Bodily Symptoms Research Articles

Unstable Gaze in Functional Dizziness: A Contribution to Understanding the Pathophysiology of Functional Disorders.

Objective: We are still lacking a pathophysiological mechanism for functional disorders explaining the emergence and manifestation of characteristic, severely impairing bodily symptoms like chest pain or dizziness. A recent hypothesis based on the predictive coding theory of brain function suggests that in functional disorders, internal expectations do not match the actual sensory body states, leading to perceptual dysregulation and symptom perception. To test this hypothesis, we investigated the account of internal expectations and sensory input on gaze stabilization, a physiologically relevant parameter of gaze shifts, in functional dizziness.Methods: We assessed gaze stabilization in eight functional dizziness patients and 11 healthy controls during two distinct epochs of large gaze shifts: during a counter-rotation epoch (CR epoch), where the brain can use internal models, motor planning, and resulting internal expectations to achieve internally driven gaze stabilization; and during an oscillation epoch (OSC epoch), where, due to terminated motor planning, no movement expectations are present, and gaze is stabilized by sensory input alone.Results: Gaze stabilization differed between functional patients and healthy controls only when internal movement expectations were involved [F(1,17) = 14.63, p = 0.001, and partial η2 = 0.463]: functional dizziness patients showed reduced gaze stabilization during the CR (p = 0.036) but not OSC epoch (p = 0.26).Conclusion: While sensory-driven gaze stabilization is intact, there are marked, well-measurable deficits in internally-driven gaze stabilization in functional dizziness pointing at internal expectations that do not match actual body states. This experimental evidence supports the perceptual dysregulation hypothesis of functional disorders and is an important step toward understanding the underlying pathophysiology.

Relationship between perceived physical self-concept and grade in physical education: The mediating role of test anxiety

The first aim of this cross-sectional study was to examine the relationships between adolescents’ physical self-perceptions (physical condition, sport competence, physical attractiveness, physical strength) and grade in Physical Education (PE). The second aim was to investigate the potential indirect effect of PE test anxiety variables (worry, self-focus, bodily symptoms, somatic tension, perceived control) on the relationships between physical self-perceptions and grade in PE. French adolescent students (N = 412; 225 girls) completed scales assessing physical self-perceptions and PE test anxiety. The results highlighted that grade in PE was positively predicted by sport competence, somatic tension, and perceived control, and negatively predicted by bodily symptoms in PE. The results also showed that bodily symptoms have a significant negative indirect effect on the relationships between perceived sport competence and grade in PE, and between physical strength and grade in PE. A significant indirect effect of somatic tension on the relationship between sport competence and grade in PE has also been found.

Intersubjectivity and psychopathology: Borderline and psychosomatic bodies “at the mind’s limits”

The body is the essential go-between between selfhood and otherness, and the site of the implicit traces of intersubjectivity that have marked the brain as well as the body. The body is also the depository of epigenetically implicit traces, sorts of implicit working models. The body is finally the site of the un/conscious, in the sense of implicit memory, something that is not conscious but guides implicitly, namely without our full awareness, behaviors, motivations, feelings, and responses. In psychopathology, only interpersonal traumatizations or “trauma of human agency” in its three levels causes dissociation in humans. At the mind’s limits, the body/mind disconnection that characterizes psychopathology, as in borderline personality disorders, is also evident in psychosomatic disorders, where the circuit between what the body feels, what the mind registers, and what the subject can name or is able to express verbally is disconnected and, as a result, bodily symptoms come forth in order to name the emotional pain. While hysterical symptoms still retain a symbolic root suitable for interpretation (retaining a metaphoric link between mind and body), psychomatic disorders show that the connection between body and mind has been severed and the symptoms speak “at the mind’s limits.”

Perception and misperception of bodily symptoms from an active inference perspective: Modelling the case of panic disorder.

