The relationship between emotion awareness and somatic complaints in children and adolescents: Investigating the mediating role of anxiety and depression

The objective of this study was to examine if emotion awareness in children and adolescents (age 7–18 years old) is directly related to somatic complaints, and if this relationship holds when considering symptoms of anxiety and depression as mediating factors. A number of questionnaires measuring emotion awareness, symptoms of anxiety and depression and somatic complaints were administered to Dutch schoolchildren (N?=?617). A path model was constructed, with the use of structural equation modelling. The results showed that two aspects of emotion awareness (bodily awareness and differentiating between emotions) contributed to the prediction of somatic complaints. However, this was no longer the case when controlling for symptoms of anxiety and depression. Thus, in this study, no direct relation was found between emotion awareness and somatic complaints. Instead, the relation was perfectly mediated by symptoms of anxiety and depression. The results suggest that focusing only on the relation between emotion awareness and somatic complaints is an oversimplified perspective that falls short as a starting point to find therapeutic solutions for children who suffer from somatic complaints.     

Emotional lability, negative affect and emotional regulation in children of anxious mothers

This study examined the role of emotional lability and negative affect and emotional regulation in the relation between maternal trait anxiety and attentional and social problems, and internalizing and externalizing symptoms of 275 six- to eleven-year-old children. The results indicated a direct moderating effect of emotional regulation in the relation between maternal anxiety and externalizing behaviour and that lability and negative affect moderated the relation between maternal anxiety and attention and social problems and somatic complaints. The links between maternal anxiety and withdrawal and anxiety/depression symptoms were also mediated by lability and negative affect. This mediation was independent of emotional regulation in the first case, and it depended on emotional regulation with regard to anxiety/depression symptoms.     

Severity of Emotional and Behavioral Problems Among Poor and Typical Readers

The purpose of this study was to examine the severity of behavioral and emotional problems among adolescents with poor and typical single word reading ability (N = 188) recruited from public schools and followed for a median of 2.4 years. Youth and parents were repeatedly assessed to obtain information regarding the severity and course of symptoms (depression, anxiety, somatic complaints, aggression, delinquent behaviors, inattention), controlling for demographic variables and diagnosis of ADHD. After adjustment for demographic variables and ADHD, poor readers reported higher levels of depression, trait anxiety, and somatic complaints than typical readers, but there were no differences in reported self-reported delinquent or aggressive behaviors. Parent reports indicated no differences in depression, anxiety or aggression between the two groups but indicated more inattention, somatic complaints, and delinquent behaviors for the poor readers. School and health professionals should carefully assess youth with poor reading for behavioral and emotional symptoms and provide services when indicated.     

Somatic complaints in anxious children

Although stomachaches and headaches are considered characteristic of children with anxiety disorders, there is converging evidence that a broader range of somatic symptoms may be associated with children's expressions of anxiety. The purpose of this study was to determine the prevalence of somatic complaints in anxious children. The results indicated that children with anxiety disorders endorsed the presence of many different somatic complaints, and that contrary to clinical intuition, stomaches and headaches were not among the most commonly reported symptoms. In addition, the anxious children endorsed significantly more somatic complaints when compared to normal controls. Furthermore, the symptom pattern reported by anxious children indicated the presence of both the somatic and cognitive components usually associated with panic attacks, although none of the children met diagnostic criteria for panic disorder. The results are discussed in terms of the contribution of somatic symptoms to the understanding of anxiety disorders in children.     

