Somatoform disorders and expressed emotions in the family: Results from a cross-sectional observational study to evaluate a novel relationship

Abstract

Background: Expressed emotions (EEs) in the family affect the presentation and course of psychiatric disorders. Somatoform disorders with their psychosocial origins may be caused or perpetuated by family dynamics like EEs. Aims: The study aimed to assess the prevalence, type, and levels of EEs in the families of patients with somatoform disorders. Methods: One hundred and six adult patients with somatoform disorders (F45; ICD-10) and their family member were recruited for the study. Patients with any comorbid medical or psychiatric disorder and substance use disorders (except tobacco dependence) or subjects living alone were excluded from the study. The study participants were assessed for somatoform disorders and EEs using a sociodemographic proforma, Mini-International Neuropsychiatric Interview structured interview, Patient Health Questionnaire-15 (PHQ-15), Family Emotional Involvement and Criticism Scale, and perceived criticism measure (PCM). Final analysis was done using statistical tests including Chi-square test, Fisher’s exact test, Student’s t-test, Pearson’s correlation coefficient, and univariate and multiple regression analysis. P ≤ 0.05 was considered to denote statistical significance. Results: The most common somatoform disorder in the sample was somatization disorder (33%) followed by persistent somatoform pain disorder (18.87%) and undifferentiated somatoform disorder (15.09%). Age (P = 0.007), married status (c2 = 6.752, P = 0.034), and a diagnosis of hypochondriacal disorder and somatization disorder (c2 = 14.613, P = 0.023) were significantly associated with perceived criticism (P < 0.05), while emotional overinvolvement (EOI) was high in subjects with somatoform autonomic dysfunction disorder (21.75) (P < 0.05). Significant positive correlation was seen between PCM and PHQ15 (severity measure) scores (r = 0.209; P = 0.032). Conclusions: Moderate level of EEs were found in the families of patients with somatoform disorders with the association being significant for criticism in hypochondriacal and somatization disorders and for EOI in somatoform autonomic dysfunction disorders. The hypothesis needs further study with follow-up and stronger statistical models to establish causation.