to certain dimensions) and treatment implications (e.g., hierarchy development).     

Somatosensory amplification as a possible source of subjective symptoms behind modern health worries

The theoretically hypothesized connection between modern health worries (MHWs) and somatosensory amplification (SSA), as well as the factor structure of the Hungarian version of the MHW scale were investigated in a cross-sectional questionnaire study. A total of 163 university students (mean age = 21.3± 2.70 yrs; 44.2% male) and 145 patients (mean age = 49.4±17.51 yrs; 31.7% male) visiting their general practitioners (GPs) completed questionnaires assessing MHWs, SSA, subjective somatic symptoms (PHQ-15), and trait anxiety (STAI-T). The previously described four-factor structure of the MHW scale was confirmed using confirmatory factor analysis (CFA). In the linear regression analysis, participants' age and SSA scores were positively related to MHWs even after controlling for gender, anxiety, and subjective somatic symptom scores. The conclusions are that: MHWs are indicators of cognitive, behavioral and social level of sensitization for health-related concerns; SSA can provide the somatic background process for generation and/or misattribution of subjective somatic symptoms; better understanding of the cognitive-emotional background of MHWs could help to determine possible interventions.     

Anxiety sensitivity as a predictor of panic disorder symptoms: a prospective 3-year study

Background and Objectives: Anxiety sensitivity (AS) is the fear of anxiety symptoms, a feature proven to be an important vulnerability factor for anxiety pathogenesis. The aim of this study was to examine whether AS (as well as its factors) predicts the onset of panic disorder symptoms when controlling for the contribution of trait anxiety.

Design: We conducted a prospective 3 year follow up study.

Methods: The participants, students at the Humanities and Social Sciences in Zagreb (N?=?1087), completed an Anxiety Sensitivity Index and State-Trait Anxiety Inventory (Trait form) and, after a period of three years, were asked to self-assess criteria for panic disorder (according to the DSM-5).

Results: The predictive validity of AS for the onset of panic disorder symptoms, regardless of trait anxiety, was confirmed. Furthermore, the physical concerns dimension of AS was the only significant predictor of panic disorder symptoms. The optimal cutoff score of 25 on the ASI provides poor to moderate accuracy indices in detecting participants who will manifest panic disorder symptoms in the next three years.

Conclusion: This study contributes to our current understanding of AS as a prospective risk factor for panic disorder symptoms.     

Obsessive-compulsive symptoms and cigarette smoking: an initial cross-sectional test of mechanisms of co-occurrence

ABSTRACT

Tobacco addiction and obsessive-compulsive symptoms (OCS; intrusive thoughts or impulses that cause distress and rituals) are both mediated by compulsivity and negative reinforcement. Little evidence exists to guide theory, research, treatment, and population-based prevention of this co-occurrence. We propose a conceptual model of OCS-smoking co-occurrence in which smokers with elevated OCS capitalize on smoking to assuage OCS. This secondary analysis examined associations between OCS levels and self-reported smoking motives that are model-concordant: i) negative reinforcement—smoking for relief; ii) sensorimotor—benefits of behaviors and sensations of the tobacco self-administration ritual; and iii) habitual—smoking without conscious control. A community sample of cigarette smokers enrolled in a cessation trial (N = 458; 47.2% female; M _age = 36.9; SD = 13.6) completed pre-quit self-report measures of OCS levels and smoking motives. Regression models adjusted for sociodemographic covariates and non-OCS psychopathologies indicated that OCS level was positively associated with each model-concordant motive. OCS level was also correlated with tobacco dependence severity and greater withdrawal symptom severity experienced during previous quit attempts. Those with higher OCS report greater motivation to smoke for negative reinforcement, sensorimotor behavioral-ritualistic, habit/automaticity, and stimulation reasons. Further examination of the proposed model of OCS-smoking co-occurrence is warranted to guide theory and intervention for this population.     

Depression and somatic symptoms in Japanese and American college students: Negative mood regulation expectancies as a personality correlate

This study clarified contradictory findings regarding whether depression and somatic symptoms are associated more strongly with each other in non‐Western countries than in Western countries, by examining the relationships of the two variables with negative mood regulation expectancies (NMRE). NMRE are beliefs about one's ability to improve one's negative moods. Participants were 155 Japanese and 176 American undergraduates. They completed self‐report measures of NMRE, coping, depression and somatic symptoms. Results showed that depression significantly correlated with somatic symptoms for both men and women in both countries, and there was no cultural difference in the relationship between depression and somatic symptoms. The relationships of depression and somatic symptoms with NMRE did not differ between cultures. NMRE explained variance in depression in both countries but variance in somatic symptoms only for women in both countries. The relationship of NMRE with depression and somatic symptoms paralleled that between depression and somatic symptoms for both cultures. These results were consistent with the previous literature that found no difference between cultures. Results support the cross‐cultural validity of measuring NMRE in the context of coping and distress.     

