Psychopathic Personality Traits and Somatization: Sex Differences and the Mediating Role of Negative Emotionality

Although a number of investigations have provided evidence for an association between antisocial personality disorder and somatization disorder, the variables underlying this association remain unknown. We examined the relations among measures of primary and secondary psychopathy, somatization, and negative emotionality (NE) in 150 undergraduates. Somatization was positively and significantly correlated with measures of secondary, but not primary, psychopathy, and the relations between secondary psychopathy indices and somatization tended to be significantly stronger in females than in males. Some support was found for the hypothesis that the association between secondary psychopathy and somatization is mediated by NE, but not for the hypothesis that low levels of behavioral inhibition lead to somatization. Although the present findings are consistent with the possibility that somatization is a sex-differentiated manifestation of secondary psychopathic traits, replication of these findings in clinical samples will be necessary.     

Gender, Somatization, and Psychopathic Traits in a College Sample

The structure of psychopathic traits and their association with somatization symptoms were investigated in a sample of 199 undergraduate college students enrolled in introductory psychology classes. Using multiple measures of psychopathic traits, an iterated principal axis (IPA) analysis revealed two dimensions of psychopathy that were similar to ones typically found in forensic samples. One dimension focused on a cold, callous, and unemotional interpersonal style and the second dimension focused on an impulsive and antisocial lifestyle. These two dimensions emerged for both men and women, although the correlation between the two was somewhat higher for men than women. Also, the callous and unemotional dimension was negatively correlated with somatization symptoms, and the impulsive and antisocial dimension was positively associated with somatization symptoms. This pattern of associations was similar for both men and women and it suggests that somatization symptoms may be one aspect of the high rate of negative affectivity experienced by antisocial individuals.     

Beyond abuse: the association among parenting style, abdominal pain, and somatization in IBS patients

This study assessed the relative strength of the association between abuse, negative parenting style, and somatization in irritable bowel syndrome (IBS) patients. Drawing from preclinical stress physiology and abuse research identifying the family social climate as a frequently stronger and independent determinant of long-term health effects than abuse-specific variables, we predicted that negative parenting behaviors would more strongly correlate with somatization than abuse. Subjects were 81 consecutively evaluated patients, who at baseline underwent psychological testing, measuring perceived parental style, abuse history, somatization, and pain. Although abuse correlated with maternal and paternal rejection, abuse was not associated with somatization. Higher levels of rejection and/or hostility among fathers (not mothers) were more strongly correlated with somatization than was abuse. Further, paternal parenting behaviors were more predictive of somatization than abuse, age, and gender. The lack of an association between abuse and somatization is discussed in light of limitations of biopsychosocial IBS models, whose strong focus on "pathological stressors" (e.g., abuse, trauma) as risk factors may overlook the importance of "less extreme" parenting variables in influencing somatic complaints. The relationship between parenting and somatization is discussed in the context of broader behavioral science research linking disruptions in the quality of parenting to dramatic and long-term changes in patterns of stress reactivity and brain abnormalities seen in IBS patients.     

Hypochondriasis Among Patients with Multiple Somatoform Symptoms—Psychopathology and Outcome of a Cognitive-Behavioral Therapy

As hypochondriasis often occurs with somatization, patients with somatization disorder plus hypochondriasis were compared to patients with somatization syndrome alone regarding psychopathology, patterns of physical symptoms and outcome of a cognitive-behavioral inpatient treatment. A sample of patients with DSM-IV hypochondriasis and multiple somatoform symptoms(N = 27) and a matched sample of patients with multiple somatoform symptoms but without hypochondriasis (N = 27) were assessed. All subjects obtained a cognitive-behavioral treatment for somatization and hypochondriasis. Assessment took place at admission and at one-year follow-up. Only a few differences between the groups were found: Hypochondriacs suffered more often from abdominal pain, and they reported a higher intolerance of bodily complaints. At follow-up, all outcome variables improved significantly. High effect sizes were found for the reduction of symptoms and the mean number of visits to the doctor. The specific effect on health care use highlights the socioeconomic relevance of these results.     

