Reports Of Somatic Symptoms Research Articles

Parental Reports of Somatic Symptoms in Preschool Children: Prevalence and Associations in a Spanish Sample

To document prevalence and associations of somatic symptoms in Spanish preschool children. Subjects were 3- to 5-year-olds attending nurseries (8 urban, 30 rural). Parental questionnaires (response rate 77%) were used to inquire about somatic symptoms in the child in the 2 weeks prior to assessment, about preschool absence and pediatric help-seeking, chronic family health problems, and recent stressful life events for the child. Parents completed questionnaires on child psychopathology (Early Childhood Inventory 4) and their own mental health (General Health Questionnaire). Children who were reported as complaining of symptoms frequently (four or more times) were compared to noncomplaining children. Parents reported that 452 of the 807 (56%) children complained of somatic symptoms at least once, significantly more so in urban than in rural areas. Frequent somatic complaints were reported for 165 of the 807 (20%) (abdominal pains 7.9%, tiredness 5.7%, leg pains 4%, headaches 2%, dizziness 0.4%). There were significant associations of frequent symptom reporting with days off preschool and pediatric clinic attendance, with emotional and behavioral symptoms in children, mental distress in parents, and urban abode. Somatic symptoms are common in preschool children. Results point to family influences.

Poster 41: Objectively measured personality traits in the prediction of early neurobehavioral symptoms after mild traumatic brain injury

Objective: To determine if objectively measured preinjury personality predicts early neurobehavioral symptoms after mild traumatic brain injury (TBI) compared with orthopedic injury. Design: Cohort study with matched controls; participants and significant others completed questionnaires of preinjury personality and early postinjury symptoms. Setting: Inpatient hospital and outpatient follow-up. Participants: 87 people hospitalized with mild TBI and 82 with orthopedic injury. Interventions: Not applicable. Main Outcome Measures: The NEO Personality Inventory-Revised (NEOPI-R) and Neurobehavioral Functioning Inventory (NFI). Results: For both mild TBI and orthopedic injury groups, personality traits were generally normal; concordance rates between self and significant others personality and symptoms scales were moderate. Self and significant others’ ratings of conscientiousness on the NEOPI-R were higher in the orthopedic injury than in the mild TBI group. Significant others’ reports of NFI somatic symptoms were higher in the orthopedic injury than in the mild TBI group. Stepwise linear regression showed that, in both groups, NEOPI-R agreeableness and neuroticism accounted for a significant proportion of aggressive symptoms (orthopedic injury group, R 2=.56; mild TBI group, R 2=.46; P<.01). In the mild TBI group, NEOPI-R neuroticism accounted for a significant proportion of depressive symptoms ( R 2=.44, P<.01). Unfortunately, significant findings appear to be the result of substantial content overlap between the NEOPI-R and the NFI, rather than reflecting predictive relationships. Conclusion: Objectively measured personality holds limited predictive value in understanding early neurobehavioral symptoms after mild TBI.

Predicting the onset of widespread body pain among children.

To determine factors associated with, and the predictors of, widespread body pain in children. A population-based prospective study was conducted among school children in Northwest England. At baseline, subjects completed a self-report questionnaire on widespread body pain. Information was collected on behavioral and emotional factors, other somatic symptoms, and measures of physical activity/inactivity. Children who were free of widespread pain were contacted again 12 months later to determine any new onset of widespread pain. Regression analyses were used to identify the factors that were associated with the reporting of widespread pain at baseline, and to determine the factors that predicted the new onset of symptoms at followup among those children free of widespread pain at baseline. Results were expressed as relative risks (RR) with 95% confidence intervals (95% CI). A total of 1,440 children (96%) agreed to participate in the survey at baseline, and of those eligible, 1,081 (88%) participated at followup. The reporting of widespread pain (prevalence 14.6%) and its new onset at the 12-month followup (prevalence 7.7%) was common. At baseline, symptoms were associated with adverse behavioral and emotional factors (RR 2.5, 95% CI 1.8-3.6), with the report of other common childhood somatic symptoms (e.g., frequent headache; RR 3.5, 95% CI 2.2-5.5), and with high levels of sports activity (RR 1.9, 95% CI 1.3-2.9). Furthermore, all of these factors (in the absence of widespread pain at baseline) increased the likelihood of symptom onset at followup. Children who report behavioral problems or other somatic symptoms are at increased risk, at least in the short term, of developing chronic widespread pain. It remains to be determined whether these are long-term risk factors for the onset of such symptoms, and whether they could be predictors of the development of other functional syndromes.

Does a Physically Active Lifestyle Improve Symptoms in Women With Irritable Bowel Syndrome?