Cultural context, obsessive-compulsive disorder symptoms, and cognitions: a preliminary study of three Turkish samples living in different countries

Previous research findings have suggested that recent cognitive accounts of obsessive-compulsive disorder (OCD) are valid across different cultural contexts for both clinical and nonclinical samples; however, there is evidence that cultural differences may have an impact on a number of cognitive variables. For this reason, immigration provides an exceptional opportunity for an examination of the role of cultural context in cognitions and possible changes in cultural characteristics. To this end, the present study examined the interrelationships between thought-action fusion, thought control strategies and OCD symptoms in three nonclinical samples, taking the immigration factor into consideration. Thus, the current study included three Turkish sample groups: those who remigrated to Turkey from Bulgaria, those still living in Bulgaria, and those that have always resided in Turkey. The findings of the study supported the role of thought and action fusion and control strategies in OCD symptoms in a cross-cultural context. To illustrate, worry, as a thought control strategy for OCD symptoms, was a common factor in all three sample groups. However, differences were also noted between the groups, despite having the same ethnic origin. Although they immigrated back to Turkey and have been living there for a considerable period of time, the Turkish remigrants retained similar characteristics to the respondents in Bulgaria on cognitions in general. Consequently, it may be suggested that cultural context might have a relative impact on certain correlates. A replication of these findings using different immigration groups and examining various cultural factors is strongly encouraged.     

Internal Validity of the Disruptive Behavior Disorder Symptoms: Implications from Parent Ratings for a Dimensional Approach to Symptom Validity

A dimensional approach was used to evaluate the internal validity of the DSM-III-R ADHD-inattention, ADHD-hyperactivity/impulsivity, oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms (i.e., whether a symptom has a stronger correlation with its own dimension than the other three). Parents rated 4,019 children between the ages of 2 and 19 on these symptoms. The results showed that 5 of the 6 inattention symptoms, 3 of the 4 hyperactivity symptoms, 1 of the 4 impulsivity symptoms, 6 of the 9 oppositional defiant disorder symptoms, and 8 of the 11 CD symptoms had significant internal validity. Confirmatory factor analysis (CFA) found support for inattention, hyperactivity/impulsivity, oppositional defiant, and conduct disorder dimensions. Multiple-group CFA also found support for factor pattern and loading invariance across gender. The implications of these results as well as the merits of the dimensional approach to symptom validity are discussed in the context of the DSM-IV changes in ADHD, ODD, and CD.     

On the dark side of work: a longitudinal analysis using self-determination theory

As the nature of work has changed in recent decades, employees are increasingly exposed to psychological demands in the workplace, which have associated consequences for employees, organizations, and society. Using self-determination theory, this study examined the dark side of work, in which frustration of basic psychological needs is associated with higher levels of work-related stress. In this model, work-related stress is associated with higher levels of somatic symptom burden, which in turn is associated with higher levels of emotional exhaustion, turnover intention, and absenteeism. Results of a longitudinal analysis using data from four time points over 15 months supported these predictions. Taken together, this study advances the literature towards an understanding of the (potential) detrimental impact that need-thwarting work contexts can have on employee wellness and work-related outcomes.     

The moderating role of distress tolerance in the association between anxiety sensitivity physical concerns and panic and PTSD-related re-experiencing symptoms

Abstract

The present investigation evaluated the moderating role of distress tolerance (DT) in the relation between the physical concerns (PC) dimension of anxiety sensitivity (AS–PC) and panic and posttraumatic stress disorder (PTSD)-related re-experiencing symptoms in a nonclinical, undergraduate sample (n = 416; 300 females; M _age=20.3 years, SD = 4.8). Consistent with prediction, there was a significant interactive effect between AS–PC and DT in regard to panic symptoms, such that greater AS–PC and low DT was associated with greater panic symptoms after controlling for the variance accounted for by negative affectivity and the respective main effects. However, contrary to prediction, AS–PC and DT did not significantly interact to predict PTSD-related re-experiencing symptoms. Also consistent with prediction, there was no interactive effect apparent for symptoms of depression or general anxiety, suggesting that the interaction between AS–PC and DT is specific to panic psychopathology.     

