Dissertations / Theses on the topic 'Somatoform disorders'

Objective. Although somatoform disorders are assumed to be chronic clinical conditions, epidemiological knowledge on their natural course based on representative samples is not available. Method. Data come from a prospective epidemiologic study of adolescents and young adults in Munich, Germany. Respondents’ diagnoses (N = 2548) at baseline and follow-up on average 42 months later are considered. The follow-up incidence, stability as well as selected baseline risk factors (sociodemographics, psychopathology, trauma exposure) for the incidence and stability of somatoform disorders and syndromes are prospectively examined. Diagnostic information was assessed by using the standardized Munich-Composite International Diagnostic Interview (M-CIDI). Results. Over the follow-up period, incidence rate for any of the covered somatoform diagnoses was 25.7%. Stability for the overall group of any somatoform disorder/syndrome was 48%. Female gender, lower social class, the experience of any substance use, anxiety and affective disorder as well as the experience of traumatic sexual and physical threat events predicted new onsets of somatoform conditions, while stability was predicted by being female, prior existing substance use, affective and eating disorders as well as the experience of a serious accident. Conclusions. At least for a substantial proportion of individuals, the overall picture of somatization seems to be relatively stable, but with fluctuation in the symptom picture over time. Being female, the experience of substance use as well as anxiety disorder seem to constitute risk factors for the onset of new somatoform conditions as well as for a stable course over time.

Objective. Although somatoform disorders are assumed to be chronic clinical conditions, epidemiological knowledge on their natural course based on representative samples is not available. Method. Data come from a prospective epidemiologic study of adolescents and young adults in Munich, Germany. Respondents’ diagnoses (N = 2548) at baseline and follow-up on average 42 months later are considered. The follow-up incidence, stability as well as selected baseline risk factors (sociodemographics, psychopathology, trauma exposure) for the incidence and stability of somatoform disorders and syndromes are prospectively examined. Diagnostic information was assessed by using the standardized Munich-Composite International Diagnostic Interview (M-CIDI). Results. Over the follow-up period, incidence rate for any of the covered somatoform diagnoses was 25.7%. Stability for the overall group of any somatoform disorder/syndrome was 48%. Female gender, lower social class, the experience of any substance use, anxiety and affective disorder as well as the experience of traumatic sexual and physical threat events predicted new onsets of somatoform conditions, while stability was predicted by being female, prior existing substance use, affective and eating disorders as well as the experience of a serious accident. Conclusions. At least for a substantial proportion of individuals, the overall picture of somatization seems to be relatively stable, but with fluctuation in the symptom picture over time. Being female, the experience of substance use as well as anxiety disorder seem to constitute risk factors for the onset of new somatoform conditions as well as for a stable course over time.

Sixteen couples in which one of the partners met criteria for Somatoform Disorder or Undifferentiated Somatoform Disorder as determined by the SOMS and who scored less than or equal to 101 on the Dyadic Adjustment Scale participated in this study. These couples were randomly assigned to 8 sessions of emotionally focused therapy or to a 12-week wait list condition. The purpose of the study was to investigate the effectiveness of emotion focused therapy as a treatment of somatoform disorders. Results suggest that the intervention of emotion focused couples therapy (EFT) was not effective in the treatment of somatoform disorders. A significant effect (.023) was found in the increased reporting of symptoms at posttest. Implications for EFT and marriage and family therapy are discussed.
Ph. D.

O presente trabalho tem o objetivo de descrever e discutir os conceitos de Transtornos Somatoformes (TS) na perspectiva psiquiátrica e psicanalítica. A pesquisa pauta-se no estudo do estado da arte relativo aos TS, mediante revisão bibliográfica semi-dirigida, tendo como meta mapear e discutir a temática historicamente e em diferentes campos de conhecimento. Pretende-se compreender, descrever e analisar o conceito de TS nos manuais de psiquiatria, a saber, no Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM) e na Classificação Internacional de Doenças (CID-10). O estudo explora o conceito de histeria na obra freudiana, buscando investigar que proximidade haveria entre o conceito psiquiátrico de TS e o de Histeria em Freud. Além dos manuais e da obra freudiana, foram utilizados textos psiquiátricos e psicanalíticos que contribuíram para o entendimento das questões. A partir da reconstrução histórica observa-se que, nas primeiras edições dos manuais psiquiátricos, os TS remetiam ao que a ciência psiquiátrica até aquele momento tinha dificuldade em classificar. Reconhecia-se também a influência dos conflitos psíquicos na manifestação dos sintomas, e o conceito de histeria estava atrelado a esta categoria diagnóstica. Após 1980 a categoria diagnóstica de histeria foi retirada do DSM. Tais aspectos explicitam a necessidade de uma maior compreensão acerca do processo histórico e da interlocução entre o campo da Psiquiatria e da Psicanálise, levando-se em conta o modo como é feito o diagnóstico deste transtorno, que ocorre, na maior parte das vezes por exclusões. Ressalta-se que a alteração da nomenclatura de TS produziu uma significativa mudança no entendimento deste tipo de sofrimento mental. Conclui-se que o conceito de histeria e o diagnóstico de TS se aproximam no que se refere ao aspecto fenomenológico e descritivo, mas se distanciam no que se refere à construção da compreensão clínica e ao tratamento tal como se processa atualmente
The present work aims to describe and discuss the concepts of Somatoform Disorders (SD) in the psychiatric and psychoanalytic perspective. The research presents a study on the state of the art related to SD, through a semi-directed literature review, with the target to map and discuss the topic historically and across different fields of knowledge. It is intended to comprehend, describe and analyse the concept of SD in the psychiatric manuals, namely: Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD-10). This study explores the concept of hysteria in the Freudian works, seeking to investigate the proximity between the psychiatric concept of SD and that of hysteria in Freud. In addition to the manuals and the Freudian works, the research refers to other psychiatric and psychoanalytical texts that contributed to the understanding of these issues. From the historical reconstruction is observed that, in the first editions of psychiatric manuals, the SD remitted to what the psychiatric science had difficult to classify. It was also recognized the influence of psychic conflict in the manifestation of the symptoms, and the concept of hysteria was linked to this diagnostic category. After 1980s, the diagnostic category of hysteria was removed from DSM. These aspects make explicit the need for greater understanding of the historical process and the dialogue between the fields of psychiatry and psychoanalysis, taking into account how this disorder is diagnosed, which occurs in most cases by exclusions. It is noteworthy that the change in the nomenclature of SD produced a significant shift in the understanding of this type of mental suffering. It follows that the term hysteria approaches SD diagnostic with regard to phenomenological aspects and description, but it differs from this disorder with respect to the construction of clinical understanding and treatment as it is currently handled