It has been proposed that physical activity moderates physiological or psychological responses to chronic conditions. The purpose of this study was to determine if women with a chronic functional gastrointestinal (GI) disorder, irritable bowel syndrome, had less active lifestyles than healthy controls and to test whether active women with irritable bowel syndrome had less severe recalled or daily reports of GI, psychological, and somatic symptoms than inactive women with irritable bowel syndrome. Questionnaires were used to measure GI and psychological distress and somatic symptoms in 89 women who participated in this study. A daily symptom and activity diary was kept for one menstrual cycle. Women with irritable bowel syndrome were significantly less likely to be active (48%) than control women (71%) (X2 = 3.4, p = .05). Within the irritable bowel syndrome group, active women were less likely to report a feeling of incomplete evacuation following a bowel movement than inactive women (p < .04), yet active women did not have less severe recalled psychological or somatic symptoms than inactive women. Active women with irritable bowel syndrome reported less severe daily somatic symptoms, which were accounted for by a lower level of fatigue (p = .003), but not daily GI or psychological symptoms. These results suggest that physical activity may produce select symptom improvement in women with irritable bowel syndrome.

Effects of Gender and Marital Status on Somatic Symptoms of Patients Attending a Mind/Body Medicine Clinic

To clarify the mechanisms of gender-related mind/body relationships, the authors analyzed the characteristics of 1,132 outpatients (848 women and 284 men) attending a mind/body medicine clinic. At entry in the program, the patients completed the Medical Symptom Checklist, Symptom Checklist-90 revised (SCL-90R), and Stress Perception Scale. Women reported 9 out of 12 symptoms (fatigue, insomnia, headache, back pain, joint or limb pain, palpitations, constipation, nausea, and dizziness) more frequently than the men did. Being a woman was a predictor of the total number of somatic symptoms endorsed. SCL-90R somatization scores were significantly higher in nonmarried women than in married women. Perceived stress ratings of family and health were higher in women than in men, despite the lower degree of perceived stress concerning work. Women, especially nonmarried women, were more likely to report somatic discomfort. Gender appears to be an important factor in relation to the report of somatic symptoms in stress-related conditions.

Symptom reporting in cancer patients II: relations to social desirability, negative affect, and self-reported health behaviors.

Patients' appraisal of somatic symptoms is correlated with their negative affect. The authors have investigated whether social desirability is associated with patients' symptom and health behavior reporting. One hundred fourteen surgical cancer patients who participated in either an outpatient or an inpatient follow-up care program filled out the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, the New Social Desirability Scale, and a health behavior checklist. Patients' reports of somatic symptoms were correlated inversely with social desirability (r = -0.50) and positively with negative affect (r = 0.72). When objective health and demographic variables (e.g., prognosis, adjuvant therapy prior to follow-up, and gender) were entered first in hierarchical multiple regression analyses, social desirability and negative affect accounted for an additional 16% and 36% of the symptom variance, respectively. Similar results were found when global quality of life was the dependent variable. Self-reported health behaviors were explained only through the set of health and demographic variables (14%), and social desirability and negative affect did not account for additional variance. On the average, patients reported that they had a median of 4.7 (out of a list of 21) self-initiated health behaviors, and 11% of the patients admitted to having used unproven therapies. Symptom reports do not give a pure picture of patients' health status, but they are strongly correlated with social desirability and negative affect. Detection of such psychologic variables is essential to understanding the dynamics of quality of life. In applied settings, quality-of-life measures should be used together with conventional criteria. As practical experience and scientific understanding grow, the relative positioning of these patient-oriented versus clinic-oriented endpoints will become clear.

Somatic style and symptom reporting in rheumatoid arthritis.

The authors studied the relative contributions of psychological characteristics and rheumatoid arthritis (RA) morbidity to RA symptoms and medication side effects. Thirty-one consecutive patients attending an RA clinic completed self-report questionnaires and diaries assessing RA symptoms and somatic style, a constellation of beliefs, attitudes, and concerns about disease and health. After 3 months, the patients were assessed for RA symptoms and self-reported medication side effects. At inception, RA symptoms were associated with several components of somatic style. At 3-month follow-up, changes in RA symptoms and the incidence of medication side effects were predicted by somatic style variables measured at inception. The symptoms of RA and the side effects of RA pharmacotherapy are prospectively predicted by somatic style as well as by the severity and extent of RA.

Hypochondriacal concerns, symptom reporting and secondary gain mechanisms.

