Abstract
Background: Patients with somatoform disorders tend to report somatic complaints, while denying the influence of psychological factors: a pattern described as “illusory mental health”. The present study investigated if somatoform patients present themselves in this way. In this context we investigated features of personality organization), selfreported personality traits, symptomatology, and coping. Methods: A cross-sectional design was applied to 79 patients with somatoform disorders and 114 psychiatric controls. We compared the two groups regarding prevalence of the several profiles of personality organization, selfreported symptoms, coping and personality traits. Results: Compared to controls, the narcissistic subtype of the borderline personality organization was 2.5 times more prevalent among patients with somatoform disorders. Unexpectedly, the psychotic personality organization was also more prevalent among patients with somatoform disorders. Furthermore, patients with somatoform disorders rated themselves as more socially competent, with higher levels of self-esteem and greater ability to cope with problems. They also reported less anger and less depressive symptoms. However, they seem to recognize feelings of anxiety. Conclusion: Patients with somatoform disorders show a favourable self-presentation and in line with this a relatively high prevalence of the narcissistic personality organization. The favourable self-presentation in patients with somatoform disorders may be related to defensive denial, i.e. illusory mental health. The utility of self-reports may be limited in these patients, given their favourable self-presentation on these instruments. This has also implications for the use of self-reports in the context of assessing treatment outcome among patients with somatoform disorders, for example in the context of routine outcome monitoring. Somatization in patients with somatoform disorders might have an integrating preserving function. Future research should investigate the role of personality organization on treatment outcome for patients with somatoform disorders. Future research should also include observer ratings, complementary to self-reports, given the favourable self-presentation of SFD-patients.
Highlights
Somatoform disorders (SFD) are a class of mental disorders that share the presentation of persistent physical symptoms, suggesting the presence of a medical condition, for which there is no adequate medical explanation [1]
The presence of Axis I co-morbidity was unequally distributed across the SFD-group and the control group (χ2(1, 183) = 5.81, p < 0.05; Cramer’s V = 0.18), the prevalence of axis I co-morbidity being higher in the SFD-group (60,8%) than in the control group (26,9%)
The results of the present study are in line with the increasing awareness of the fact that the usefulness of self-reports depends on the willingness or ability of self-disclosure [63], and that many psychological processes are implicit rather than explicit and are not accessible via selfreport [6,64]
Summary
Somatoform disorders (SFD) are a class of mental disorders that share the presentation of persistent physical symptoms, suggesting the presence of a medical condition, for which there is no adequate medical explanation [1]. Associated with this, SFD-patients frequently seek medical attention resulting in disproportionately elevated rates of medical care utilization [2,3,4], and total health care costs [3] In this context, Shedler et al [5] introduced the concept of the “illusion of mental health” as a characteristic of patients who use defensive denial and related to this tend to present themselves as mentally healthy on self-reports. Shedler and colleagues showed that the mental health reported by subjects from a university community who were judged distressed by clinicians, was illusory: their verbal responses reflected the operation of psychological defence processes, whereas, at the same time, these persons showed high levels of physiological reactivity in response to stress They concluded that illusory mental health might even be a risk factor for physical illness. In this context we investigated features of personality organization), selfreported personality traits, symptomatology, and coping
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