Causal illness attributions in somatoform disordersAssociations with comorbidity and illness behavior
Philipps-University of Marburg, Marburg, Germany. Journal of Psychosomatic Research
(Impact Factor: 2.74).
11/2004; 57(4):367-71. DOI: 10.1016/j.jpsychores.2004.02.015
To compare causal illness beliefs between patients with unexplained physical symptoms and different comorbid disorders and to assess the association of causal illness beliefs with illness behavior.
We examined a sample of 233 patients attending treatment in primary care. Inclusion criteria were "unexplained physical symptoms." All patients were investigated using structured interviews and self-rating scales [Screening for Somatoform Symptoms (SOMS), Beck Depression Inventory (BDI), Beck Anxiety Inventory, and a 12-item instrument to assess causal attributions]. By means of factor analysis, the following illness attributions were considered: vulnerability to infection and environmental factors, psychological factors, organic causes including genetic and aging factors, and distress (including exhaustion and time pressure).
Most patients reported multiple illness attributions. The more somatoform symptoms patients had, the more explanations in general they considered. Especially for vulnerability and organic illness beliefs, patients with somatoform symptoms had increased scores. Comorbidity with depression and with anxiety disorders was associated with more psychological attributions. Even when the influence of somatization, depression, and anxiety is controlled for, illness beliefs still showed associations with illness behavior. Organic causal beliefs and vulnerability attributions were associated with a need for medical diagnostic examinations, increased expression of symptoms, increased illness consequences, and bodily scanning.
Multiple causal attributions can coexist demonstrating different associations with comorbid depression and illness behavior.
Available from: Per Fink
- "In somatoform disorders, previous studies have found that comorbid anxiety or depression increases the likelihood of patients holding psychological attributions   , and it has therefore been suggested that this comorbidity may largely explain why some patients with somatoform disorders include psychological factors in their understanding of their symptoms. "
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ABSTRACT: We examined whether primary care patients were more likely to perceive a current health problem as 'physical illness only' as opposed to entailing psychological difficulties if they had a comorbid somatoform disorder compared to patients who had (a) both comorbid somatoform disorder and anxiety/depression or (b) comorbid anxiety and/or depression, and a reference group of (c) patients with well-defined physical disease. We examined whether attributions predicted future health expenditures.
A total of 1209 of 1785 patients completed questions on patient-perceived illness. The physicians diagnosed the current health problem. A stratified subsample was interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. Health expenditure was obtained from registers for a 2-year period.
The belief that the current health problem was only physical was endorsed by 86% of patients presenting physical disease, 58% of patients with somatoform disorders, 29% of patients with both somatoform disorders and anxiety/depression and 24% of patients with anxiety or depressive disorders (χ(2)=269.2, df=3, P<.0001). In a multiple regression model, a 'physical illness only' perception predicted lower health expenditures [β=-0.31, 95% confidence interval (-0.55; -0.07), P=.013].
The prevalent assumption that physical symptom attributions are a central aspect in somatoform disorders is not supported by the current study.
Copyright © 2015 Elsevier Inc. All rights reserved.
Available from: Rainer Schaefert
- "Several cognitive, emotional and behavioural features have been described in previous Western studies    : Illness worries, also referred to as health-related anxiety, are a ubiquitous experience that arises when bodily sensations or changes are believed to be indicative of a serious disease  . Catastrophising is the tendency to overinterpret the likelihood and/or intensity of potential negative consequences of symptoms . "
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ABSTRACT: Objective: In primary care populations in Western countries, high somatic symptom severity (SSS) and low
quality of life (QoL) are associated with adverse psychobehavioural characteristics. This study assessed the
relationship between SSS, QoL and psychobehavioural characteristics in Chinese general hospital outpatients.
Methods: Thismulticentre cross-sectional study enrolled 404 patients from10 outpatient departments, including Neurology, Gastroenterology, Traditional ChineseMedicine [TCM] and Psychosomatic Medicine departments, in Beijing, Shanghai, Chengdu and Kunming. A structured interview was used to assess the cognitive, affective and behavioural features associated with somatic complaints, independent of their origin. Several standard instruments were used to assess SSS, emotional distress and health-related QoL. Patients who reported low SSS (PHQ-15 b 10, n = 203, SOM−) were compared to patients who reported high SSS (PHQ-15 ≥ 10, n = 201, SOM+).
Results: As compared to SOM− patients, SOM+ patients showed significantly more frequently adverse
psychobehavioural characteristics in all questions of the interview. In hierarchical linear regression analyses
adjusted for anxiety, depression, gender and medical conditions (SSS additionally for doctor visits), high SSS
was significantly associated with “catastrophising” and “illness vulnerability”; low physical QoL was associated with “avoidance of physical activities” and “disuse of body parts”; low mental QoL was associated with “need for immediate medical help.”
Conclusion: In accordancewith the results from Western countries, high SSS was associatedwith negative illness and self-perception, low physical QoL with avoidance behaviour, and low mental QoL with reassurance seeking in Chinese general hospital outpatients.
Available from: Bernd Löwe
- "Organic attributions as part of previous suggestions for DSM-5 appears to be a promising construct as well. Subjects with somatic complaints exhibited pronounced somatic illness attribution in numerous studies     where as in depression and anxiety more psychological attributions can be found   . "
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ABSTRACT: Current diagnostic criteria for somatoform disorders demand revisions due to their insufficient clinical as well as scientific usability. Various psychological and behavioral characteristics have been considered for the proposed new category Somatic Symptom Disorder (SSD). With this study, we were able to jointly assess the validity of these variables in an inpatient sample.
Using a cross-sectional design, we investigated N=456 patients suffering from somatoform disorder, anxiety, or depression. Within one week after admission to the hospital, informed consent was obtained and afterwards, a diagnostic interview and a battery of self-report questionnaires were administered. Logistic regression analyses were performed to determine which variables significantly add to construct and descriptive validity.
Several features, such as somatic symptom severity, health worries, health habits, a self-concept of being weak, and symptom attribution, predicted physical health status in somatization. Overall, our model explained about 50% of the total variance. Furthermore, in comparison with anxious and depressed patients, health anxiety, body scanning, and a self-concept of bodily weakness were specific for DSM-IV somatoform disorders and the proposed SSD.
The present study supports the inclusion of psychological and behavioral characteristics in the DSM-5 diagnostic criteria for somatoform disorders. Based on our results, we make suggestions for a slight modification of criterion B to enhance construct validity of the Somatic Symptom Disorder.
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