Somatization tendencies and ability to detect internal body cues

39 subjects performed a task in which they were required to detect the presence of a resistive load during the inhalation phase of breathing. Subjects were also measured on somatization tendencies, using the SCL-90-R test. A signal-detection analysis indicated an inverse relationship between ability to detect the resistive load during breathing and somatization score. Results are discussed relative to possible ramifications for somatoform disorders.     

The psychological health of employed and unemployed recent graduates as a function cognitive appraisal and of coping

In the literature on the effects of unemployment on graduates two competing hypothesis have found support. On one hand graduates have higher expectations about status and occupational identity, hence being unemployed should be more distressing. On the other hand graduates have access to more personal and situational resources and should cope better with the stress of unemployment. In a study of 181 recent graduates it was found that those who were employed (n = 88) scored higher on both somatization and interpersonal sensitivity than those who were unemployed (n = 93). A large percentage also reported not being in the job to which they aspired and scored low on job commitment. The unemployed graduates had a more positive approach to problem-solving, higher achievement motivation, more perceived social support, were more assertive, and felt less hopeless than their employed peers. They also engaged in more constructive leisure activities than the employed group. The data provide tentative support for the hypothesis that graduates are better at coping with unemployment. However the indication is that any advantage to be gained is relative to the type of job occupied by the employed group to whom they are compared. The general conclusion is that opting for a job which does not meet expectations or aspirations may be more psychologically damaging in the short term than being unemployed and hopeful. This is a function of the individual's vulnerability or resistance to stress and highlights the need for graduates to be prepared more effectively for the path to a career.     

恐惧的代价：疼痛恐惧、心理忧虑和躯体化对疼痛感知预测作用的比较

首次在无痛群体中比较疼痛恐惧、心理忧虑和躯体化对疼痛感知的预测作用大小及调节和中介关系。以多个同类量表得分的Z分数加和作为三者的因子分,以冷压痛觉测验（CPT）疼痛指标（阈限、耐受性、强度、不愉快度）为目标变量,通过分层回归及调节和中介作用分析,发现疼痛恐惧对疼痛不愉快度的预测作用最强,心理忧虑对疼痛体验（强度、不愉快度）的预测作用被疼痛恐惧完全中介,躯体化只有在高疼痛恐惧条件下才显著负向预测疼痛不愉快度。综上,疼痛恐惧是三因素中预测CPT疼痛体验的主要因素。     

The Use of the Social Cognition and Object Relations Scale in a Primary Care Setting

Research has indicated that as many as 10% to 15% of primary care patients have symptoms that are not well explained medically. These patients could be labeled as “somatizers.” This study assessed the extent to which underlying psychological characteristics contribute to a person's level of somatization and service utilization. The Social Cognition and Object Relations Scale–Global Rating Method (SCORS–G; Stein, Hilsenroth, Slavin-Mulford, & Pinsker, 2011; Westen, 1995) was used to rate early memory narratives of 100 patients in a suburban primary care setting. Using principal axis factoring, the SCORS–G was divided into 2 components and these components (cognitive and affective) were used in subsequent analyses. The affective component was significantly negatively correlated with 2 measures of somatization and positively related to physician ratings of global health. The affective component also showed a trend toward significance on overnight hospital stays and patient-rated health. The cognitive component showed a trend toward significance with both measures of somatization, but it was not correlated with other measures of health. This study demonstrates the value of assessing underlying processes (via SCORS–G ratings of early memory narratives) that contribute to increased rates of somatization and health care utilization. Clinical implications for the relationship between affect and physical health are explored.     

Affektverarbeitung und Beziehungsgestaltung bei somatoformen Störungen

Somatoform disorders are usually associated with disturbances in affective processing and consequently with relational disorders. The effect of psychotherapy on the emotional regulation and the relational behaviour in the course of treatment of a patient with somatoform autonomous dysfunction and dysthymia has been examined. Pre-post comparisons of inpatient treatment have been performed by means of standardized questionnaire data; the course of therapy has been evaluated by the analysis of the dependence of the leading symptom of hypogastric pain on mood parameters with the help of multivariate time-series analyses. One effect of psychotherapy was the initiation of an intrapsychic discourse, which led to an improved ability of affect regulation as well as to a better functioning in relationships. This was accompanied by a reduction of somatization. The interrelations between somatization, affect- and relationship-regulation are discussed.     