Hypochondriacal concerns (HCs) and somatic symptom reporting (SSR) are associated. However, HCs are believed to be linked to the ego-defence coping strategy of avoiding help and SSR is believed to be linked to secondary gain. One hundred and twenty undergraduate students completed measures of HCs, SSR and the Desire for Control (DC) Scale. Subscales of the DC scale were used as indices of help avoidance and secondary gain. Both hierarchical multiple linear regression and LISREL structural modelling were used to control for the confound between HCs and SSR and explore the links with help avoidance and secondary gain. HCs were found to be primarily associated with an increased desire to strive for independence (avoid help) and levels of SSR were associated with the desire to have others make decisions (secondary gain).

Selected symptoms associated with sexual and physical abuse history among female patients with gastrointestinal disorders: the impact on subsequent health care visits

Despite a growing literature pointing to the deleterious health effects of sexual and physical abuse history, few studies provide evidence about which medical symptoms are most affected. The aim of this paper is to determine the impact of sexual and physical abuse history on a selected set of medical symptoms, and to test how such abuse, medical symptoms and functional disability may affect subsequent health care visits. We studied 239 women from a referral-based gastroenterology clinic; follow-up data were available on 196 of these women. All women were interviewed about sexual and physical abuse history. Women with abuse history, particularly those with severe abuse, were much more likely to report somatic symptoms related to panic (e.g. palpitations, numbness, shortness of breath), depression (e.g. difficulty sleeping, loss of appetite), musculoskeletal disorders (e.g. headaches, muscle aches), genito-urinary disorders (e.g. vaginal discharge, pelvic pain, painful intercourse), skin disturbance (e.g. rash) and respiratory illness (e.g. stuffy nose). Furthermore, we found that the severity of abuse history, somatic symptoms and functional disability predicted 30% of the variance in health care visits during the subsequent year, and that the effect of abuse severity on visits was explained by abused women having more somatic symptoms and functional disability. Patients' reports of abuse history, somatic symptoms and functional disability appear to be important factors in explaining the number of health care visits among a clinic sample of women with gastrointestinal disorders.

Symptom reporting in cancer patients: the role of negative affect and experienced social stigma.

Recent research suggests that patients' appraisal of somatic symptoms is more closely related to emotional variables (particularly negative affect) than to their actual health as determined by external criteria. Sixty surgical cancer patients who at the time of a routine follow-up examination filled out the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire-C30, which included a positive/negative affect scale and a scale tapping into experienced social stigma. Patients' health status was determined in two ways: the examining physician gave a global judgement on a standardized scale at the end of the examination, and an additional two external physicians later rated the patients based on the findings listed in the medical record. Patients' reports of somatic symptoms were strongly correlated with two measures of negative affect (r = 0.75 and r = 0.65, respectively) and with experienced social stigma (r = 0.51). In contrast, the correlations between reported symptoms and the examining or external physicians' ratings were considerably weaker (r = 0.31 and r = 0.19). According to a multiple linear regression with 6 predictors, negative affect was the best single predictor of symptom reporting (beta = 0.68; P < 0.001) and global quality of life (beta = 0.48; P < 0.001). Factor analysis yielded a dimension of somatopsychosocial distress that accounted for 44.1% of the variance and is comprised of reported symptoms (factor loading = 0.86), negative affect (0.90 and 0.82), experienced social stigma (0.74), and global quality of life (0.70). Physicians' ratings and positive affect constituted two additional separate factors. Cancer patients' reporting of somatic symptoms by means of a standardized quality of life questionnaire is closely related to emotional and social distress and is not equivalent to health status as determined from a clinical perspective. Researchers and practitioners have to be aware of this fact when interpreting quality of life data. Furthermore, negative affect deserves attention as an important signal for intervention in tumor follow-up programs.

Infant-mother attachment and behavior problems in healthy and chronically ill preschoolers

AbstractAnalysis of longitudinal data for 145 children [51 healthy, 40 with cystic fibrosis (CF), and 54 with congenital heart disease (CHD)] was conducted: (a) to ascertain whether behavioral problems evident in older medically compromised children would be reported as early as 2–3 years-of-age; and (b) to test theoretical predictions concerning the role of infant-mother attachment in the etiology of behavior problems. As predicted, children with a medical diagnosis received higher scores from parents on the Child Behavior Checklist (CBCL), primarily on the Internalizing scale. Reports of somatic symptoms did not account for this effect. Contrary to predictions, children with CHD were reported to have more behavior problems than those with CF. Secure attachment was associated with lower CBCL scores for internalizing problems regardless of medical status. The increase in behavior problem reports associated with insecure attachment was shown to reflect an effect of avoidance rather than insecurity per se. The importance of distinguishing effects of different types of insecurity and the need for meta-analytic strategies to do so is emphasized.

