Persistent Somatic Complaints Research Articles

Understanding and Treatment of Patients with Persistent Somatic Complaints Through the Lens of Contemporary Attachment Theory

This paper describes recent progress in our understanding of patients with persistent somatic complaints, based on a broad and integrative attachment approach. Attachment theory indeed provides a powerful lens through which to understand patients with persistent somatic complaints and the often extremely negative states in which they find themselves. It was Bowlby's genius to describe how the attachment system is activated in times of threat and distress and normatively serves to seek the proximity of others in an attempt to co-regulate stress. Yet, this primary attachment strategy typically increasingly fails when faced with the continuous distress associated with chronic somatic complaints. What often ensues is a negative vicious cycle characterised by an excessive reliance on secondary attachment strategies (either hyperactivation or deactivating the attachment system), problems with (embodied) mentalizing, and severe problems with epistemic trust, that is, trust in others as a reliable source of knowledge, including knowledge of the patient's physical and mental state. These issues are discussed in relation to Bowlby's original formulations and contemporary thinking about persistent somatic complaints and functional somatic disorders. We also summarise implications for clinical practice.

A Longitudinal Study of Somatic Complaints in Urban Adolescents: The Role of Internalizing Psychopathology and Somatic Anxiety

Despite the frequent association between anxiety and somatization, the role of somatic anxiety--a tendency to experience somatic sensations, when anxious--in relationship to persistent somatic complaints has not been addressed previously. This study assessed the predictive role of internalizing psychopathology (anxiety, posttraumatic stress, depression) and somatic anxiety for somatic complaints over a 1-year period in a community sample of urban youth. The Social and Health Assessment, a self-report survey, was administered to 2,524 (mean age = 12.8, 54 % female) American urban adolescents in two consecutive years. There was significant continuity of somatic complaints over 1 year. Girls reported higher levels of somatic complaints and somatic anxiety than boys. All types of internalizing psychopathology significantly predicted somatic complaints over time. Somatic anxiety was associated with somatic complaints over and above the role of internalizing symptoms. Internalizing psychopathology and somatic anxiety should both be considered in the assessment and treatment of youth with persistent somatic complaints.

Somatic symptoms in women 11 years after the Chornobyl accident: prevalence and risk factors.

Exposure to the Chornobyl nuclear power plant explosion resulted in widespread, persistent somatic complaints, but little is known about the nature and risk factors for these conditions. This study compares the health reports of 300 women evacuated to Kyiv from the contamination zone around the plant and 300 controls with a child in the same homeroom as the evacuees in 1997. The interview addressed somatic concerns, risk factors for poor health, and Chornobyl-related stress. Compared with controls, evacuees reported significantly more health problems and rated their health more poorly overall. These differences remained significant after controlling for demographic and clinical risk factors, including the tendency to amplify physical symptoms. Significantly more evacuees received a diagnosis of a Chornobyl-related illness by a local physician, believed that their health and their children's health had been adversely affected, and were positive for Chornobyl-induced post-traumatic stress disorder. After controlling for these Chornobyl stress variables, the differences in number of health problems commonly attributed to Chornobyl remained significant but differences in general health ratings did not. The perceptions of controls were similar to those of women in a national sample. The relationship between Chornobyl stress and illness was twice as strong in evacuees (odds ratio = 6.95) as in Kyiv controls (odds ratio = 3.34) and weakest in the national sample (odds ratio = 1.64). The results confirm the persistence and nonspecificity of the subjective medical consequences of Chornobyl and are consistent with the hypothesis that traumatic events exert their greatest negative impacts on health in vulnerable or disadvantaged groups.

Persistent somatization in cancer: A controlled follow-up study

Nature and frequency of somatic complaints, severity of anxiety and depression, and nature of psychiatric symptoms and disorders were evaluated in 81 adequately treated cancer patients, disease-free or with residual disease, using a controlled, prospective follow-up design. Patients were included in the index group n=60 if they had persistent somatic complaints or unexplained nature or severity of somatic complaints, or the control group n=21 , if they did not report somatic complaints. Instruments used for evaluation were the Scale for Assessment of Somatic Symptoms, Hospital Anxiety and Depression Scale, Psychiatric Assessment Schedule, and DSM-III-R. Common somatic complaints in the index group were pain (19%), fatigue (17%), sensory symptoms (30%), and mixed symptoms (27%). Subjects in the index group significantly ( p<0.001) more often had depressive or anxiety disorder (19%) and atypical somatoform disorder (15%). Patients were treated appropriately with psychotropic medications and counseling. Follow-up at 4–6 months revealed a significant reduction in the number of somatic symptoms ( p<0.001) and anxiety ( p<0.001) and depression ( p<0.05) scores. The observations confirm that somatic symptoms may persist in cancer patients, which are related to concomitant psychopathology, and require psychiatric intervention.

Relationships of somatic symptoms to behavioral and emotional risk in young adolescents

Junior high students (n = 1508) from a midwestern community completed a health behavioral questionnaire that asked the frequency of headache and abdominal pain and of a number of behavioral and emotional risk indicators. Headache (24%) and abdominal pain (13%) were frequently reported among these young adolescents, particularly among girls. Those reporting frequent somatic complaints also reported significantly more behavioral and emotional symptoms indicative of risk (p less than 0.001). Further, the interaction between somatic complaint and gender significantly affected risk status (p less than 0.01). This interaction was greater with behavioral risk: boys with both abdominal pain and headaches reported higher behavioral risk than all other groups (p less than 0.0001). Somatic symptoms continued to account for a significant amount of variance in behavioral risk after the effects of emotional risk and age were removed. This suggests that behavioral risk and emotional risk are independently associated with somatic complaints. The evaluation of persistent somatic complaints in adolescents, particularly in boys with abdominal symptoms, should include careful examination of emotional risk factors and other health-endangering behaviors such as substance use, early sexual activity, and delinquency.

The chronic depressive in the community: Unrecognized and poorly treated

Several previous studies have reported that a significant minority of patients (approximately 15%) remain chronic or in partial remission following an acute depressive episode. In 1969 Robins and Guze reviewed 20 follow-up studies of affective disorders and concluded a chronic course occurred in from 1% to 28%, with an average of 12%–15% of the patients. 1 Other recent studies have published figures in the same range (Table 1). 2–4 Chronically depressed patients can pose diagnostic and treatment challenges. Since they are high users of medical services, their persistent somatic complaints often lead to costly laboratory and X-ray procedures. If these diagnostic studies are negetive, such patients are considered troublesome and are labeled neurotic or “crocks.” Lipsitt and others working in general medical settings have proposed that many hypochondriac patients are unrecognized and poorly treated depressives. 5,6 This paper reports data from a 20 month follow-up of 150 female acute depressives who had responded initially to a tricyclic antidepressant with reduction in symptoms and then had entered a maintenance trial in which they were randomly assigned to drugs and/or psychotherapy or to a no-further-treatment control group. Among these 150 patients, we identified a group who remained chronically depressed during the year after maintenance therapy had ended. These patients had persisting depressive symptoms, continuing impairment in their daily lives, and were high users of medical and psychiatric services. We have four purposes in presenting these data: to describe the clinical and other characteristics of these chronic depressives; to identify factors predictive of chronic course after acute depression; to draw attention to the diagnostic implications of unrecognized chronic depressions; and to recommend treatment interventions which may reduce the frequency and intensity of chronic depression.