Attention control in middle childhood: relations to psychopathological symptoms and threat perception distortions

The present study examined the construct of attention control, which is an important aspect of effortful control, in a sample of non-clinical children aged between 9 and 13 years. Results demonstrated that attention control was associated with a broad range of psychopathological complaints, including symptoms of anxiety, aggression, depression, and ADHD. As predicted, lower levels of attention control were accompanied by higher levels of these symptoms. Further, attention control was also negatively related to threat perception distortions, which indicates that children who display low levels of this regulative temperament factor are more prone to such cognitive biases. Third, when controlling for neuroticism, attention control remained significantly (negatively) associated with symptoms of anxiety, depression (child report only), and ADHD. The correlations between attention control and threat perception distortions largely disappeared when the influence of neuroticism was partialled out. Only the link between attention control and anxious interpretations of ambiguous vignettes survived this correction. Finally, no evidence was found for the hypothesised mediating role of cognitive distortions on the relation between temperament factors and psychopathological symptoms.     

Common Etiological Sources of Anxiety,Depression, and Somatic Complaints in Adolescents: A Multiple Rater twin Study

Somatic complaints in children and adolescents may be considered part of a broader spectrum of internalizing disorders that include anxiety and depression. Previous research on the topic has focused mainly on the relationship between anxiety and depression without investigating how common somatic symptoms relate to an underlying factor and its etiology. Based on the classical twin design with monozygotic and dizygotic twins reared together, our study aimed to explore the extent to which the covariation between three phenotypes in adolescent girls and boys can be represented by a latent internalizing factor, with a focus on both common and specific etiological sources. A population-based sample of twins aged 12–18 years and their mothers and fathers (N?=?1394 families) responded to questionnaire items measuring the three phenotypes. Informants’ ratings were collapsed using full information maximum likelihood estimated factor scores. Multivariate genetic analyses were conducted to examine the etiological structure of concurrent symptoms. The best fitting model was an ACE common pathway model without sex limitation and with one substantially heritable (44 %) latent factor shared by the phenotypes. Concurrent symptoms also resulted from shared (25 %) and non-shared (31 %) environments. The factor loaded most on depression symptoms and least on somatic complaints. Trait-specific influences explained 44 % of depression variance, 59 % of anxiety variance, and 65 % of somatic variance. Our results suggest the presence of a general internalizing factor along which somatic complaints and mental distress can be modeled. However, specific influences make the symptom types distinguishable.     

A longitudinal study of early reading difficulties and subsequent problem behaviors

It is generally believed that early academic failure in school develops into a downward spiral of negative motivational and behavioral consequences. In this study, children with reading difficulties were compared with typical readers on questionnaires measuring ADHD symptoms and other behavior problems such as withdrawn symptoms, somatic complaints, anxiety/depression, social problems, and aggression. The results revealed that reading difficulties and problem behaviors appear more independent of each other rather than problem behaviors being a consequence of reading failure. In addition, gender differences were negligible when examining the relationship between reading difficulties and subsequent problem behavior. Some implications for special education and intervention are suggested.     

Internalizing Symptoms in Female Adolescents: Associations with Emotional Awareness and Emotion Regulation

The transition into adolescence involves a number of changes that for many adolescents result in increased negative affect and internalizing symptoms, especially for females. In the current study we examined the direct and indirect effects of emotional awareness on internalizing symptoms by exploring the extent to which certain emotion regulation strategies influence this relationship. Participants were 123 female adolescents aged 13–16 years (M = 14.51 years) who completed measures of emotional awareness, emotion regulation (emotional reappraisal and expressive suppression), and symptoms of depression and social anxiety. Two multiple indirect effect models were conducted including both reappraisal and suppression (one for each of the dependent variables, depression and social anxiety) via the bootstrapping method. Results found that reappraisal accounted for the effect of emotional awareness on depressive symptoms but suppression accounted for the effect of emotional awareness on social anxiety symptoms. Results suggest that emotion regulation strategies play an important role in determining depressive and social anxiety symptoms and are associated with an adolescent’s level of emotional awareness.     