We advance a novel computational model that characterizes formally the ways we perceive or misperceive bodily symptoms, in the context of panic attacks. The computational model is grounded within the formal framework of Active Inference, which considers top-down prediction and attention dynamics as key to perceptual inference and action selection. In a series of simulations, we use the computational model to reproduce key facets of adaptive and maladaptive symptom perception: the ways we infer our bodily state by integrating prior information and somatic afferents; the ways we decide whether or not to attend to somatic channels; the ways we use the symptom inference to make decisions about taking or not taking a medicine; and the ways all the above processes can go awry, determining symptom misperception and ensuing maladaptive behaviors, such as hypervigilance or excessive medicine use. While recent existing theoretical treatments of psychopathological conditions focus on prediction-based perception (predictive coding), our computational model goes beyond them, in at least two ways. First, it includes action and attention selection dynamics that are disregarded in previous conceptualizations but are crucial to fully understand the phenomenology of bodily symptom perception and misperception. Second, it is a fully implemented model that generates specific (and personalized) quantitative predictions, thus going beyond previous qualitative frameworks. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Ayahuasca Improves Self-perception of Speech Performance in Subjects With Social Anxiety Disorder

Ayahuasca is a classic hallucinogen with anxiolytic and antidepressive properties. Anecdotal evidence also suggests that it improves performance (eg, singing, speech). This controlled trial assessed the effects of ayahuasca on speech performance and anxiety in individuals with social anxiety disorder. Seventeen volunteers with social anxiety disorder participated in a pilot, proof-of-concept, randomized, parallel-group trial. Self-perception of performance during a public-speaking test was assessed with the Self-statements During Public Speaking Scale primary outcome). Secondary outcomes included anxiety/subjective effects (Visual Analog Mood Scale; Bodily Symptoms Scale), recognition of emotions in facial expressions (REFE), tolerability measures (cardiovascular measures, self-reports), and brain-derived neurotrophic factor plasma levels. Effects on anxiety and REFE were assessed again 7, 14, and 21 days postdrug. Compared with placebo, ayahuasca significantly improved self-perception of speech performance (Self-statements During Public Speaking Scale) and increased somatic symptoms (Bodily Symptoms Scale). There was also a significant time × group interaction in the cognitive deterioration Visual Analog Mood Scale factor and a significant effect of time in the REFE task, especially in reaction time. Other measures were not significantly modified. Ayahuasca was well tolerated, producing mainly nausea, gastrointestinal discomfort, and vomiting. Ayahuasca improved self-perception of speech performance in socially anxious individuals. These effects occurred independent of task-related anxiety and REFE, suggesting that ayahuasca could specifically improve the cognitive aspect of speech performance. Further studies should try to unveil the mechanisms involved in the effects of ayahuasca and to better understand its effects on anxiety.

Gender differences on psychological factors in fibromyalgia: a systematic review on the male experience.

Fibromyalgia (FM) is highly prevalent in the female gender. Scarce attention has been given to the exploration and description of this syndrome, from a psychological point of view, when occurring in males. The aim of the present study is to develop further knowledge, and to summarise the literature regarding subjective psychological experience, characteristics of symptoms presentation (both onset and development), and treatment options for FM in male patients, in order to highlight differences with FM in females. All studies published between January 1993 and February 2020 using PubMed and PsycInfo were included, provided that they met the following criteria: 1) written in English; 2) original articles on studies with a longitudinal design; 3) prospective or retrospective, observational (analytical or descriptive), experimental or quasi-experimental, controlled or non-controlled studies. Reviews and non-original articles (i.e. editorials, letters to the editor, and book chapters) were not included. We utilised the following keywords: (male), (female), (fibromyalgia), combined with Boolean operators 'AND' and 'NOT'. We found an initial number of 55 papers. Duplicated records were excluded (n=13), as well as papers not focusing on male patients or not fulfilling the inclusion criteria (n=25), thus narrowing the research to 17 papers. FM male patients consider their masculine identity as inefficiently re-negotiated after the onset of symptoms. FM males tend to endure pain for longer periods of time than females before seeking treatment; bodily symptoms are prevalent with a compromised exploration of feelings about FM. Unfortunately, there is still a paucity of evidence on clinical characterisation and treatment options when FM occurs in males. Moreover, no studies have addressed the issue of the psychopharmacological/non-pharmacological management of males with FM and comorbid psychiatric syndromes.

