The Relationship Between Somatic Symptoms, Health Anxiety, and Outcome in Medical Out-Patients
ABSTRACT The author and colleagues tested cut point scores on measures of total somatic symptoms and health anxiety of new medical out-patients, to determine whether they predicted health status and number of medical consultations. High-scoring participants had significantly more impaired health status and medical consultations. High scores were associated with dissatisfaction with the doctor's explanation of their symptoms. Whether symptoms were medically explained or not made little difference to these results; anxiety and depression were not found to have effect. The author and colleagues found support for the combination of somatic symptoms and health anxiety as proposed in DSM-V complex somatic symptom disorder.
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ABSTRACT: The DSM-5 revision of the health anxiety classification (i.e., hypochondriasis) highlights deficiencies in the present DSM taxonomy and the need to consider an alternative. Health anxiety is a clinical syndrome that has been and remains difficult to classify in the DSM system. We argue that the current DSM-5 proposal that splits this syndrome between two diagnoses, somatic symptom disorder (SSD) and illness anxiety disorder (IAD), has significant limitations. We anticipate that SSD will problematically increase comorbidity because criteria for this syndrome feature nonspecific symptoms that overlap with depressive and anxiety disorders. Further, the proposed IAD criteria are overly restrictive and not likely to capture the heterogeneous presentation of individuals with anxiety about their health. We propose an alternative organization that will increase the clinical utility and construct validity of many DSM-IV-TR, Axis I disorders, including health anxiety. This taxonomy, proposed by Goldberg, Krueger, Andrews and Hobbs, is based on the shared etiology of syndromes called emotional disorders. The emotional disorders include health anxiety, other somatoform, unipolar depressive, and anxiety disorders, all of which share the risk factor of negative emotionality/neuroticism (NE/N). We propose a research agenda to support this alternative taxonomy.Current Psychiatry Reviews 01/2014; 10(1). DOI:10.2174/1573400509666131119010129
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ABSTRACT: The new DSM-5 Somatic Symptom Disorder (SSD) emphasizes the importance of psychological processes related to somatic symptoms in patients with somatoform disorders. To address this, the Somatic Symptoms Experiences Questionnaire (SSEQ), the first self-report scale that assesses a broad range of psychological and interactional characteristics relevant to patients with a somatoform disorder or SSD, was developed. This prospective study was conducted to validate the SSEQ. The 15-item SSEQ was administered along with a battery of self-report questionnaires to psychosomatic inpatients. Patients were assessed with the Structured Clinical Interview for DSM-IV to confirm a somatoform, depressive, or anxiety disorder. Confirmatory factor analyses, tests of internal consistency and tests of validity were performed. Patients (n=262) with a mean age of 43.4years, 60.3% women, were included in the analyses. The previously observed four-factor model was replicated and internal consistency was good (Cronbach's α=.90). Patients with a somatoform disorder had significantly higher scores on the SSEQ (t=4.24, p<.001) than patients with a depressive/anxiety disorder. Construct validity was shown by high correlations with other instruments measuring related constructs. Hierarchical multiple regression analyses showed that the questionnaire predicted health-related quality of life. Sensitivity to change was shown by significantly higher effect sizes of the SSEQ change scores for improved patients than for patients without improvement. The SSEQ appears to be a reliable, valid, and efficient instrument to assess a broad range of psychological and interactional features related to the experience of somatic symptoms. Copyright © 2015 Elsevier Inc. All rights reserved.Journal of Psychosomatic Research 03/2015; 78(6). DOI:10.1016/j.jpsychores.2015.03.004 · 2.84 Impact Factor
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ABSTRACT: Abstract The number of patients who seek help at primary and secondary care for somatic symptoms which cannot be explained by any known medical condition is enormous. It has been proposed to rename 'somatoform disorders' in DSM-IV as 'somatic symptom disorders' in DSM-5. This is supposed to include disorders such as somatization disorder, hypochondriasis, undifferentiated somatoform disorder, pain disorder and factitious disorder. The reason for the renaming and grouping is that all these disorders involve presentation of physical symptoms and/or concern about medical illness. In the literature, there is considerable variation adopted with respect to diagnosis and in the approaches adopted for intervention. However, the common feature of these disorders is the chronicity, social dysfunction, occupational difficulties and the increased healthcare use and high level of dissatisfaction for both the clinician and the patient. A number of behavioural and psychological interventions for somatic symptoms have been carried out at primary, secondary and tertiary care settings and recently there have been more attempts to involve the primary care physicians in the psychological interventions. This review aims at giving an overview of the components of the behavioural and other psychological interventions available for addressing medically unexplained somatic symptoms and to present their efficacy.International Review of Psychiatry 02/2013; 25(1):116-24. DOI:10.3109/09540261.2012.746649 · 1.80 Impact Factor