Experiential Avoidance and Anxiety Sensitivity: Independent and Specific Associations with Children’s Depression,Anxiety, and Social Anxiety Symptoms

Experiential avoidance (EA) is a key component in acceptance and commitment therapy (ACT) theory and research. EA is associated with a wide range of psychopathology in adults including anxiety, in particular social anxiety, and depression, yet little research exists on EA in youth. Anxiety sensitivity (AS), like EA, has been viewed as a form of distress tolerance or emotion regulation. In a sample of 124 children (age 10 to 12), this study examined the independent and specific relations of EA and AS to children’s depression, anxiety, and social anxiety symptoms, both before and after controlling for comorbid symptoms. EA and AS had independent associations with each of children’s depression, anxiety, and social anxiety; and EA had significantly stronger relations than AS with each of children’s social anxiety and anxiety. After controlling for depression, only EA (and not AS) was uniquely related to both children’s anxiety and social anxiety. After controlling for anxiety and social anxiety, only AS (and not EA) was uniquely related to depression. After controlling for depression and social anxiety, neither EA nor AS was significantly related to anxiety. In contrast, after controlling for depression and anxiety, EA (and not AS) showed a significant and unique relation to children’s social anxiety. These findings indicate: 1) there are distinctions between EA and AS; 2) EA and AS are overlapping yet independent correlates for each of depression, anxiety and social and anxiety; and 3) EA and AS show some differential relations with children’s depression, anxiety, and social anxiety when comorbid symptoms are considered. Theoretical and treatment implications are highlighted.     

The impact of direct and indirect bullying on the mental and physical health of Italian youngsters

The aim of the present study was to determine the extent to which direct and indirect bullying and victimization at school affects the mental and physical health of 661 Italian boys and girls, aged 11 to 15 years old. The impact of bullying and victimization is assessed by taking into account the relative buffering effect of a positive relationship with one or both parents. Internalizing symptoms such as withdrawn behaviors, somatic complaints, and anxiety and depression, measured with the self‐administered Youth Form of the Achenbach's Child Behavioral Checklist, are indicators of maladjustment. Multiple regression analyses revealed that being a girl is a strong significant risk factor for all internalizing symptoms. Being a victim of indirect bullying is the strongest predictor of withdrawn behaviors, somatic complaints, and anxiety/depression, independent of direct victimization, which significantly predicts somatic complaints, anxiety, and depression, but not withdrawn behaviors. Bullying others directly by hitting, threatening, or calling names is not a significant predictor the poor mental and somatic health of youngsters, whereas indirect bullying (spreading rumors or not talking to someone on purpose) does significantly predict anxiety and depression, as well as withdrawn behaviors. The negative impact of victimization and bullying is buffered by youngsters' positive relationship with one or both parents. Recommendations are provided with regard to possible intervention strategies underlying the importance of distinguishing between different forms of bullying and victimization and providing social support in each different case. Aggr. Behav. 30:343–355, 2004. © 2004 Wiley‐Liss, Inc.     

Sex differences in oppositional defiant disorder

The goal was to analyze the sex differences in symptoms, comorbidity and functional impairment in outpatient children with Oppositional Defiant Disorder (ODD). A sample of 343 children, aged 8 to 17 years and diagnosed with ODD, were assessed with a semi-structured diagnostic interview and dimensional measures of psychopathology and functional impairment. Boys with ODD more frequently displayed the symptoms "deliberately annoys" and "blames others", presented comorbid ADHD, and had greater functional impairment in school and community contexts; girls presented higher comorbidity with internalizing symptomatology (anxiety, depression and somatic complaints). Given that some clinical differences are apparent in ODD between boys and girls, it is necessary to consider the sex of the patient in order to identify and treat this disorder efficiently and effectively in boys and in girls.     