HiTOP Assessment of the Somatoform Spectrum and Eating Disorders.

We report on Phase 1 efforts of the Hierarchical Taxonomy of Psychopathology (HiTOP) measurement subgroup tasked with developing provisional scales for the somatoform spectrum and eating disorders. In Study 1, items were written to assess five somatoform spectrum constructs (bodily distress symptoms, conversion symptoms, health anxiety, disease conviction, and somatic preoccupation). Scale development analyses were conducted on 550 university students. The conversion symptom items were too infrequently endorsed and were set aside for Phase 2. Analyses of the other items yielded four scales corresponding closely to their hypothesized structure. In Study 2, we delineated 15 specific feeding and eating disorder constructs. A sample of 400 university students were administered candidate items and several eating disorder questionnaires for criterion validity. Analyses yielded six scales capturing previously described constructs, tapping content related to body image and weight concerns, restricting and purging, cognitive restraint, binging, excessive exercise, and muscle building. Two scales representing additional constructs deemed to be of high clinical import-negative attitude towards obesity and avoidant/restrictive food intake disorder-were retained for Phase 2, for a total of eight scales. Overall, we concluded that Phase 1 had been successful at generating a comprehensive set of provisional scales for inclusion in Phase 2.

How do you feel during the COVID-19 pandemic? A survey using psychological and linguistic self-report measures, and machine learning to investigate mental health, subjective experience, personality, and behaviour during the COVID-19 pandemic among university students

BackgroundThe WHO has raised concerns about the psychological consequences of the current COVID-19 pandemic, negatively affecting health across societies, cultures and age-groups.MethodsThis online survey study investigated mental health, subjective experience, and behaviour (health, learning/teaching) among university students studying in Egypt or Germany shortly after the first pandemic lockdown in May 2020. Psychological assessment included stable personality traits, self-concept and state-like psychological variables related to (a) mental health (depression, anxiety), (b) pandemic threat perception (feelings during the pandemic, perceived difficulties in describing, identifying, expressing emotions), (c) health (e.g., worries about health, bodily symptoms) and behaviour including perceived difficulties in learning. Assessment methods comprised self-report questions, standardized psychological scales, psychological questionnaires, and linguistic self-report measures. Data analysis comprised descriptive analysis of mental health, linguistic analysis of self-concept, personality and feelings, as well as correlational analysis and machine learning. N = 220 (107 women, 112 men, 1 = other) studying in Egypt or Germany provided answers to all psychological questionnaires and survey items.ResultsMean state and trait anxiety scores were significantly above the cut off scores that distinguish between high versus low anxious subjects. Depressive symptoms were reported by 51.82% of the student sample, the mean score was significantly above the screening cut off score for risk of depression. Worries about health (mental and physical health) and perceived difficulties in identifying feelings, and difficulties in learning behaviour relative to before the pandemic were also significant. No negative self-concept was found in the linguistic descriptions of the participants, whereas linguistic descriptions of feelings during the pandemic revealed a negativity bias in emotion perception. Machine learning (exploratory) predicted personality from the self-report data suggesting relations between personality and subjective experience that were not captured by descriptive or correlative data analytics alone.ConclusionDespite small sample sizes, this multimethod survey provides important insight into mental health of university students studying in Egypt or Germany and how they perceived the first COVID-19 pandemic lockdown in May 2020. The results should be continued with larger samples to help develop psychological interventions that support university students across countries and cultures to stay psychologically resilient during the pandemic.