The role of private body consciousness and anxiety in the report of somatic symptoms during magnetic resonance imaging

The present study examined an information processing model of symptom reporting (Ahles, Cassens, & Stallings, Journal of Behavior Therapy and Experimental Psychiatry 18, 215–222, 1987) in a medical sample during an anxiety-arousing diagnostic medical evaluation. The predisposition to attend to physical sensations (private body consciousness), state anxiety, and symptom reporting were assessed in 47 patients undergoing a magnetic resonance imaging (MRI) procedure. The results of this study provide further support for the information processing model; the interaction between private body consciousness and state anxiety significantly predicted symptom reporting during the MRI. The pattern of results points to attention to physical sensations and anxiety as important mediators of symptom reporting.

Effects of dispositional self-focus, appraisal and attention instructions on responses to a threatening stimulus

Abstract Two studies are reported which explored the relationship between self-focused attention and anxiety. The first study tested the hypotheses that self-focused attention is associated with anxiety in threatening situations and that the relationship is mediated by negative appraisal processes. Study 1 showed no significant interaction between self-focus and negative appraisal on state-anxiety. However, self-focus was associated with increments in state-anxiety, high levels of worry and somatic symptom reports in a threatening situation. The relationship between self-focus and state-anxiety was mediated by somatic symptoms. Study 2 used cognitive and somatic self-attention instructions and external focus instructions to verify the hypothesis that self-focus on somatic arousal is associated with anxiety. It is concluded that specific self-focusing tendencies are associated with the elicitation and exacerbation of anxiety.

Treatment effects of alprazolam and imipramine: Physiological versus subjective changes in patients with generalized anxiety disorder

The correspondence between changes in physiological activity and somatic symptom reports was assessed in generalized anxiety disorder patients treated with alprazolam or imipramine. After 6 weeks, the two medications produced comparable reductions in self-reported somatic symptoms. However, patients taking alprazolam showed decreases in systolic blood pressure, epinephrine, and norepinephrine, and patients taking imipramine showed increases in heart rate, blood pressure, electromyographic activity, and norepinephrine. Thus, though the physiological changes associated with alprazolam treatment were consistent with changes in symptom reports, treatment with imipramine produced a desynchrony: patients reported significant decreases in cardiovascular symptoms and muscle tension in spite of the fact that heart rate, blood pressure, and electromyographic activity increased. Possible explanations for this counterintuitive phenomenon are discussed.

Somatic manifestations in anxiety disorders

Anxiety disorders differ in speed of onset, intensity and duration, but not in quality, of self reported somatic symptoms. Self reports, however, are often unreliable and must be confirmed by objective measures. Therefore, we examined self-reports and physiological states (skin conductance, heart interbeat interval, blood pressure, forehead and gastrocnemius muscle activity, and respiration) during rest and under psychological stress in patients with generalized anxiety disorder (GAD), panic disorder (PD) and obsessive-compulsive disorder (OCD). Patients with all three anxiety disorders showed increased muscle tension during rest and during psychological stress. On autonomic measures, however, GAD and OCD patients did not differ from controls during rest. During psychological stress OCD patients showed physiological responses comparable to controls, while GAD patients actually showed a diminished skin conductance response. In contrast to GAD and OCD, PD patients exhibited significantly higher skin conductance and heart rate at rest and continued to do so during stress. They also. showed increased systolic blood pressure during stress. These findings demonstrate that anxiety disorders differ not only in self reports of somatic symptoms, but also in physiological manifestations. Further, they support the validity of the separation of PD from GAD as formulated by DSM-III.

Facial expressions of pain and emotions in chronic TMD patients

This research was designed to identify and validate facial expressions of pain occurring in a clinical chronic pain condition. Facial expressions of 28 patients with chronic temporomandibular disorder pain were videotaped during a painful clinical examination procedure and coded using an anatomically based system. Characteristics of the expressions occurring most frequently were compared with self-report measures of pain, anxiety, depression and somatic symptoms. The frequency, duration and intensity of the identified expressions were dependably correlated with pain report, but unrelated to self report of other somatic symptoms, depression or anxiety. A small number of facial expressions of specific negative emotions were also observed; pain report and pain facial expressions were higher for persons showing a greater number of negative affects. These findings support the promise of facial expressions as measures of clinical pain.

The effects of blood sugar level changes on cognitive function, affective state, and somatic symptoms.