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.     

Symptom Expression and Somatization Among Elderly Korean Immigrants

In a study of expression of symptoms of somatization, depression, and other biopsychological conditions, 70 elderly Korean immigrants in the greater Washington, D.C., metropolitan area (35 who met the criteria for major depression and 35 who did not meet those criteria) were administered a Korean version of the Brief Symptom Inventory (BSI). Subjects who met the criteria for depression had the highest mean score on the BSI somatization dimension compared with other normative samples including a sample of psychiatric inpatients. A factor analysis of data from the BSI showed that for elderly Korean immigrants, a factor of somatization was identified that included the items from the original BSI obsessive-compulsive, somatization, and anxiety dimensions. Items loading on the somatization factor suggest that elderly Korean subjects experience body and mind as a unitary system and tend to communicate the distress associated with old age, cultural adjustment, and family and social changes through somatic symptoms.     

Sampling frequency and the study of eye-hand coordination in aiming

This study synchronized sampling of point of gaze (PG) and hand movements in a fast aiming task, using a 60- and a 120-Hz sampling frequency. The subjects moved eyes, head, hand, and trunk freely. For limb kinematics, a significant difference between sampling conditions was only found for the number of accelerations in the profile following peak velocity of the hand. For PG movements, no differences were found for initiation time, saccade angle, fixation duration, and overall number of saccades. However, significant differences were observed for saccade duration. Previously, an invariant feature was found for the ratio of PG and hand response times (50%). For both sampling frequencies, a significant correlation and, thus, temporal coupling was found between PG response time and time to peak acceleration for the hand. Depending on the measures required, a 60-Hz sampling of PG and hand movements may provide as meaningful results as a 120-Hz sampling.     

Workload and burnout in nurses

This paper examines the relationship between workload, burnout and somatization in nurses. The respondents consisted of 1363 nurses employed in hospitals, which were undergoing extensive restructuring. Results of structural equation analyses showed that workload was positively related to emotional exhaustion. Emotional exhaustion led to cynicism and somatization, and cynicism was negatively related to nurses' professional efficacy. Implications of the results for nursing practice are discussed. Copyright © 2001 John Wiley & Sons, Ltd.     

Correlates of malingering

The author presented anonymous questionnaires to 172 patients and 160 medical students to assess the frequency and correlates of malingering in various groups in a medical center on a V.A. campus. The results indicate that sociopaths, drug abusers, and alcoholics are more prone to malinger than other individuals, supporting previous assertions that mental health professionals should have a higher index of suspicion for malingering in these diagnostic groups. Race and age were found to have small but significant correlations with malingering, but at present, this finding must be viewed cautiously. No association was found between somatization disorder and malingering.     

Cultural Identity and the Expression of Depression: A Social Identity Perspective

The present research interrogates the greater tendency for Chinese people to somaticize depression relative to Westerners. Drawing from a social identity perspective, three studies were conducted examining the role that cultural norms play in symptom expression. In an initial study, we confirmed greater somatization, minimization of distress and suppression of emotional expression among Chinese participants compared with Australians (Study 1). Asian normative expectations of collectivism moderated these effects such that somatization was higher among those who endorsed collectivism norms, but only among Chinese participants. Studies 2a and 2b found that only when Asian participants identified strongly with Asian culture did collectivism norms predict somatic symptoms. These findings have implications for practitioners working with people from Asian cultures, highlighting that it is not culture per se, but the endorsement of normative expectations in the context of strong identification with cultural groups that predicts which symptoms of depression are emphasized. Copyright © 2016 John Wiley & Sons, Ltd.     