COVID-19 Pandemisinin Üniversite Öğrencilerinde Sağlık Anksiyetesi, Ölüm Kaygısı ve Bedensel Belirtiler Üzerine Etkisi

Objective: Coronavirus disease 2019 (COVID-19), which was first identified in Wuhan, China's Hubei province in December 2019, and affected the whole world, although it may seem that it affects the elderly and its comorbid population more seriously, as the data on the disease increased, it was observed that the disease significantly affected young and non-comorbid people as well. Material and Method:789 students consisting of two year degree and undergraduate university students who have formal education in İstanbul province were included in the research. In the research, a data collection tool consisting of four parts, namely Sociodemographic Data Form, Health Anxiety Scale (HAS), Death Anxiety Scale (DAS) and DSM-5 Level 2 Physical Symptoms Scale (PSS) were used. Results: it was determined that as students’ health anxiety levels were 31.9%, death anxiety levels were 48.3%, and physical symptom severity levels were 32.6%. The fact that the person has a COVID-19 contact history and hospital application or hospitalization in near of kin and the test is positive, makes a significant impact in effect of health anxiety on death anxiety and physical symptom severity and the effect of death anxiety on bodily symptom severity. Conclusion: When the psychiatric results of the pandemic were evaluated, it was found that the students had below the average health anxiety and physical symptom severity and moderate death anxiety. Therefore, this result shows that the young population also has serious mental uneasiness.

Hypochondria as a form factor: The role of colonial anxieties as shapers of buildings and urban spaces in British Africa

ABSTRACT The paper explores the role played by hypochondria, defined as the preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms, in the definition of buildings and urban spaces throughout the history of British presence in the tropics, with a special regard to the African continent. From the medical and hygiene experts to the army engineers and the establishment of Tropical Architecture the relationship with the climatic and health conditions of the tropical belt has triggered fears and anxieties that have often prevented the definition of solutions. This paper shows how the scientific attitude that has characterized the exploration and settlement of tropical areas has not been a steady process but rather a complex mix of fears, false truths, wrong beliefs and slow improvements.

Experiences with basic body awareness therapy as an add-on to cognitive behavioural therapy among Danish military veterans with PTSD: An interview study

BackgroundThe Danish Veterans Centre offers a body-orientated therapy, Basic Body Awareness Therapy (BBAT), in addition to the psychological trauma-focused therapy to military veterans suffering from symptoms of post-traumatic stress disorder (PTSD). This study explored how the veterans a) experienced BBAT as a physiotherapeutic approach and as an add-on treatment to their usual Cognitive Behavioural Therapy (CBT) and b) whether it makes sense for the individual veteran to incorporate BBAT into their treatment. Materials and methodsIndividual semi-structured interviews with four veterans who had completed 12 BBAT sessions concurrently with their usual CBT treatment. Interviews were transcribed and analysed using Malterud's version of Giorgi's 4-step systematic text condensation. ResultsThree main categories emerged: “Effects of treatment”, “The setting of the treatment” and “Complementary nature of BBAT and CBT”. Within each category were 2–5 underlying subgroups. Participants found it made sense to combine BBAT with their CBT since it benefitted them differently and addressed their bodily symptoms and improved body perception/awareness. ConclusionBBAT showed potential as a supplement to CBT and seemed to benefit the veterans through focusing on bodily symptoms and how to calm them. Future studies are needed because of the limited research on the topic.

Psoriasis Flare-Up and New-Onset Psoriatic Arthritis Induced by Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, discovered in December 2019 in China is now a pandemic affecting >200 countries worldwide. The general population is susceptible to infection, however elderly people and those with a background of chronic medical illnesses are at increased risk for severe symptoms and complicated outcomes. The SARS-CoV-2 virus usually establishes itself and replicates in the respiratory system and can establish infection in the upper part of the respiratory tract as well as the lower part of the respiratory tract, presenting in a spectrum ranging from asymptomatic infection reaching up to severe acute respiratory distress syndrome,; however, SARS-CoV-2 infection can affect other systems of the human body as many cases have been reported where the patients present with different bodily system symptoms without having respiratory symptoms as usual. We report a case of a 44-year-old male patient who had a psoriasis flare-up and new-onset psoriatic arthritis likely induced by SARS-CoV-2 infection.