This thesis focusses on the role of attentional bias for health-threat information in the production and maintenance of medically unexplained symptoms, somatoform disorders and high levels of physical symptom reporting. It is comprised of three separate papers. Paper 1 was prepared for Clinical Psychology Review as a systematic review of the evidence concerning attentional bias for health–threat information in populations presenting with somatoform/somatic symptom disorders and high levels of physical symptom reporting. From the 20 studies deemed relevant for review, it was concluded that - although limited - the evidence indicated that a relationship existed between attentional bias for health-threat information and levels of physical symptom reporting. No robust evidence was found to establish whether this relationship was a casual one. Paper 2 was prepared for Journal of Abnormal Psychology and investigated whether an exogenous cueing task could be used to reduce presumed attentional bias for health-threat information in a sample of high symptom reporting students. The results showed an unexpected attentional avoidance of health-threat information at baseline, which the study manipulation unintentionally exacerbated. No change in levels of physical symptom reporting was noted between groups (attributed to a methodological error) but a trend in relatively greater anxiety for those who received the manipulation was noted. It was concluded that avoidance may be a key factor in high symptom reporting and that this merited further research. Paper 3 provided a critical reflection of Papers 1 and 2, as well as the research process as a whole. Implications for theory and clinical practice as well as future research directions were discussed.

Abstract The aim of this cross-sectional controlled study was to determine frequent attenders' chronic diseases and their reasons for encounter in primary health care. Furthermore, the study aimed to determine the associations of social, psychological and family factors with frequent attendance in a Finnish health centre. Patients who made eight or more annual visits to physicians in the health centre during one year were defined as frequent attenders (FA). All the FAs during 1994 (N=304) and 304 randomly selected age- and sex-matched controls constituted the study population. The data were collected from annual statistics, medical records and postal questionnaires. Over one third of the study population was interviewed. International Classification of Primary Care (ICPC) was used to determine the reasons for encounter and Symptom Checklist - 36 (SCL-36) to assess the psychological distress. Toronto Alexithymia Scale -20 (TAS-20) was used as a measure of alexithymia and Whiteley Index (WI) to determine hypochondriacal beliefs. The results showed that 4.7% of the whole population aged 15 years or older in Oulainen were FAs. They accounted for 23.5% of all visits made within the respective age group. The mean age of the FAs was 49.8 years. Over two thirds of them were female. The FAs had lower basic education and occupational status than the controls. The FAs visited physicians in the health centre mostly for reasons related to the musculoskeletal, respiratory and digestive systems. There appeared to be more chronic diseases among the FAs than among the controls. The FAs had over three times more mental disorders than the controls. The interviewed FAs had significantly more psychological distress, somatization and hypochondriacal beliefs than the controls. The risk of frequent attendance was higher in the older family life cycle phases than in the younger family life cycle phases. Multivariate analyses showed chronic somatic disease and hypochondriacal beliefs to be risk factors for frequent attendance. Concurrence of somatization and hypochondriacal beliefs increased the risk to be a FA. As a conclusion, the results emphasize the need to consider the FAs' own bodily concerns expressed as hypochondriacal beliefs when managing them. Furthermore, the study implicates a need to integrate the biomedical, psychological and social dimensions in the care of FAs in primary health care.