Alexithymia, emotion, and somatic complaints

Alexithymia, by definition, involves difficulties in identifying and describing emotions and has been assumed to be associated with somatization (i.e., a tendency to express psychological distress in somatic rather than emotional form). Empirical research so far, however, has produced no convincing evidence that alexithymia is more associated with somatic complaints than with emotional complaints or that alexithymia correlates with somatic complaints when negative affect is controlled for. In the present study, alexithymia, as measured by the TAS-20, showed no association with somatic complaints in a community sample of 137 individuals when trait anxiety and depression were controlled. Alexithymia did correlate negatively with positive affect, and positively with negative affect. The former association, however, was much more robust, whereas the latter association was found mainly on subjective trait measures of negative affect (as distinct from state measures and more objective trait measures derived from daily recordings during an 8-week period). It is suggested that the association between alexithymia and lack of positive affect deserves more attention in future research.     

Parental Anxiety and Child Symptomatology: An Examinzation of Additive and Interactive Effects of Parent Psychopathology

The current study examined relations between parent anxiety and child anxiety, depression, and externalizing symptoms. In addition, the study tested the additive and interactive effects of parent anxiety with parent depression and externalizing symptoms in relation to child symptoms. Forty-eight parents with anxiety disorders and 49 parents without any psychiatric disorder participated with one of their children (ages 6 to 14 years; 46.4% male; 75.8% Caucasian). Parent anxiety was related to both child anxiety and depression, but not child externalizing symptoms. Hierarchical regression analyses showed that only parent externalizing symptoms had additive effects, beyond parent anxiety symptoms, in relation to child anxiety symptoms. Further, parent anxiety symptoms moderated the relationship between parent and child externalizing symptoms, such that the strength of this relationship was reduced in the presence of high levels of parent anxiety symptoms. Results of this study illuminate the role of parent comorbidity in understanding relations between parent and child symptoms.     

Erratum to: Parental Anxiety and Child Symptomatology: An Examination of Additive and Interactive Effects of Parent Psychopathology

The current study examined relations between parent anxiety and child anxiety, depression, and externalizing symptoms. In addition, the study tested the additive and interactive effects of parent anxiety with parent depression and externalizing symptoms in relation to child symptoms. Forty-eight parents with anxiety disorders and 49 parents without any psychiatric disorder participated with one of their children (ages 6 to 14 years; 46.4% male; 75.8% Caucasian). Parent anxiety was related to both child anxiety and depression, but not child externalizing symptoms. Hierarchical regression analyses showed that only parent externalizing symptoms had additive effects, beyond parent anxiety symptoms, in relation to child anxiety symptoms. Further, parent anxiety symptoms moderated the relationship between parent and child externalizing symptoms, such that the strength of this relationship was reduced in the presence of high levels of parent anxiety symptoms. Results of this study illuminate the role of parent comorbidity in understanding relations between parent and child symptoms.     

Alexithymia,memory of emotion,emotional awareness,and perfectionism

The Toronto Alexithymia Scale (TAS-20; R. M. Bagby, J. D. A. Parker, & G. J. Taylor, 1994) is a self-assessment instrument designed to measure deficits in meta-emotional functioning (e.g., difficulties in identifying and describing emotions). Four studies were carried out to examine the association between the TAS-20 and (a) performance measures of meta-emotional functioning (memory of emotion and emotional awareness; Studies 1-2) and (b) measures of perfectionistic standards that may possibly be involved in the self-assessment of abilities-difficulties (Studies 3-4). The TAS-20 failed to correlate in the predicted direction with the performance measures but showed sizable correlations with measures of perfectionism. Moreover, perfectionism was found to predict TAS-20 scores independent of depression, anxiety, and somatic complaints. The results are discussed in terms of the TAS-20 measuring primarily certain aspects of meta-emotional self-efficacy.     

CBT for Anxiety and Associated Somatic Complaints in Pediatric Medical Settings: An Open Pilot Study

Objective To examine the initial feasibility and potential efficacy of a cognitive-behavioral intervention for youth with anxiety disorders and non-medical somatic symptoms. Background Based on a strong relationship between somatic complaints and anxiety disorders, screening youngsters seeking medical care due to physical symptoms with no organic basis may enhance the recognition of anxiety disorders and facilitate access to appropriate services. Method Seven boys and girls, ages 8 through 15, with medically unexplained gastrointestinal complaints and anxiety disorders received a 12-session cognitive-behavioral intervention targeting anxiety and physical symptoms. Assessments were conducted at baseline and following treatment. Results All participants were classified as treatment responders. Three of the seven participants no longer met diagnostic criteria for their principal anxiety disorder. Children’s physical discomfort decreased from a moderate to minimal level based on self- and parent-reports. Conclusions Our modified cognitive-behavioral approach has promise for reducing anxiety and somatic symptoms in children seeking medical care.     