FACTORS AFFECTING ADHERENCE TO MEDICAL APPOINTMENT AMONG HYPERTENSIVE PATIENTS OF PUBLIC HEALTH FACILITIES IN PUNJAB, INDIA

Objective: Objective: Regular visit to health facilities is important for hypertension control. Under India Hypertension Control Initiative, hypertensive patients are enrolled in public hospitals and provided with patient-specific monthly medication for regular treatment at home and advised to return to the health facility after a month. However, at least 50% -60% of registered patients were not visiting the health facility for 3 to 6 months following their last visits. This article aims to document the major reasons for missed appointments and to characterize the patient and health system barriers. Design and method: We used a telephonic interview for collecting information from the patients who missed the appointments for more than 3 consecutive months. Out of 300 randomly selected patients, 206 were interviewed with a pre-structured questionnaire to explore patients’ experiences along with medical record reviews from the patient database. Interviews were conducted during the last quarter of 2019 and analyzed in both descriptive statistics and textual descriptions. Results: Not feeling sick or not experiencing any bodily symptoms due to hypertension (18.4%) followed by far distance between the health facility and the patient's home (16.5%) were the major reasons reported by the patients. Among other reasons, lack of proper instructions/guidance from the facility (11%), acute health conditions of patients (6%) and long waiting time at the public health facilities (5%) are also documented as the reasons for poor follow up. These factors cumulatively shifting a patient towards private sectors as 54% patients who were continuing their treatment are preferring private sectors. Conclusions: The results suggest the need for a more patient-centric care model such as guiding the patient properly at the health facility, saving patients time in the clinic, personalized care for acutely ill and aged patient and addressing the distance barriers between a patient's home and the health facility. Further, introducing reminder system by means of phone calls/SMS/visit may help to retain the higher follow-up of the patient.

Illness anxiety disorder

IntroductionThe diagnosis of hypochondria has disappeared in the new classification of mental illness. About 25% of patients who were diagnosed with hypochondria now fall into the category illness anxiety disorder. This disorder constitutes a new diagnostic category in DSM5 and is included within the somatic symptom and related disorders.ObjectivesWe propose to carry out a bibliographic review off the new diagnostic category of illness anxiety disorder.MethodsWe present the clinical case of a 27-year-old man in the context of the Covid19 pandemic.Results The illness anxiety disorder is characterized by being concerned about having or acquiring a serious illness. Somatic symptoms are not present, but if they are, they are of mild intensity. The level of concern is excessive or disproportionate if there is any disease or if there is a high risk of developing it. There is a high level of health anxiety and the individual is easily alarmed by personal health status. It is a disorder that tends to be chronic and recurrent. The exact comorbidity is still unknown. However, it is important to keep in mind that hypochondria concurs with anxiety disorders and depressive disorders. Treatment is based on the cognitive restructuring of bodily symptoms. In addition, exposure therapy and acceptance and commitment therapy are also effective. Regarding pharmacological treatment, SSRIs are useful in relation with comorbidity.ConclusionsIllness anxiety disorder is characterized by significant attention to somatic concerns in medical places, making it very useful for primary care professionals.

Cognitive and behavioral factors of quality of life in patients with somatoform disorders

IntroductionStudies of the cognitive and behavioral factors of perpetuation and quality of life in patients with somatoform disorders are important for identifying targets for psychological interventions and risk groups (Piontek et al., 2018, Dehoust et al., 2017, Schaefer et al., 2012, Flasinski et al., 2020).ObjectivesTo reveal beliefs and behavior in patients with somatoform disorders associated severity of somatic complaints and poorer subjective well-being.Methods125 patients with somatoform disorders 17-68 years old filled Screening for Somatoform Symptoms (Rief, Hiller, 2003), Cognitions About Body And Health Questionnaire (Rief et al., 1998), Scale for the Assessment of Illness Behaviour (Rief, Ihle, Pigler, 2003), and Quality of Life Enjoyment and Satisfaction Questionnairie-18 (Ritsner et al., 2005).ResultsSeverity of somatoform symptoms is higher in patients with catastrophization of bodily sensations, autonomic sensations, belief in their bodily weakness, somatosensory amplification, scanning for bodily symptoms, and disturbances in daily activities due to illness (r=.18-.38, p<.05). Adjusting for the severity of somatoform symptoms, subjective well-being was lower in patients with higher belief in their bodily weakness and somatosensory amplification, autonomic sensations, expression of symptoms, and changes in daily activities due to illness (r=.21-.40, p<.05).ConclusionsThe results suggests that regardless of symptoms severity poorer quality of life in patients with somatoform disorders is associated with beliefs about body and body perception that could be addressed in psychotherapy.