Introdução e justificativa. A dissociação pode ser definida como a temporária desconexão (patológica ou não patológica) entre módulos psíquicos e / ou motores que se encontram, em geral, sob o controle voluntário ou acesso direto da consciência, do repertório comportamental usual e / ou do autoconceito (Krippner, 1997). As pesquisas internacionais têm sustentado sua recorrente associação com determinadas crenças e experiências alegadamente paranormais e / ou de cunho religioso. Tais crenças e experiências estão também frequentemente correlacionadas com outras variáveis ligadas à dissociação como sintomas depressivos e ansiógenos, queixas somáticas, trauma infantil e transliminaridade. O fato de algumas pessoas apresentarem características psicológicas que as predispõem a tais ocorrências sugere a importância de se compreender melhor como nelas se dá a formação da identidade, seu desenvolvimento cognitivo, emocional e social, de modo a permitir uma abordagem mais ampla de outros aspectos envolvidos nessas alegações e na assunção de várias dessas crenças. A revisão da literatura indica grande quantidade de estudos quantitativos e poucos estudos de natureza qualitativa, com a consequente ausência de aprofundamento em aspectos biográficos e sociais. Até o momento, não existem estudos brasileiros sobre as relações entre dissociação, crença paranormal e transliminaridade. Objetivos. Investigar as relações existentes entre dissociação (e seus tipos específicos), crença e formação da identidade em grupos religiosos e não religiosos de participantes brasileiros; Pesquisar os possíveis fatores etiológicos das experiências dissociativas e das crenças e experiências paranormais, bem como suas interações, a partir do estudo de variáveis psicopatológicas e psicossociais diversas; Investigar o papel dos processos inconscientes na formação e manutenção das crenças e experiências paranormais; Verificar a extensão e o impacto dos processos dissociativos e das crenças e práticas paranormais e religiosas na formação da identidade e na história de vida, com especial atenção ao desenvolvimento afetivo / emocional e social do indivíduo; Aprofundar a compreensão do contexto grupal e social de inserção dos participantes, de modo a averiguar como tal contexto contribui na construção de suas crenças e experiências, e de como estas afetam ou determinam, em contrapartida, esse mesmo contexto; Pesquisar empiricamente o nível de adesão a crenças religiosas tradicionais e outras categorias de crença paranormal em grupos religiosos e não religiosos de participantes brasileiros. Método. De modo a permitir certa generalização para os dados obtidos na pesquisa, bem como, paralelamente, um aprofundamento nos processos individuais e coletivos de construção da identidade, utilizou-se de uma proposta de investigação tanto quantitativa quanto qualitativa. Por meio de questionário sociodemográfico e escalas, compôs-se a frente quantitativa do estudo. No que diz respeito à frente qualitativa, empregou-se entrevistas biográficas abertas, questionário semi-dirigido sobre experiências anômalas / paranormais e observações de campo. Pressupondo-se que determinados contextos religiosos são aparentemente mais receptivos e estimuladores de vivências dissociativas, e que afiliações religiosas mais tradicionais ou mesmo grupos ateístas tenderiam a estimular menos esse tipo de experiências, os participantes do estudo foram divididos em três grupos, com vistas a uma análise mais detalhada dessas diferenças: grupo um (espíritas, umbandistas e membros de círculos esotéricos e ocultistas), grupo dois (outros religiosos e pessoas sem afiliação definida) e grupo três (ateus e agnósticos), abrangendo um total de 1450 respondentes para a frente quantitativa. O único critério de exclusão foi a idade (18 anos ou mais). O número de entrevistas biográficas (22) e de observações de campo (31) foi determinado com base no critério de saturação. No caso das entrevistas, considerou-se também certo equilíbrio em termos de gênero, idade e número de participantes acima e abaixo da nota de corte utilizada para diferenciar high e low scorers em dissociação. Para efetuarmos a análise dos dados, recorremos às hipóteses propaladas na literatura psicológica e sociológica recente acerca das crenças e experiências paranormais e de sua relação com os fenômenos dissociativos, buscando avaliar até que ponto nossos dados confirmavam ou não tais modelos hipotéticos. Nossas avaliações também tiveram como pano de fundo trabalhos que versam sobre os processos de construção psicossocial da identidade no mundo contemporâneo e sobre as transformações mais recentes na família e na religião (Bauman, 2005, 2007; Castells, 1999; Giddens, 2002; Paiva, 2007; Poster, 1979), bem como sobre novas formas de subjetivação e sofrimento psíquico (Roudinesco, 2006), incluindo contribuições de teorias psicodinâmicas atualmente em voga, em particular a teoria do apego (Granqvist & Kirkpatrick, 2008) e a teoria da gestão do terror (Pyzscynski, Solomon & Greenberg, 2003). Principais resultados. O grupo um e o grupo dois não diferiram em termos de dissociação cognitiva, mas ambos pontuaram acima dos ateus e agnósticos. Não obstante, o grupo um obteve média significativamente maior em dissociação somatoforme (sintomas conversivos e psicossomáticos), crença paranormal e transliminaridade comparativamente aos demais grupos. Não houve diferença entre os grupos para os relatos de experiência traumática na infância. A escala de experiências dissociativas correlacionou positiva e significativamente, embora em diferentes graus de magnitude, com a crença paranormal, a transliminaridade, a medida composta de sintomas psicossomáticos, a escala de sintomas conversivos e várias formas de experiência traumática na infância. Todavia, quando controlados os efeitos da transliminaridade, a correlação entre dissociação e crença se desfez, apontando para um possível paper mediador da transliminaridade na relação entre as duas variáveis. A dissociação (somatoforme e cognitiva) não foi elevada nos líderes dos grupos visitados, mas se observou histórico de aparente somatização em alguns casos. Indivíduos com escores elevados na escala de experiências dissociativas denotaram personalidade regredida e impulsiva, além de relatarem mais experiências anômalas espontâneas. Discussão. Sugere-se a existência de dois tipos de dissociação, uma tendencial, outra contextual. Sugere-se também a existência de uma série de mecanismos psicossociais de mimetismo, desempenho de papéis e gerenciamento da impressão que podem passar por fenômenos dissociativos, embora não o sejam. Relaciona-se o fenômeno da crença paranormal, do sincretismo religioso e da dissociação a variáveis sócio-históricas mais amplas, como a procura por sensação nas sociedades contemporâneas, certas consequências do processo de secularização, as relações de consumo, identidades líquidas e uma compensação frente a padrões de apego familiares desorganizados. Relaciona-se a personalidade regredida e impulsiva dos high scorers a formas de defesa narcísicas, a uma maior flexibilidade da barreira entre consciência e inconsciente e a uma manutenção da infância e da fantasia na vida adulta. Associa-se o aumento das crenças paranormais e religiosas com a idade à saliência da morte (teoria da gestão do terror), e certos aspectos da psicodinâmica adolescente ao ateísmo, que se mostrou mais frequente entre adultos jovens e adolescentes em conflito com suas famílias
Introduction and rationale. Dissociative experiences can be defined as reported experiences and observed behaviours that seem to exist apart from, or appear to have been disconnected from, the mainstream, or flow, of ones conscious awareness, behavioural repertoire, and/or self-identity (Krippner, 1997). Research has long sustained a positive relationship between dissociation and paranormal beliefs and experiences. Allegations of paranormal phenomena are also frequently correlated with dissociation-related variables such as depression and anxiety symptoms, somatic complaints, childhood trauma and transliminality. The fact that some people have psychological characteristics that predispose them to such occurrences suggests the importance of studying their identity formation and cognitive, emotional and psychsocial development in order to gain insight into other aspects involved in the assumption of paranormal beliefs. The literature on paranormal beliefs indicates large amount of quantitative studies and few qualitative data, with a consequent gap in biographical and cultural aspects. The majority of studies have also neglected contextual and social variables which are better understood through interviews and ethnographic observations. There is virtually no Brazilian studies on the subject of dissociation, paranormal belief and transliminality. Objectives. 1) To investigate the relationship between dissociation, paranormal belief and associated variables, including its possible impact on the life history and identity of Brazilian respondents from different religious and non-religious groups; 2) To identify some of the possible etiological factors underlying the presumed association between dissociativ eexperiences and paranormal beliefs, from the study of several psychosocial and psychopathological variables; 3) To investigate the role of unconscious and psychodynamic processes in the formation and maintenance of paranormal beliefs and experiences; 4) To improve the understanding of the social context underlying religious and non-religious dissociative practices, in order to ascertain how such a context assist in the construction of certain experiences or beliefs, and, on the other hand, how these beliefs and experiences affect or determine the same context; 5) To explore the level of adherence to traditional religious beliefs and other categories of paranormal belief in religious and non-religious groups of Brazilian participants; 6) To compose a Brazilian sample that could map the associations between the aforementioned variables, aiming to a comparison with data from other sociocultural contexts. Methods. A quali-quantitative approach was proposed. Through socio-demographic questionnaires and psychological scales, it was designed a quantitative online questionnaire. Regarding qualitative techniques, the study employed 1) biographical interviews, 2) semi-structured interviews concerning the phenomenology of paranormal / anomalous experiences and 3) field observations. Assuming that certain religious contexts are apparently more receptive to dissociative experiences, and that more traditional religious affiliations or even atheist groups tend to discourage such experiences, the participants were divided into three groups, with a view to a more detailed analysis of these differences: group one (also called dissociators: spiritualists, umbandists, members of esoteric groups, catholic carismatics and pentecostals); group two (members of other religious affiliations and people without defined philosophical or religious affiliation) and group three (atheists and agnostics), covering a total of 1450 respondents. The only exclusion criterion was age (18-years-old or above). The number of biographical interviews (22) and field observations (31) was determined on the basis of data saturation criterion. For the qualitative interviews, a balance was seek in terms of gender, age and number of participants above or below the cutoff (>= 20) used to differentiate high and low scorers on the Dissociative Experiences Scale. To perform data analysis, we considered some of the most important sociological and psychological hypotheses concerning the relationship between dissociation and paranormal beliefs and experiences, assessing the extent to which our data confirmed or not such hypothetical models. We were also based on works dealing with the psychosocial construction of identity in the contemporary world and the most recent changes in family and religion (Bauman, 2005, 2007, Castells, 1999; Giddens, 2002; Paiva 2007; Poster, 1979), as well as new forms of subjectivity and 7 psychological distress (Roudinesco, 2006), including contributions from psychodynamic theories currently in vogue, particularly the Attachment theory (Granqvist & Kirkpatrick, 2008) and the Terror Management Theory (Pyzscynski, Solomon & Greenberg, 2003). Main results. The group one and group two did not differ in terms of cognitive dissociation, but both scored above atheists and agnostics. Nevertheless, the group one scored significantly higher in somatoform dissociation (conversion and psychosomatic symptoms), paranormal belief, syncretism and transliminality compared to the other groups. There was no difference between the groups for reports of childhood traumatic experiences. The Dissociative Experiences Scale correlated positively and significantly, though in different degrees of magnitude, with paranormal belief, transliminality, the composite measure of psychosomatic symptoms (somatization, depression and anxiety combined), an original scale of conversion symptoms and various forms of childhood traumatic experience. However, when controlling for the effects of transliminality, the correlation between dissociation and belief disappeared, indicating a possible mediator effect of transliminality on the relationship between the other two variables. Dissociation (somatoform and cognitive) was not high on the leaders of the groups visited, but a history of apparent somatization was observed in some of these cases. High scorers on the dissociative experiences scale denoted regressive and impulsive behaviors, and reported more spontaneous anomalous experiences. Discussion. We suggest the existence of two types of dissociation: tendential and contextual. It is also suggested the existence of a number of psychosocial mechanisms of mimicry, role playing and impression management which may be wrongly interpreted as dissociative phenomena. Paranormal beliefs, religious syncretism, new age mentality and dissociative tendencies are hypothesized to be influenced by broader socio-historical variables such secularization and globalization, consumer relations, liquid identities and a compensation for disorganized attachment patterns developed in childhood. The regressive and impulsive personality of high scorers is described in terms of narcissistic defense mechanisms, flexibility of boundaries between conscious and unconscious processes, and a tendency to extend childhood fantasy into adult life. The increase in paranormal belief with age is explained as a result of mortality salience (terror management theory), but also in terms of a generational conflict, as atheism showed to be more frequent among adolescents and young adults in disagreement with their families