The elephant tied up with string: a clinical case study showing the importance of NHS provision of intensive,time-limited psychoanalytic psychotherapy treatments

Prof. Richard Layard's influential advocacy for greater provision of ‘evidence-based’ psychological therapies, based in part on an economic rationale, has lead to greatly increased provision of cognitive behavioural therapy (CBT) and short-term therapies for depression, through the Increasing Access to Psychological Therapies (IAPT) initiative, whilst longer-term psychodynamic treatments are under threat, criticised as lacking an evidence base. This paper argues for the continuing provision of intensive thrice-weekly psychoanalytic psychotherapy treatments, time-limited to two years. It does so by describing such a treatment within an NHS psychotherapy department with a patient with a long history of severe personality pathology, including significant levels of perversity. The paper describes the patient's difficulties and his movement through the treatment, focussing on his difficulties making genuine emotional contact, his destructiveness of such contact, his acting out in the treatment, his perversity and the vital working through of the ending. The shifts the patient made are described, and follow-up information on the patient is given. The paper discusses the unique benefits of time-limited treatment and intensive psychoanalytic treatments for this ‘hard-to-help’ group of patients, and the economic rationale that can be made for such treatments.     

A multi-modal investigation of the roles of distress tolerance and emotional reactivity in obsessive-compulsive symptoms

Emerging evidence implicates important roles of poor distress tolerance and heightened emotional reactivity in obsessive-compulsive disorder. To date, investigations have relied mostly on self-report measures, and we sought to extend the literature by examining the relationship between OC symptoms and distress tolerance, as well as emotional reactivity, using three laboratory assessments. Nonclinical participants (N=167) viewed emotional films associated with four different negative emotions and also completed mirror tracing and handgrip persistence tasks. Greater obsessions scores were predictive of poorer emotional tolerance for a sad film and shorter persistence on the mirror tracing task. Among men only, obsessions were negatively correlated with persistence on the handgrip task. Associations between increased emotional reactivity and washing symptoms also emerged. These findings provide further evidence for the role of poor distress tolerance in obsessions and suggest heightened emotional reactivity may play a role in compulsive washing.     

The association of relational and physical victimization with hostile attribution bias,emotional distress,and depressive symptoms: A cross‐cultural study

The purpose of the present study was to examine the association between relational victimization and socio‐cognitive patterns (i.e. hostile attribution biases and emotional distress) or social–psychological adjustment problems (i.e. depressive symptoms) in Japanese and European American children (N = 272; ages 9–10). Results showed that relational victimization, which was conceptually different from physical victimization, was associated with a greater level of emotional distress for an overall sample; however, the links between relational victimization and hostile attribution biases and depressive symptoms were evidenced only for Japanese children. A follow‐up analysis revealed that hostile attribution biases had a direct effect on depressive symptoms for European American children; however, these biases mediated the link between relational victimization and depressive symptoms for Japanese children. These findings are discussed from normative and cross‐cultural perspectives.     

Development of a measure of symptoms in chronic fatigue syndrome: The profile of fatigue-related symptoms(pfrs)

Abstract

Chronic fatigue syndrome (CFS) is a disorder of uncertain aetiology which attracts increasing research interest. This paper describes the development of a multidimensional measure incorporating the diverse symptoms associated with the illness. The Profile of Fatigue-Related Symptoms (PFRS) has four scales: emotional distress, cognitive difficulty, fatigue and somatic symptoms. These showed good convergence with comparison measures, high reliability and high internal consistency. CFS patients had markedly elevated scores compared with a student comparison group, and these scores correlated with indices of illness severity. The PFRS is a short and easily administered measure which, it is suggested, may be used to assess patients in terms of the severity and pattern of their disorder, to relate subjective symptoms to immunological and other findings, to evaluate the effects of treatments, and to compare the symptomatology of CFS with that in other fatiguing illnesses.     

Distinguishing between level and impact of rumination as predictors of depressive symptoms: An experience sampling study

Rumination—repetitively thinking about one's emotional state, its causes and consequences—exacerbates negative mood and plays an important role in the aetiology and maintenance of depression. Yet, it is unclear whether increased vulnerability to depression is associated with simply how much a person ruminates, or the short-term impact rumination has on a person's negative mood. In the current study, we distinguish between the level versus the impact of rumination, and we examine how each uniquely predicts changes in depressive symptoms over time in an undergraduate sample. Using experience sampling, we assessed students’ (N = 101) subjective experiences of positive and negative affect and their use of rumination and distraction in daily life for seven days. Participants also reported their depressive symptoms before and after the experience sampling. Increases in depressive symptoms over the week were predicted by how much people ruminated, but not by its impact on negative mood.