The marked body - a qualitative study on survivors embodied experiences of a COVID-19 illness trajectory.

BackgroundResearch on COVID‐19 has reported data on epidemiology and pathophysiology but less about what it means to be a person living through this illness. Research involving the patients’ perspectives may help to improve healthcare professionals' understanding of ways to support patients.AimsTo gain in‐depth understanding of the meaning of a COVID‐19 illness trajectory from the patients’ perspective.MethodsFifteen participants who had undergone an illness trajectory due to confirmed COVID‐19 infection participated in individual qualitative interviews. Data collection, analysis and interpretation were inspired by Ricoeur’s philosophy and Merleau‐Ponty’s phenomenology of perception and embodiment has been applied as a theoretical frame.FindingsBeing infected with coronavirus is expressed as an experience in which the participants oscillate between relief, security, imprisonment and raw fear. A predominant focus on the physical dimensions of the diseased body was found in the encounters between patient and healthcare system, and distance may furthermore be a consequence of use of protective equipment. Stigma and fear of infection were also expressed. After COVID‐19, an overwhelming feeling of a door opening to freedom is perceived. However, the body is marked, and bears witness to decay from this insidious and frightening virus. The responsibility for assessing their bodily symptoms is placed with the individual patients themselves, who feel lonely and fearful and this keeps them indoors.ConclusionsDuring a COVID‐19 illness, trajectory concerns about the unknown course of this disease are highlighted. Isolation is confrontational; however, a companionship between patients might emerge. The study shed light on an unavoidable gap between the patients and healthcare professionals due to the use protective equipment. After COVID‐19, the body is labelled as something others fear and become a symbol of awe and alienation for others.

What is in a name? Autonomic imbalance and medically unexplained symptoms in Taiwan

Medically unexplained symptoms (MUS) are persistent bodily symptoms without known pathology. An unofficial term has recently emerged in Taiwan to accommodate MUS: autonomic imbalance (AI). AI literally refers to disturbances of the autonomic nervous system (ANS) that innervates vital organs. However, AI is variously conceptualised by different parties. This study intends to investigate what is in the name of AI. It draws on available databases and in‐depth interviews with AI sufferers and Western and Chinese medicine physicians. Some physicians research ANS functions through heart rate variability measurements. Research findings show that physicians regard AI as a convenient term for clinical communication and a euphemistic substitute for MUS or even psychiatric diagnoses. It is not a ‘real thing’. However, AI sufferers treat AI as a bona fide disease, only that it has not been officially classified. AI is therefore an unfaithful translation, or an uncontrolled equivocation, of MUS. The paper concludes by discussing the implications of treating AI as an equivocation. These implications include the limitations of the current diagnostic criteria, the necessity to rethink the dichotomy of mind and body, and the underlying realities exposed or masked by ‘diagnosis’.

