Abstract
BackgroundMedically unexplained somatic symptoms are common, associated with disability and strongly related to depression and anxiety disorders. One interesting, but to date rarely tested, hypothesis is that deficits in both theory of mind (ToM) and emotional awareness may undergird the phenomenon of somatization. This study sought to investigate whether or not differences in ToM functioning and self-reported emotional awareness are associated with somatic symptoms in a sample from the general population.MethodsThe sample consisted of 50 healthy participants (37 females, 13 males) aged between 22 and 64 years (46.8 ± 11.7) of whom 29 reported a high extent of somatic symptoms (HSR), whereas 21 reported a low extent of somatic symptoms (LSR) based on the 30 highest and lowest percentiles of the Symptom List norms. The participants’ affective and cognitive ToM were assessed with two experimental paradigms by experimenters who were blind to the participants’ group membership. In addition, self-reports regarding emotional awareness, alexithymia, depressive and anxiety symptoms and current affect were collected.ResultsIn the experimental tasks, HSR showed lower affective ToM than LSR but the groups did not differ in cognitive ToM. Although HSR reported lower emotional awareness than LSR in the self-report measure, this group difference vanished when we controlled for anxiety and depression. Depression, anxiety, emotional awareness and alexithymia were correlated positively.ConclusionsThe data supported the hypothesis that deficits in affective ToM are related to somatic symptoms. Neither cognitive ToM nor self-reported emotional awareness were associated with somatic symptoms. Self-reported emotional awareness, alexithymia and symptoms of depression and anxiety shared a considerable amount of variance.
Highlights
Unexplained somatic symptoms are common, associated with disability and strongly related to depression and anxiety disorders
Group differences in ToM Affective theory of mind (ERaToM) Emotion recognition being a precondition of the Affective Theory of Mind (aToM) task, we calculated whether the groups differed in their ability to recognize the emotions of the displayed person’s facial expression (ER task) using an Analysis of covariance (ANCOVA) with age and sex as covariates
In order to evaluate whether High symptom reporter (HSR) participants showed reduced aToM compared to Low symptom reporter (LSR) participants, we calculated an ANCOVA to compare the number of correct answers in the aToM task using age and sex as covariates
Summary
Unexplained somatic symptoms are common, associated with disability and strongly related to depression and anxiety disorders. Unexplained somatic symptoms are common and give rise to high health care utilization resulting in substantial economic burden for the health care system [1,2,3]. They represent 22.9% of patients in general practice (12-months prevalence) [4]. Preis et al BMC Psychiatry (2017) 17:200 causal relationships cannot be ascertained on the basis of the available evidence The former diagnoses of somatoform disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM, Fourth edition, text-revision; [13]) including somatization disorder, undifferentiated somatoform disorder, conversion disorder, pain disorder, hypochondriasis and body dysmorphic disorder were characterized by the occurrence of somatic symptoms that suggested, but could not be fully explained by, an underlying medical condition or the effect of a substance. SubicWrana and colleagues proposed that decreased emotional awareness, which corresponds to lower stages in the model of Lane and Schwartz, may lead to the failure to experience affective arousal as feelings and instead process it as somatic symptoms [15, 19]
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