Auf der Grundlage der Basisuntersuchung einer epidemiologischen prospektiven Verlaufsstudie (1995–1999) an 3021 Personen im Alter zwischen 14 und 24 Jahren werden epidemiologische Befunde zur Häufigkeit von somatoformen Beschwerden und somatoformen Syndromen/Störungen bei Jugendlichen und jungen Erwachsenen berichtet. Die Jugendlichen und jungen Erwachsenen wurden mit Hilfe des M-CIDI, einem standardisierten Interview zur Erfassung psychischer Symptome, Syndrome und Störungen nach dem DSM-IV, befragt. Die Ergebnisse der ersten Untersuchung zeigen, daß 50% der Jugendlichen einmal in ihrem bisherigen Leben unter einem somatoformen Symptom litten. Junge Frauen berichten häufiger von somatoformen Beschwerden als junge Männer (61 vs. 40%). Die im DSM-IV operationalisierten Kriterien einer somatoformen Störung werden nur von wenigen Jugendlichen und jungen Erwachsenen (2,7%) erfüllt. Die Prävalenz erhöht sich jedoch, wenn man nicht ausschließlich voll ausgeprägte somatoforme Störungen, sondern zusätzlich unterschwellige Syndrome in die Betrachtung einschließt: Hier berichten etwa 11% der Jugendlichen von somatoformen Syndromen. Somatoforme Störungen/Syndrome zeigen sich häufig im Verbund mit anderen psychischen Störungen, wobei die Komorbidität mit dem Alter zunimmt. Wie unsere Analysen ergaben, berichten Jugendliche und junge Erwachsene mit somatoformen Störungen, aber auch solche mit unterschwelligen Syndromen, vermehrt Beeinträchtigungen in verschiedenen sozialen Rollenbereichen und der Arbeitsproduktivität
As part of a longitudinal study, prevalence findings of somatoform symptoms, syndromes and disorders are presented for a random sample of 3021 respondents aged 14 to 24 years. The response rate was 71%. Assessment was made using the computer- assisted Munich-Composite International Interview (M-CIDI). Findings of the first part of the study revealed that 50% (men: 40%; women: 61%) of the sample once had a somatoform symptom in their life. Threshold somatoform disorders were rare with 2.7%. However, when including subthreshold somatoform syndromes (11%), the lifetime prevalence of any somatoform disorder/syndrome was 13%. Somatoform disorders and syndromes are often comorbid with other mental disorders, and comorbidity rises with age. Further, they are associated with disabilities and impairments in social and work domains

There is a paucity of research on the diagnosis of dissociative disorders in children. Most children are misdiagnosed with more common mental disorders with similar symptoms. Earlier recognition of dissociative disorders can save years of pain, suffering, and cost. This qualitative collective case study examined the process of diagnosing dissociation in two children under the ages of 12 at the beginning of treatment. A concurrent focus on the training and development of the therapist/researcher is included. Archival data including progress notes, psychotherapy notes, assessments, correspondence, legal documents, school records, and medical records were analyzed using within-case and cross-case analyses to identify individual and common themes that may expedite the diagnosis of dissociative disorders in children. The narrative presentation of a qualitative study with its thick, rich description may increase the understanding of clinicians with little or no experience and help them to differentiate these disorders from other disorders with overlapping symptoms. Factors that impeded and advanced the recognition of dissociative disorders were identified. Clinical findings underscore the role of knowledge and training, experience, and consultation in the diagnosis of dissociative disorders.

In Study 1, 280 undergraduate students (177 female, 103 male) were administered a battery of questionnaires assessing functional somatic symptoms, psychosocial variables, and behavioral responses to health-related situations. Significant predictors of functional somatic symptoms differed for females and males. The amount of stress experienced, perceived susceptibility to illness, perceived barriers to health care and level of pain tolerance were significant predictors for males. Significant predictors for females included perceived susceptibility to illness, amount of stress experienced, and not responding to health-related situations by seeking medical attention. A discriminant analysis correctly classified 21.25% of these groups.