Therapeutic Challeng es of COVID-19 in a Patient Admitted to the Psychosomatic Ward: A Case Report

Introduction: Early diagnosis of 2019-nCoV infection is of great importance and can be challenging in psychiatric patients, especially when a mental illness such as somatoform disorder causes one or more bodily symptoms because the clinical features of this group of patients may be more confusing compared with non-psychiatric patients. On the other hand, treating this infection in psychiatric patients faces some challenges. Case Presentation: A case of the 2019-nCoV infection is reported in a patient who was admitted to the psychosomatic ward with a diagnosis of somatic symptom disorder. The patient had a history of numerous unexplained physical complaints, usually complained of some new physical symptoms when informed of the time of his discharge. Although the possibility of misdiagnosis was high, based on examinations and some paraclinical evaluations, the patient underwent a simultaneous diagnosis of COVID-19. Unlike usual, he did not complain of any new physical complaints after informing of the 2019-nCoV infection and was willing to be discharged. Some diagnostic and therapeutic challenges regarding 2019-nCoV infection in the patient were examined. Conclusions: There are three clinically relevant learning points to be noted from this case report. Firstly, the importance of paying attention to the patient's complaints in any mental patient, even disorders related to unexplained physical complaints. Secondly, the introduction highlights the differences in the care of patients with COVID-19 between psychiatric and non-psychiatric patients and the need for a multidisciplinary approach. Third, this introduction identifies a crucial diagnostic role for CT thorax in symptomatic patients with suspected COVID-19 because the false-negative rate with RT-PCR COVID-19 nasopharyngeal swabs is high.

Neuropathic Pain in the Eyes, Body, and Mouth: Insights from the Sjögren's International Collaborative Clinical Alliance.

To evaluate how ocular, oral, and bodily neuropathic pain symptoms, which characterize small fiber neuropathies, are associated with Sjögren's syndrome (SS) classification based on the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria. Participants enrolled in the Sjögren's International Collaborative Clinical Alliance (SICCA) registry had ocular, rheumatologic, oral, and labial salivary gland (LSG) biopsy examinations, blood and saliva samples collected, and completed questionnaires at baseline. We used mixed effects modeling with age, country, gender, and depression being fixed effects and study site, a random effect, to determine if neuropathic pain indicators (assessed via questionnaires) were associated with being classified as SS. A total of 3,514 participants were enrolled into SICCA, with 1,541 (52.9%) meeting the 2016 ACR/EULAR classification criteria for SS. There was a negative association between being classified as SS and experiencing bodily neuropathic pain features of needle-like pain, prickling/tingling sensation, ocular neuropathic pain of constant burning, and constant light sensitivity, and having a presumptive diagnosis of neuropathic oral pain. We found that those classified as SS had lower scores/reports of painful neuropathies compared with those classified as non-SS. Non-SS patients with dry eye disease or symptoms could benefit from pain assessment as they may experience painful small-fiber neuropathies (SFNs). Pain questionnaires may help identify pain associated with SFNs in patients with SS and non-SS dry eye. Future studies would be helpful to correlate self-reports of pain to objective measures of SFNs in those with SS, non-SS dry eye, and healthy controls.

Predicting test anxiety using the 3x2 achievement goal model

ABSTRACT Past research has demonstrated that the reasons underlying students’ decisions to engage in academic tasks (i.e., achievement goals) are associated with the experience of test anxiety. Empirical investigations focused on the association between achievement goals and test anxiety have historically been guided by the dichotomous, trichotomous, and 2 × 2 achievement goal models. However, few investigations have explored the association between achievement goals and test anxiety using the newly developed 3 × 2 achievement goal model. Therefore, the current study was designed to determine if task-approach, task-avoidance, self-approach, self-avoidance, other-approach, and other-avoidance goal orientations are associated with cognitive, physical, and social dimensions of test anxiety. Participants (N = 482) completed the 3 × 2 achievement goal questionnaire, the reactions to tests instrument, and the social derogation subscale of the FRIEDBEN test anxiety scale. Results indicated that after controlling for important covariates, task-approach goals were a negative predictor of worry, test-irrelevant thinking, tension, bodily symptoms, and fear of social derogation. Interestingly, the results of the current examination highlight that the endorsement of other-avoidance goals is associated with an increased fear of social derogation. The discussion explores how efforts to promote task-approach focused goals may be an effective method of reducing test anxiety within undergraduate and graduate populations.