Skip to main content Accessibility help
×
Home

Neuroticism, alexithymia, negative affect and positive affect as predictors of medically unexplained symptoms in primary care1

  • V. De Gucht (a1)

Abstract

Background:

Somatization has been defined in a number of ways. Despite their differences, these definitions have one element in common, namely the presence of somatic symptoms that cannot be explained (adequately) by organic findings.

Objective:

The primary objectives of the dissertation were to gain a better insight into the concept of somatization, and to study (prospectively) the relationship between neuroticism and alexithymia, two personality traits that have been shown to be related to somatization, the affective state dimensions positive and negative affect (or psychological distress) and medically unexplained symptoms.

Method:

A selective review was conducted regarding conceptual and methodological issues related to somatization. A total number of 318 patients, presenting to their primary care physician with medically unexplained symptoms, participated in the prospective study. Both at baseline and at 6-month follow-up a number of measures were filled out with respect to somatization, neuroticism, alexithymia, negative and positive affect, anxiety and depression.

Results:

The concept of somatization was clarified, thereby making use of the distinction between presenting and functional somatization. The personality traits neuroticism and alexithymia were found to have an indirect influence on symptom reports. Both the cross-sectional and follow-up data pointed to the importance of positive and negative affect as determinants of (changes in) number of symptoms (over time). Negative affect, together with the alexithymia dimension measuring difficulty identifying feelings, predicted symptom persistence.

Conclusions:

The theoretical as well as therapeutic implications of the present paper may give an impetus to new research in the domain of somatization.

Copyright

Corresponding author

Veronique De Gucht PhD, Leiden University, Department of Clinical and Health Psychology, Pieter de la Court Building, Wassenaarseweg 52, 2300 RB Leiden, the Netherlands. Tel: + 31 71 527 37 37; Fax: + 31 71 527 36 19; E-mail: degucht@fsw.leidenuniv.nl