Master of Science

Objectives: Historically, conversion symptoms have been understood to emerge within situations that generate strong emotions. From the modern perspective of integrative neuroscience, conversion symptoms can be conceptualised more specifically as involving motor-sensory/autonomic responses to situations that present a serious threat to self and that, in turn, elicit strong negative emotions. Like other responses to threat, they may be primed and fine tuned in the context of repeating, stressful interactions with attachment figures—the child’s environmental context—and automatically triggered when the individual is highly aroused and when other mechanisms for managing threat and danger (for example, verbal negotiation or running away) have failed or been blocked. This theoretical framework predicts that children and adolescents presenting with conversion disorders ought to process emotional information differently to healthy controls and that differences in emotion processing ought to be evident on standardized measures of emotion processing. To study this hypothesis, a research program was developed, involving multiple levels of analysis—psychological (cognitive and behavioural), physiological, and neural. The material presented in this thesis includes (a) articulation of the ideas (theory) that underpin the individual studies and the broader research program; (b) a detailed description of the methodology for the research program as a whole, and of the Dynamic-Maturational-Model of attachment (DMM) methodology used to assess emotion processing on the cognitive-psychological level (as investigated in the studies comprising this thesis); (c) presentation of the pilot attachment data; and (d) presentation of the final attachment data. The remaining components of the broader research program—analyses on the behavioural-psychological, physiological, and neural levels—are still in progress and will be carried through after completion of the thesis. Methods: Consecutive conversion subjects and age- and sex-matched controls were recruited over four years from the candidate’s consultation-liaison service at The Children’s Hospital at Westmead, Australia. Seventy-six subjects participated in structured interviews about attachment relationships and autobiographical events. Fifty-seven of these subjects completed a computerized battery of psychological and physiological tests in the laboratory (the broader research program). Recruitment for a modified version of this test battery in the functional magnetic resonance imaging machine (fMRI) is still ongoing. Publications Being Presented for Examination (Articles 1-4): Kozlowska, K. (2007). The developmental origins of conversion disorders. Clinical Child Psychology and Psychiatry, 12(4), 487–510. Kozlowska, K., & Williams, L. M. (2010). Self-protective Organization in Children with Conversion Symptoms: A Cross-Sectional Study Looking at Psychological and Biological Correlates. Mind & Brain, The Journal of Psychiatry, 1(2), 43–57. Kozlowska, K., & Williams, L. M. (2009). Self-protective organization in children with conversion and somatoform disorders. Journal of Psychosomatic Research, 67, 223–233. Kozlowska, K., Scher, S. et al. (2011). Patterns of emotional-cognitive functioning in pediatric conversion patients: implications for the conceptualization of conversion disorders, Psychosomatic Medicine 73(9): 775–788. Summary of Results: On a cognitive level of analysis—using the DMM—children and adolescents with conversion disorders show differences in emotion processing versus controls. Children and adolescents with conversion disorders were classified as falling into non-normative patterns of attachment, implying a chronic disruption of what are normally safe and nurturing attachments. Their attachment narratives were characterised by distortions in information processing: discrepancies in information about emotional events held in different memory systems; imbalance of information about affect and temporal order; imbalance of self and other perspectives; imbalance of self-responsibility and blame on others; a lack linguistic coherence and a high frequency of linguistic markers for unresolved loss and trauma. Unlike controls who fell largely into normative patterns of attachment (Type A1-2, Type B1-5, Type C1-2), children with conversion disorders showed two distinct patterns of emotion processing. Psychological inhibition (Type 3-6 or Type A+) was associated with conversion symptoms defined by discrete motor-sensory loss and positive motor symptoms (tremors and tics). Psychological coercion-preoccupation (Type 3-6 or Type C+) was associated with all other motor symptoms—bizarre gaits and postures, whole-body floppiness, and refusal to move. Non-epileptic seizures occurred across both groups. Additional publications articulating the application of this research to clinical practice. The following articles describe the integration of theoretical ideas and research findings from this thesis into clinical practice. The articles were written by the candidate in collaboration with her clinical team during the period of the thesis and are included in appendix 3 (articles B-E). Kozlowska, K. and R. Khan (2011). A developmental, body-oriented intervention for children and adolescents with medically unexplained chronic pain. Clinical Child Psychology and Psychiatry, 16(4): 575–598. Kozlowska, K., English, M., & Savage, B. (in press). Connecting body and mind: The first interview with somatizing patients and their families. Clinical Child Psychology and Psychiatry. Kozlowska, K., English, M., Savage, B., & Chudleigh, C. (in press). Multimodal rehabilitation: A mind-body, family-based intervention for children and adolescents impaired by medically unexplained symptoms. Part 1: The program. American Journal of Family Therapy. Kozlowska, K., English, M., Savage, B., Chudleigh, C., Davies, F., Paull, M., et al. (in press). Multimodal rehabilitation: A mind-body, family-based intervention for children and adolescents impaired by medically unexplained symptoms. Part 2: Case studies and outcomes. American Journal of Family Therapy. Conclusions: Contrary to the classic understanding of conversion disorder as a unified diagnostic entity with diverse symptoms, the studies comprising this thesis identified two distinct subgroups of conversion patients—those using psychological inhibition and those using psychological coercion-preoccupation—whose symptoms fell into discrete clusters. Psychological inhibition was associated with conversion symptoms reflecting motor-sensory inhibition or failure of inhibition, and psychological coercion-preoccupation was associated with all other motor-sensory conversion symptoms. Non-epileptic seizures occurred across both groups. These results suggest functional linkages between cognitive and motor-sensory processes in patients with conversion disorders. Motor-sensory conversion symptoms appear to be subcomponents or the unwanted consequences of broader self-protective patterns of response to threats—integrated sets of reactions involving psychological (cognitive and behavioural), physiological, and neural components. By contrast, non-epileptic seizures appear to be underpinned by an independent mechanism. Further research is needed to determine the neural mechanisms underlying these various processes.