In an attempt to find out whether decreased blood sugar level is associated with impaired cognitive function, adverse emotional changes, or somatic symptoms, 35 subjects who suspected that they had hypoglycemia were given 5-hr glucose tolerance tests (GTTs). Nine blood samples were taken during the GTT, and the subject's mood, Serial Sevens Test (SST) performance, and somatic symptom reports were recorded on each occasion of sampling. The subjects reported significantly more negative affect and somatic symptoms after glucose nadir than before nadir. SST performance deteriorated at glucose nadir. These effects were more pronounced for subjects with high hypoglycemic index scores than for subjects with low index scores. The impairment in SST performance was greater for subjects who showed rapid decreases in blood sugar than for subjects who showed slow decreases. Dividing subjects by high and low nadirs did not reveal any differences in symptomatology.

The influence of hardiness on the relationship between stressors and psychosomatic symptomatology.

Thirty male and 58 female students responded to questionnaires based on a 9-month period in a prospective study of the impact of hardiness, life events, and hassles on reports of somatic symptoms. The data were analyzed utilizing cross-lagged panel analyses, analyses of variance, and multiple regression analyses. The results suggested that life events, hassles, and symptoms were significantly related in a recursive, mutually interactive manner. Although life events shared a high degree of variance with hassles, hassles consistently contributed above and beyond life events in predicting somatic symptoms. In addition, hardiness tended to have additive and opposite effects to that of stressors in its impact on symptomatology. Finally, and perhaps most important, compared to lower-hardy individuals, those higher in hardiness tended to experience less frequent stressors and to perceive the minor events they did experience as less stressful.

Alexithymia: A comparative study of three self-report measures

This study evaluates and compares the psychometric properties of three self-report measures of alexithymia — a hypothetical personality construct thought to be associated with hypochondriasis, somatization disorder and a variety of other medical and psychiatric disorders. Two hundred and nine college students were administered the Schalling-Sifneos Personality Scale (SSPS), MMPI alexithymia scale (MMPI-A), Toronto Alexithymia Scale (TAS), and two measures of functional somatic symptoms. Results indicated that the TAS is internally consistent and sensitive to reports of somatic symptoms. In contrast, the SSPS and MMPI-A were found to have response and/or gender biases, poor internal reliabilities, and no systematic relationship with somatic symptoms. In addition, factor analysis showed the TAS to have a stable, replicable factor structure, while the SSPS demonstrated little factor stability. These findings suggest that the TAS is the most psychometrically sound measure of the alexithymia construct.

Effects of response styles on the report of psychological and somatic distress.

The present study (N = 247) assessed the impact of two major response style dimensions (self-deception and impression management) on the report of psychological and somatic symptoms. Self-deception was assessed with the Self-Deception Questionnaire (SDQ) and the Repression-Sensitization (R-S) scale. Impression management was assessed with the Other-Deception Questionnaire (ODQ). The study confirmed that response styles were more predictive of psychological than somatic symptoms. Nevertheless, the SDQ and R-S explained a surprising 13%-15% of the variance in physical symptom reports over and above the effects of impression management. Self-deceivers and repressers reported significantly fewer symptoms of both types. Although women reported more symptoms of both types, no significant sex differences were noted in the effects of response style on symptom reporting. Both anxiety and depression were associated with a high rate of physical symptoms, particularly among women. In recent research on stress and anxiety, response styles such as defensiveness , repression,' denial, and socially desirable responding have received considerable attention. Such response styles provide a challenge to psychological research because they may serve two distinct roles: First, they may be characteristic of particular stress-related disorders like the hypertensive personality (Jorgensen & Houston, 1983; Linden, 1984; Linden & Feuerstein, 1983; G. Schwartz, 1983). Second, they have been alleged to be confounds in the self-report assessment of a variety of stressrelated characteristics including trait anxiety (Edwards, 1957; Kimble & Posnick, 1967), state anxiety (Asendorpf & Scherer, 1983; Linden & Prankish, 1984; Weinberger, Schwartz, & Davidson, 1979), self-monitoring of stressful events (Kiecolt-Glaser & Murray, 1980; Linden & Feuerstein, 1983), as well as hopelessness and suicidal tendencies (Linehan & Nielsen, 1981, 1983). Relative to this large body of literature on reponse styles in self-reports of psychological symptoms (e.g., anxiety and depression), little attention has been given to stylistic responding in self-reports of physical symptoms (e.g., nausea, headache, and itching). Consistent with psychosomatic theory, less frequent and less severe health problems are reported by those scoring as repressers on Byrne's Repression-Sensitization (R-S) scale (Byrne, Steinberg, & Schwartz, 1968). A later study (M. Schwartz, Krupp, & Byrne, 1971) was designed to test whether R-S tendencies in symptom reporting were merely a response style or whether they could be linked to definitive differences in psychological and