Effects of worry and somatic anxiety induction on thoughts, emotion and physiological activity

Thirty-six Ss received Velten (1968) emotion inductions designed to produce either worrisome, somatically anxious, or neutral states. A breathing-focus task assessed the frequency of negative thought intrusions before and after the emotion induction. Worry induction produced the greatest increase in negative intrusions, significantly greater than the neutral condition. Somatic anxiety induction produced some increase in intrusions, nonsignificantly between worry and neutral inductions. Both worry and somatic anxiety inductions generated significant increases in cardiovascular activity relative to the neutral condition, while no effect was observed on gastric myoelectric activity. Worry was characterized by emotions on the Multiple Affect Adjective Checklist that overlap with those of depression and somatic anxiety.     

Social anxiety and perceptions of likeability by peers in children

The current study aimed to investigate the discrepancy between self-reported and peer-reported likeability among children, and the relation with social anxiety, depression, and social support. In total, 532 children between 7 and 12 years completed questionnaires about social anxiety symptoms, depressive symptoms, and social support, estimated their own likeability, and indicated how much they liked their classmates. Children with higher levels of social anxiety or depression overestimated their likeability less or even underestimated their likeability. Social anxiety symptoms, but not depressive symptoms, were significant predictors of the discrepancy. Social support was positively related to likeability and negatively related to social anxiety, but did not moderate the association between social anxiety symptoms and perception accuracy of likeability. These results are in line with cognitive theories of childhood social anxiety, and they stress the importance of using multi-informant measures when studying the relation between social anxiety and social functioning in children.     

Brain Fag: A Case Study Showing the Diagnosis and Therapy in Nigeria

The co-occurrence of somatic complaints along with other forms of mental illness such as depression, anxiety and brain fag is well documented in mental health literature. In Africa, the notion that somatic complaints are a variant of depression is popular. However objective empirical efforts to prove this notion are inconclusive. The common co-occurrence of somatic complaints along with depression, anxiety and brain fag complaints in Nigeria may put clinicians in a dilemma in making diagnostic and therapeutic decisions for their clients. In this paper the authors applied the Harmony Restoration Therapy (HRT) in the management of somatic, depressive, anxiety and brain fag symptoms of a client. The HRT is a psychotherapeutic framework based on the Africa world view of health and illness where health is harmony and illness is disharmony in one’s world of relationships. The case was used to illustrate the co-morbidity of depression, anxiety, somatization and Brain Fag and tries to contribute to how Brain Fag can be treated.     

The mediating role of anxiety in self-reported somatic complaints of depressed adolescents

This study examined the mediating role of anxiety in the self-reports of somatic complaints in 96 depressed adolescent inpatients. Sixty-four subjects with major depressive episodes and comorbid anxiety disorders (MDE-A) determined from the Diagnostic Interview for Children and Adolescents-Revised (DICA-R) reported significantly more somatic complaints than 32 adolescents having major depressive episodes without comorbid anxiety (MDE). An analysis of covariance demonstrated that, with anxiety symptoms controlled, MDE and MDE-A groups did not differ significantly in somatic complaints. A hierarchical multiple-regression analysis revealed that, with demographic and anxiety symptoms controlled, depressive symptoms did not contribute to the explanation or prediction of somatic complaints. The results suggest that anxious, but not depressive symptoms, are independently associated with somatic complaints. The results are discussed in light of new affective models of psychopathology.