Auf der Grundlage der Basisuntersuchung einer epidemiologischen prospektiven Verlaufsstudie (1995–1999) an 3021 Personen im Alter zwischen 14 und 24 Jahren werden epidemiologische Befunde zur Häufigkeit von somatoformen Beschwerden und somatoformen Syndromen/Störungen bei Jugendlichen und jungen Erwachsenen berichtet. Die Jugendlichen und jungen Erwachsenen wurden mit Hilfe des M-CIDI, einem standardisierten Interview zur Erfassung psychischer Symptome, Syndrome und Störungen nach dem DSM-IV, befragt. Die Ergebnisse der ersten Untersuchung zeigen, daß 50% der Jugendlichen einmal in ihrem bisherigen Leben unter einem somatoformen Symptom litten. Junge Frauen berichten häufiger von somatoformen Beschwerden als junge Männer (61 vs. 40%). Die im DSM-IV operationalisierten Kriterien einer somatoformen Störung werden nur von wenigen Jugendlichen und jungen Erwachsenen (2,7%) erfüllt. Die Prävalenz erhöht sich jedoch, wenn man nicht ausschließlich voll ausgeprägte somatoforme Störungen, sondern zusätzlich unterschwellige Syndrome in die Betrachtung einschließt: Hier berichten etwa 11% der Jugendlichen von somatoformen Syndromen. Somatoforme Störungen/Syndrome zeigen sich häufig im Verbund mit anderen psychischen Störungen, wobei die Komorbidität mit dem Alter zunimmt. Wie unsere Analysen ergaben, berichten Jugendliche und junge Erwachsene mit somatoformen Störungen, aber auch solche mit unterschwelligen Syndromen, vermehrt Beeinträchtigungen in verschiedenen sozialen Rollenbereichen und der Arbeitsproduktivität.
As part of a longitudinal study, prevalence findings of somatoform symptoms, syndromes and disorders are presented for a random sample of 3021 respondents aged 14 to 24 years. The response rate was 71%. Assessment was made using the computer- assisted Munich-Composite International Interview (M-CIDI). Findings of the first part of the study revealed that 50% (men: 40%; women: 61%) of the sample once had a somatoform symptom in their life. Threshold somatoform disorders were rare with 2.7%. However, when including subthreshold somatoform syndromes (11%), the lifetime prevalence of any somatoform disorder/syndrome was 13%. Somatoform disorders and syndromes are often comorbid with other mental disorders, and comorbidity rises with age. Further, they are associated with disabilities and impairments in social and work domains.

O desenvolvimento desta pesquisa é fruto da experiência psicanalítica junto ao Ambulatório de Transtornos Somatoformes (SOMA) do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IPq-HCFMUSP), um setor que funciona, desde 2009, para receber os casos advindos do complexo hospitalar ou da rede pública, nos quais a questão subjetiva ganha relevo a partir de possíveis causas orgânicas. As manifestações são de alguma forma agravadas ou oriundas de conflitos psíquicos. Desde a quinta edição do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-V-2013), tais pacientes são classificados como Transtornos de Sintomas Somáticos e Transtornos Relacionados. A tese confronta as inquietações clínicas de dez anos (2009-2018) de trabalho como analista no SOMA e indagações teóricas que foram sendo buscadas do que se trata, como se trata e o que se trata? Quatro eixos estruturam a condução da pesquisa e sua escrita: a) como os sistemas classificatórios definem os Transtornos Somatoformes (TS) e os Sintomas Somáticos; b) como são possíveis aproximações entre as duas categorias e a leitura psicanalítica; c) como os profissionais de outras instituições lidam com estes mal-estares; d) como entendo a subjetividade destes pacientes. A literatura médica responde, em linhas gerais, que, fundamentalmente, o vínculo médico-paciente configura-se como a maior potência para cuidar dos que adoecem, tendo-se mostrado produtiva a articulação entre a psiquiatria e a psicanálise. A experiência clínica corrobora os achados científicos. Quando admitidas no serviço, as pessoas são convidadas a falarem de seu sofrimento e suas histórias evidenciam vidas marcadas pela violência física, sexual e/ou psicológica, associadas à restrições de afeto. A escuta e a disponibilidade dos profissionais da equipe tende a fazer a diferença com relação aos que se encontram aferrados à rotina hospitalar em busca de exames, de atenção, de nomes e de compreensão de si e de seus corpos. Noção de trauma, dificuldade simbólica, flexibilidade do setting, empatia, vínculo, nomeação, contratransferência são valiosos para o entendimento e o cuidado destes pacientes e para o enfrentamento desta clínica que se mostra complexa e desafiadora aos que dela se ocupam. Freud e Ferenczi, dentre outros, são vitais para a tarefa. A aposta é que ao dispor da escuta do analista o paciente pode criar uma nova narrativa a propósito de sua vida e das dimensões clínicas de seu sofrimento. Tal narrativa, como aquelas com as quais nos constituímos, passa a ter papel estruturante nas transformações dos sintomas e na condução da própria existência. Dentre os efeitos do trabalho assim conduzido no ambulatório pode-se também observar a prevenção de riscos e de iatrogenias
The development of this research is the result of the psychoanalytic experience at the Somatoform Disorders Ambulatory (SOMA) of the Institute of Psychiatry of the Clinical Hospital of the Medical School of the University of São Paulo (IPq-HCFMUSP). Since 2009 the SOMA treats cases from the hospital and public network, in which subjective issues are highlighted by possible organic causes. The patients manifestations are all in some way aggravated or derived from psychic conflicts. Since the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V-2013), such patients are classified with Somatic Symptom Disorders and Related Disorders. The thesis confronts questions derived from ten years (2009 2018) of work experience as an analyst at SOMA Ambulatory Care and the theoretical questions that have been investigated what is it, what is it about, and how to treat it? Four facets structured the conduction of the research and its writing: a) how do the classificatory systems define Somatic Symptom Disorders (SSD) and the Somatoform Disorders; b) what are the possible approximations between the two categories and the psychoanalytic reading; c) how do professionals from other institutions deal with these malaise; d) how do I understand the subjectivity of these patients. The medical literature shows, in general, that the doctor-patient-relationship fundamentally appears as the greatest power while taking care of those who fall ill, and indicates that the relationship between psychiatry and psychoanalysis is productive. And clinical experience corroborates the scientific results. When admitted in the services of the ambulatory, people are invited to talk about their suffering and their stories evidence lives marked by physical, sexual and/or psychological violence in association with affection restrictions. Listening and availability of team professionals tends to make difference in relation to those who are stuck in the hospital routine searching for examinations, attention, terms, and understanding of themselves and their bodies. The notions of trauma, symbolic difficulty, flexibility of the setting, empathy, bonding, determination, countertransference are as valuable for the understanding and care of the patients as well as for the medical field that appears as complex and challenging to those who take care of it. Freud and Ferenczi, among others, are vital to the task. The expectation is that by providing the analysts listening the patient can create a new narrative about his life and the clinical dimensions of his suffering. Such a narrative, like those with which we are constituted, has a fundamental role in the transformation of symptoms and in the conduct of our own existence. Among the effects of the work conducted in the ambulatory one can also observe the prevention of risks and iatrogenies