References

Hide All
1.De Gucht, V, Fischler, B. Conceptual and clinical developments in somatization and its disorders. Acta Psychiatr Belg 2000;100: 1522.
2.Kellner, R. Somatization. Theories and research. J Nerv Ment Dis 1990;178: 150160.
3.Kroenke, K, Price, RK. Symptoms in the community. Prevalence, classification, and psychiatric comorbidity. Arch Int Med 1993;153: 24742480.
4.Escobar, J I, Waitzkin, H, Silver, C R, Gara, M, Holman, A. Abridged somatization: a study in primary care. Psychosom Med 1998;60: 466472.
5.Fink, P. The use of hospitalizations by persistent somatizing patients. Psychol Med 1992;22: 173180.
6.Fink, P, Sörensen, L, Engberg, M, Holm, M, Munk-Jorgensen, P. Somatization in primary care. Prevalence, health care utilization, and general practitioner recognition. Psychosomatics 1999;40: 330338.
7.Kroenke, K, Spitzer, RL, Degruy, FVet al. Multisomatoform disorder. An alternative to undifferentiated somatoform disorder for the somatizing patient in primary care. Arch General Psychiatry 1997;54: 352358.
8.Smith, GR. The course of somatization and its effects on utilization of health care resources. Psychosomatics 1994;35: 263267.
9.Kellner, R. Somatization and Hypochondriasis. New York: Praeger Publishers, 1986.
10.Bass, C. Somatization. Physical symptoms and psychological illness. Oxford: Blackwell Scientific Publications, 1990.
11.Kirmayer, LJ, Robbins, JM. Current concepts of somatization: research and clinical perspectives. Washington, DC: American Psychiatric Press, 1991.
12.Mayou, R, Bass, C, Sharpe, M. Treatment of functional somatic symptoms. Oxford: Oxford University Press, 1995.
13.Craig, TKJ, Drake, H, Mills, K, Boardman, AP. The South London somatisation study. II. Influence of stressful life events, and secondary gain. Br J Psychiatry 1994;165: 248258.
14.Jorgensen, LS, Christiansen, PM, Raundahl, U, Ostgaard, SE. Long-lasting functional abdominal pain and duodenal ulcer are associated with stress, vulnerability and symptoms of psychological stress. A controlled study including healthy and patient controls. Dan Med Bull 1996;43: 359363.
15.Scaloubaca, D, Slade, P, Creed, F. Life events and somatisation among students. J Psychosom Res 1988;32: 221229.
16.Whitehead, WE. Psychosocial aspects of functional gastrointestinal disorders. Gastroenterol Clin North Am 1996;25: 2134.
17.Drossman, DA, Talley, NJ, Leserman, J, Olden, KW, Barreiro, MA. Sexual and physical abuse and gastrointestinal illness. Rev Recommend Arch Int Med 1995;123: 782794.
18.McCauley, J, Kern, DE, Kolodner, Ket al. Clinical characteristics of women with a history of childhood abuse. JAMA 1997;277: 13621368.
19.Reilly, J, Baker, GA, Rhodes, J, Salmon, P. The association of sexual and physical abuse with somatization: characteristics of patients presenting with irritable bowel syndrome and non-epileptic attack disorder. Psychol Med 1999;29: 399406.
20.Whitehead, WE, Crowell, MD, Heller, BR, Robinson, JC, Schuster, MM, Horn, S. Modeling and reinforcement of the sick role during childhood predicts adult illness behavior. Psychosom Med 1994;56: 541550.
21.Barsky, AJ. Amplification, somatization, and the somatoform disorders. Psychosomatics 1992;33: 2834.
22.Pennebaker, JW, Watson, D. The psychology of somatic symptoms. In: Kirmayer, LJ, Robbins, JM, eds. Current concepts of somatization. Washington, DC: American Psychiatric Press, 1991: 2135.
23.Bridges, KW, Goldberg, DP. Somatic presentation of DSM-III psychiatric disorders in primary care. J Psychosom Res 1985;29: 563569.
24.Katon, W, Ries, RK, Kleinman, A. Part II: a prospective DSM-III study of 100 consecutive somatization patients. Compr Psychiatry 1984;25: 305314.
25.Lipowski, ZJ. Somatization: medicine's unsolved problem. Psychosomatics 1987;28: 294297.
26.Costa, PT, McCrae, RR. Neuroticism, somatic complaints and disease: Is the bark worse than the bite? J Pers 1987;55: 299316.
27.Sifneos, PE. The prevalence of ‘’alexithymic characteristics in psychosomatic patients. Psychother Psychosom 1973;22: 255262.
28.Taylor, GJ. Somatoform disorders. In: Taylor, GJ, Bagby, RM, Parker, JDA, eds. disorders of affect regulation: alexithymia in medical and psychiatric illness. Cambridge: Cambridge University Press, 1997: 114137.
29.Bagby, RM, Taylor, GJ, Parker, JDA. The twenty-item Toronto Alexithymia Scale-II. Convergent, discriminant and concurrent validity. J Psychosom Res 1994;38: 3340.
30.Hendryx, MS, Haviland, MG, Shaw, DG. Dimensions of alexithymia and their relationships to anxiety and depression. J Pers Assess 1991;56: 227237.
31.Honkalampi, K, Hintikka, J, Tanskanen, A, Lehtonen, J, Viinamäki, H. Depression is strongly associated with alexithymia in the general population. J Psychosom Res 2000;48: 99104.
32.Luminet, O, Bagby, RM, Wagner, H, Taylor, GJ, Parker, JDA. Relation between alexithymia and the five-factor model of personality: a facet-level analysis. J Pers Assess 1999;73: 345358.
33.Kirmayer, LJ, Robbins, JM. Three forms of somatization in primary care: prevalence, co-occurence, and sociodemographic characteristics. J Nerv Ment Dis 1991;179: 647655.
34.Simon, G, Gater, R, Kisely, S, Piccinelli, M. Somatic symptoms of distress: an international primary care study. Psychosom Med 1996;58: 481488.
35.Simon, GE, Von Korff, M. Somatization and psychiatric disorder in the NIMH Epidemiological Catchment Area study. Am J Psychiatry 1991;148: 14941500.
36.De Gucht, V, Fischler, B. Somatization. A critical review of conceptual and methodological issues. Psychosomatics 2002;43: 19.
37.American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3rd edn. Washington, DC; American Psychiatric Association, 1980.
38.American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3rd rev. edn. Washington, DC: American Psychiatric Association, 1987.
39.American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edn. Washington, DC: American Psychiatric Association, 1994.
40.Manu, P. Functional somatic syndromes. Cambridge: Cambridge University Press, 1998.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed