Understanding alexithymia within a psychoanalytical framework

The object of this paper is to provide a metapsychological definition of alexithymia as described in 1967 in terms of operational thinking and negative hallucination. This is a familiar and established concept in the fields of psychopathology, psychology, and of clinical and psychosomatic medicine. From a psychoanalytic and psychosomatic point of view, the term is conceptually close to P. Marty's “operative thinking”, as described in 1963, even though we know they do not belong to the same epistemological field: on one hand Neuroscience, Psychiatry and the objectalization of the symptom at different levels, and on the other, as regards mechanical functioning, a psychoanalytic clinical approach within the dynamics of the relationship between transference and counter‐transference. The present authors consider that Freudian metapsychology, as now complexified by Andrè Green, allows for a metapsychological approach to alexithymia insofar as it relates to Marty's operative thinking. Thus does Green’s conceptualization of the mother’s negative hallucination, of negative introjection, of a psychically ‘dead (and insecure) mother’, now provide us with the opportunity to describe, in metapsychological terms, the genesis of this particular mode of psychical functioning. Given the mother’s negative hallucination produces a host structure as a background to negativity that will fit future object representations, we will assume that in the case of … future operational or alexithymic …?, this negative hallucination will pathologically and defensively involve the endo‐psychic perception of affect.     

Psychometric evaluation and normative data for a Swedish version of the Patient Health Questionnaire 15‐Item Somatic Symptom Severity Scale

The lack of an available Swedish version of the Patient Health Questionnaire 15‐Item Somatic Symptom Severity Scale (PHQ‐15) motivated the present psychometric evaluation of such a version as well as providing normative data for the PHQ‐15. Data from 3,406 individuals who took part in the Västerbotten Environmental Health Study in Sweden were used. The respondents constitute a random sample, aged 18 to 79 years, stratified for age and sex. They responded to a Swedish translation of the PHQ‐15 as well as the Hospital Anxiety and Depression Scale, the Perceived Stress Scale, and the Shirom Melamed Burnout Questionnaire for assessment of convergent validity. The distribution of PHQ‐15 scores was positively skewed and mesokurtic in shape, and the internal consistency of the PHQ‐15 was satisfactory. Correlation coefficients between PHQ‐15 score and the measures of anxiety, depression, stress and mental/physical exhaustion indicate satisfactory validity. Normative data for PHQ‐15 scores as well as for categories of somatic symptom severity are provided. The favorable psychometric properties of the Swedish version of the PHQ‐15 suggest use of this instrument for quantification of somatization in Swedish and similar populations, and has the advantage of available normative data.     

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.     

Equanimity: The somatization of a moral sentiment from the eighteenth to late twentieth century

Over the past 40 years, mindfulness‐based therapies (MBTs) have gained a reputation among the biomedical community for their ability to contribute to health, mental capital, and human flourishing. Recently, however, critical mindfulness scholars have questioned the moral import of MBTs, claiming that, in modernizing meditation, they strip Buddhist practices of their ethical and soteriological content. Inspired by Harrington and Dunne's (2015, p. 630) recent call to historicize this present discontent, I offer an account for this perceived “de‐ethicization” of mindfulness, locating it in a long history of changes in the ontological infrastructures supporting moral reasoning from the eighteenth century onwards. Through the example of equanimity—a virtue that has been a part of Western and Eastern character ethics and theories of flourishing from the ancient period to the modern age—I show how, from the eighteenth century, research in the natural sciences on nervous diseases, stress, and relaxation, provided a frame for rethinking moral equanimity as a somatic experience of physiological calm. This transformation reaches its peak in the late twentieth century in research on mindfulness, which builds upon that tradition by folding into its ambit Eastern conceptions of equanimity as well. Insofar as modern MBTs continue to somatize moral virtues, I argue that they raise questions about the degree to which they are conducive to human flourishing and well‐being, as opposed to the related but narrower notions of health and mental capital.     

躯体化的心身交互机制及其中的文化因素

基于神经生物学的心身交互作用是当前躯体化病理机制的一个研究重点。在生理-心理的功能连续体中, 认知学习、感觉监控、注意、记忆过程等都会影响躯体症状的呈现。文化则会通过这些过程塑造个体对症状的归因和解释, 引发躯体症状的呈现和扩大, 最终通过不同文化特有的民族生理学模式形成具有文化特异性的疑病焦虑和医学无法解释症状。     

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.     

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.     

躯体症状障碍的特点及综合诊疗原则

从美国精神疾病诊断与统计手册第三版（DSM-Ⅲ）的躯体形式障碍,到甚至更早的诊断名称为DSM-5的躯体症状障碍,这类疾病的名称一直在变化;学界对躯体化症状的分类和定义也一直存在争议.进行分类和诊断的主要目的是为了治疗.本文从躯体症状障碍相关概念的变迁及本质特点入手,分析、总结躯体症状障碍的心理行为特点及接诊和治疗原则,以期对广大临床工作者治疗工作的开展有所帮助.     

The Verbal Summator and a Method for the Study of Latent Speech

Three age groups of children (7-8-, 10-11-, and 13-14-years) were administered a questionnaire dealing with their smoking experiences and attitudes and beliefs about cigarette smoking. The results indicated that the vast majority of children recognized the harmfulness of smoking and most strongly disapproved of smoking. However, experimentation with smoking was found to increase with age, and older children expressed less negative attitudes about smoking. The effects of age were due largely to the differences between the preadolescent groups, on the one hand, and the adolescent group, on the other. In addition, a similar percentage of children in all three age groups perceived strong parental pressure against smoking; however, with increasing age, less opposition from their teachers and friends was perceived. Theories of social influence and moral development are considered in explaining the results.