Objetivo: avaliar as diferenças estruturais e funcionais entre o cérebro de pacientes com tontura postural-perceptual persistente (TPPP) e controles. Método: o estudo foi aprovado pela comissão de ética local. As voluntárias deram consentimento formal. 16 mulheres com TPPP (44.7±8.3 anos) e 16 controles (46.5±8.5 anos) foram pareadas por sexo e idade. Imagens de ressonância magnética funcional (RMf) e estrutural foram adquiridas utilizando sistema 3.0 T durante a visibilização de figuras padronizadas do International Affective Pictures System (IAPS) com valência negativa, positiva e neutra. Realizou-se análise estrutural segmentar e volumétrica com o programa Freesurfer e funcional com o FSL (FMRIB Software Library) usando correção fatia-tempo e de movimento, suavização espacial (5mm FWHM), e normalização no espaço standard MNI (Montreal Neurological Institute). O modelo linear geral (GLM) incluiu regressores por grupo e condições. Adotou-se um limiar de Z = 3.09 (p < 0.001) para cada vóxel, e um nível de significância para correção de clusters de p < 0.05. O Z=2.3 foi utilizado na comparação entre grupos. Resultados: o grupo com TPPP apresentou ativação na região do córtex cingulado anterior na diferença entre contrastes positivos e negativos por queda de sinal na visibilização de estímulos negativos; enquanto o grupo controle teve efeito BOLD (Blood Oxygen Level Dependent) positivo na região amigdaliana bilateralmente na diferença entre contrastes negativos e positivos. Houve ativação em giro angular esquerdo na diferença entre contrastes negativos e positivos e entre grupos (pacientes > controles). Conclusão: ativação em região amigdaliana em resposta a estímulos negativos em relação aos positivos é frequentemente encontrada em pacientes com ansiedade e síndrome do estresse pós-traumático, mas não foi vista no nosso grupo com TPPP, só no controle. Por outro lado, o grupo com TPPP mostrou desativação da região do córtex cingulado anterior, um modelo descrito em algumas, mas não em todas as disfunções ansiosas, e não identificado no grupo controle. Além disto, o efeito BOLD positivo na região do giro angular esquerdo, área não inclusa no sistema límbico, com múltiplas funções, dentre elas a orientação espacial, indicam que mais trabalhos são necessários para elucidar o mecanismo cerebral da TPPP
Objectives: evaluate structural and functional differences in brain among patients with postural perceptual persistent dizziness (PPPD) and controls. Method: The study was approved by local IRB, and volunteers gave their informed consent. Sixteen women with PPPD (44.7 ± 8.3 years-old) were compared to 16 controls (46.5 ± 8.5 years-old) matched by age and gender. Structural and functional brain images were acquired in a 3.0T MRI system while subjects were presented with pictures from a standard reference (International Affective Pictures System - IAPS) with positive, neutral and negative emotional valence stimuli. Structural images were analysed in Freesurfer program and fMRI images in FSL (FMRIB Software Library) using slice-time and motion correction, spatial smoothing (5mm FWHM), and normalized images into MNI standard space. The GLM model included regressors for groups and conditions. A threshold Z-score = 3.09 (p < 0.001) was used for each voxel, and was adopted the correction by clusters at a p < 0.05 significance level. A Z-score = 2.3 was used for comparison between groups. Results: the PPPD group showed increased brain response at anterior cingulate cortex when comparing [positive > negative] stimuli as a result of deactivation during negative stimuli, whereas the control group had positive BOLD when comparing [negative > positive] stimuli at amigdala region in both sides. PPPD group had increased brain response when comparing [negative>positive] stimuli and [patients > controls] in the left angular gyrus. Conclusion: The amygdala region activation in control group in response to negative than positive stimuli is a pattern often found in patients with anxiety and traumatic stress but not was seen in our patient group. In contrast, they showed deactivation of the anterior cingulate cortex in response to negative stimuli, a pattern found in some, but not all anxiety disorders, and not identified in the control group. Otherwise, the positive BOLD in angular gyrus, brain area not included in limbic system, with multiple functions, including spatial orientation, indicate that more work is needed to elucidate brain mechanisms underlying PPPD

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O presente trabalho pretendeu investigar, por meio de estudo qualitativo exploratório, utilizando-se da metodologia Estudo de Caso, a presença ou ausência de manifestações psicossomáticas em sujeitos com transtorno mental psicótico. Para o fim proposto, discutiu-se o papel das emoções, em especial do medo e do estresse, potenciais desencadeadores das manifestações psicossomáticas. Contextualizou-se o campo da pesquisa, no qual usuários com transtorno mental têm acesso ao tratamento diferenciado do modelo hospitalocêntrico, respeitados como sujeitos e cidadãos de direito. A pesquisa de campo foi realizada com pessoas de ambos os sexos, maiores de 18 anos, que apresentam transtorno mental psicótico, usuários de um Centro de Atenção Psicossocial (CAPS), situado em Juiz de Fora, selecionadas por meio de amostragem, por variedade de tipos. Verificou-se que, junto à psicose, também se podem evidenciar manifestações orgânicas, de cunho psicossomático. Impossível evidenciar uma relação causa/efeito; contudo, afirma-se a existência de fatos concretos, sentimentos, emoções e reações, que facilitam, direcionam e confluem para o adoecimento do corpo. Confirmou-se que os sujeitos pesquisados sofrem da emoção do medo, do estresse, e que esses fatores podem ser desencadeadores das doenças psicossomáticas.
This work intended to investigate, through exploratory qualitative study, using the methodology Case Study, the presence or absence of somatoform disorders in subjects with psychotic mental disorders. For this purpose, it was discussed the role of the emotions, such as the fear and the stress, as potential trigger of the somatoform disorders. The field of the research was contextualized, in which users with mental disorders have access to the differentiated treatment of the hospital-centered model, in which they are treated as individuals and citizens with rights. The field research was conducted among individuals of both sexes, over 18 years old, who present psychotic mental disorder and users of a Center of Psychosocial Attention situated in Juiz de Fora, selected by sampling by variation in the types. It was verified that with the psychosis we can also evidence organic manifestations with a psychosomatic character. Although impossible to evidence a cause/effect relation, it is stated the existence of facts, feelings, emotions and reactions that facilitate, direct and converge to the illness of the body. It was confirmed that the surveyed subjects suffer the emotion of fear, stress and that these may be triggers of psychosomatic illnesses.