The Unique Relationship of Emotion Regulation and Alexithymia in Predicting Somatization Versus PTSD Symptoms

Posttraumatic stress disorder (PTSD) has received considerable attention in the field of trauma studies. Yet trauma survivors suffer from other psychological and physical symptoms including somatic complaints, or somatization. The extent to which the same emotional processes that predict PTSD are implicated in somatization has remained relatively unexamined. We contend that emotion regulation difficulties and alexithymia are also implicated in somatization, and the way in which these factors interact differentially place one at risk for somatization or PTSD. Regression analyses revealed that emotion regulation difficulties were more highly correlated with somatization for individuals who also reported greater alexithymia. This interaction was not observed for PTSD symptoms where both alexithymia and emotion regulation difficulties uniquely predicted PTSD symptoms.     

Diagnosis of posttraumatic stress disorder with the MMPI: PK scale scores in somatization disorder

Clinic patients with diagnoses of either major depression or somatization disorder were given the MMPI. Women with somatization disorder had high scores on Keane's MMPI scale (PK) for posttraumatic stress disorder. Following the procedure for the MMPI-2 (46 of the 49 PK items and MMPI-2 norms), 59% of the women with somatization disorder and 21% of the women with major depression would have T scores > or = 65 on the MMPI-2 scale although none of them were known to have developed psychiatric disorder after exposure to a life threatening event. The PK scale has little use in the differential diagnosis of women patients with somatization disorder.     

MMPI screening scales for somatization disorder

44 items on the MMPI were identified which appear to correspond to some of the symptoms in nine of the 10 groups on the Perley-Guze checklist for somatization disorder (hysteria). This list was organized into two scales, one reflecting the total number of symptoms endorsed and the other the number of organ systems with at least one endorsed symptom. Full MMPIs were then obtained from 29 women with primary affective disorder and 37 women with somatization disorder as part of a follow-up study of a consecutive series of 500 psychiatric clinic patients seen at Washington University. Women with the diagnosis of somatization disorder scored significantly higher on the somatization disorder scales created from the 44 items than did women with only major depression. These new scales appeared to be slightly more effective in identifying somatization disorder than the use of the standard MMPI scales for hypochondriasis and hysteria. Further development is needed.     

A Unified,Transdiagnostic Treatment for Adolescents With Chronic Pain and Comorbid Anxiety and Depression

Chronic pain disorders represent a significant public health concern, particularly for children and adolescents. High rates of comorbid anxiety and unipolar mood disorders often complicate psychological interventions for chronic pain. Unified treatment approaches, based on emotion regulation skills, are applicable to a broad range of emotional disorders and suggest the possibility of extending these interventions to chronic pain and pain-related dysfunction. This case report describes the use of a unified protocol for treatment of an adolescent boy with chronic daily headache and social anxiety and an adolescent girl with whole body pain and depression. Following weekly, 50-minute individual treatment sessions, the boy demonstrated notable improvement in emotional symptoms, emotion regulation skills, somatization, and functional disability. The girl showed some improvement on measures of anxiety and depression, although there appeared to be a worsening of pain symptoms and somatization. However, both patients demonstrated improvement over follow-up. This case study illustrates the potential utility of a unified treatment approach targeting pain and emotional symptoms from an emotion regulation perspective in an adolescent population.     

The use of realistic and mechanical hands in the rubber hand illusion,and the relationship to hemispheric differences

Embodiment, as measured through the rubber-hand illusion (RHI), depends on the similarity between object to be embodied and part of the body it replaces. We compared a fake hand similar to a real hand, and one matched in size but made of wires (mechanical). Left and right versions were tested to investigate whether the effect of appearance was stronger in the left hand. We found that the mechanical hand induced embodiment, though to a reduced degree relative to the realistic hand (N = 120). Left and right versions of the mechanical hand did not differ in strength of the illusion. However, with the left realistic hand there was a stronger relationship between drift (an objective measure of the illusion) and agreement on the questionnaire (subjective experience). With the mechanical hand, objective and subjective measures were unrelated. We discuss the results in relation to factors that influence the RHI and hemispheric differences.