Objective: The perceptual mechanisms underlying the development and maintenance of excessive physical symptom reporting (i.e. 'somatisation') are poorly understood. Research with non-clinical participants suggests that high and low symptom reporters perform differently when detecting somatosensory signals and have different false alarm rates in which the presence of a signal is incorrectly reported when no signal is present. High symptom reporters often incorrectly report the presence of a signal particularly when a stimulus in a different sensory modality is presented. Previous research has shown that it may be possible to reduce false alarm rates by perceptual training using bi-modal visuo-tactile stimuli pairing. The current was designed to test this hypothesis. Methods: Seventy non-clinical participants scoring either high or low on the Patient Health Questionnaire (PHQ-15; a measure of somatisation) completed the Somatic Signal Detection Task (SSDT), a novel perceptual paradigm that purports to measure individual differences in somatosensory distortion. Prior to the SSDT, approximately two thirds of the sample completed either a 'weak' or 'strong' perceptual training protocol in which a suprathreshold tactile and visual stimuli were paired either infrequently (25%) or frequently (75%), with the intention of training participants to discriminate tactile signal from noise more effectively. The remaining participants received no perceptual training. Factors known to be strongly associated with somatisation were controlled for. Negative affectivity was controlled for using the State-Trait Anxiety Inventory Trait Version (STAI-T; Spielberger, Gorsuch & Lushene, 1970), somatosensory amplification was controlled for using the Somatosensory Amplification Scale (SSAS; Barsky, Goodson, Lane & Cleary, 1988), the Patient Health Questionnaire (PHQ-9; Kroenke, Spitzer, & Williams, 2001) was used to control for depression and the Health Anxiety Inventory-Short Version (SHAI; Salkovskis, Rimes, Warwick & Clark, 2002) was used to control for hypochondriacal factors with the Patient Health Questionnaire-Generalised Anxiety Disorder (PHQ-GAD-7; Spitzer, Kroenke, Williams & Löwe, 2006) being used to control for anxiety. Results: The high PHQ-15 group reported significantly more false alarms and had a significantly higher response criterion than the low PHQ-15 group in the no perceptual training conditions. The perceptual training reduced the false alarm rate for the high PHQ-15 group but did not alter response criterion. Although the findings were in the predicted direction, neither of these findings reached significance. The effect size indicated that this was due to low power. Conclusions: The findings were suggestive of the effect of perceptual training reducing false alarm rates; however, low power meant that it was impossible to draw firm conclusions. Further research with a larger sample is required.

Thesis (M.A.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
Body Dysmorphic Disorder, or BDD, is a prevalent disease that affects children, adolescence, and adults. Its onset is usually in late childhood/early adolescence, and the disorder frequently extends for the lifetime ofthe patient. The disorder has been in the Diagnostic and Statistical Manual ofMental Disorders since its third edition as a somatoform disorder. The primary definition of BDD centers around the fact that those suffering from the disorder have a preoccupation with an imagined defect in their physical appearance that is usually not seen from an outsider's perspective. This preoccupation results in impairment in one's social life, education, and employment atmosphere. Through various research projects, it has been discovered that BDD shares many common similarities to other disorders, including obsessive-compulsive, social anxiety, and eating disorders. Like obsessive-compulsive disorder, those with BDD have several types of obsessions and compulsions, such as mirror checking for multiple hours a day to study their defect. This can further lead into the yearning desire to obtain cosmetic surgery. Patients with BDD often suffer from anxiety and depression, which can result in a low educational level, no employment, and trouble being in any sort of relationship. These symptoms tend to be more severe in those with the non-delusional form of BDD versus the delusional form. Research via functional Magnetic Resonance Imaginf and other imaging techniques has shown that those suffering from BDD may have different brain patterns than healthy subjects, especially concerning spatial frequency. Currently there are no FDA-approved medications specifically for the treatment ofBDD, but serotonin-reuptake inhibitors often used to treat depression have shown to be successful in alleviating BDD symptoms. Cognitive behavioral therapy, exposure and response prevention, and interpersonal psychotherapy, are also implemented as alternative treatment options to pharmacological therapy. The fifth edition of the Diagnostic and Statistical Manual ofMental Disorders is expected to be released in 2013 addressing the new information that has resulted from the great amount of research that has been conducted in the past decade and a half.

São cada vez mais freqüentes as queixas cosméticas na sociedade contemporânea objetivando a perfeição das formas do corpo e da pele. Os dermatologistas e cirurgiões plásticos são frequentemente consultados para avaliar e tratar essas queixas. Sendo assim é importante conhecer o Transtorno Dismórfico Corporal, inicialmente chamado de dismorfofobia que foi pouco estudado até recentemente. Esse transtorno é relativamente comum, por vezes incapacitante, e envolve uma percepção distorcida da imagem corporal caracterizada pela preocupação exagerada com um defeito imaginário na aparência ou com um mínimo defeito corporal presente. A maioria dos pacientes apresenta algum grau de prejuízo no funcionamento social e ocupacional e como resultado de suas queixas obsessivas com a aparência podem desenvolver comportamentos compulsivos, em casos mais graves há risco de suicídio. O nível de juízo crítico é prejudicado, não reconhecem que seu defeito é mínimo ou inexistente e freqüentemente procuram tratamentos cosméticos para um transtorno psíquico. A prevalência do transtorno na população geral é de 1 a 2% e em pacientes dermatológicos e de cirurgia cosmética de 2,9 a 16%. Neste estudo investigou-se a prevalência do Transtorno Dismórfico Corporal em pacientes dermatológicos. Entrevistadores treinados avaliaram com questionários e entrevistas semi-estruturadas (SCID) pacientes que procuravam tratamentos cosméticos clínicos e cirúrgicos (grupo Cosmiatria, n=150), que procuravam a dermatologia em geral (grupo Geral, n=150) e grupo controle de 50 pacientes. Três psiquiatras independentes fizeram a melhor estimativa diagnóstica (best estimate diagnosis). Foram diagnosticados 32 pacientes (Cosmiatria 14%; Geral 6,7%; Controle 2%). As diferenças entre as prevalências nos três grupos foram significativas, bem como entre o grupo da Cosmiatria e o Controle. A regressão logística mostrou maior prevalência na Cosmiatria do que no grupo Geral e Controle, em indivíduos solteiros e com menor índice de massa corpórea. A gravidade foi moderada (em escala validada) e as obsessões foram mais significativas no grupo da Cosmiatria do que no Geral. A aplicação de escala de avaliação de crenças mostrou que o nível de juízo crítico estava mais prejudicado nos pacientes do grupo da Cosmiatria. Nenhum paciente havia sido diagnosticado previamente. As comorbidades psiquiátricas foram freqüentes, principalmente o Transtorno Depressivo Maior e o Transtorno Obsessivo Compulsivo. A comparação de subgrupos de pacientes que tinham o Transtorno Dismórfico Corporal ou este associado ao Transtorno Obsessivo-Compulsivo não mostrou diferenças significativas quanto às variáveis demográficas, comorbidades psiquiátricas, gravidade do transtorno ou nível de juízo crítico. As queixas dermatológicas mais freqüentes, em média duas, foram: discromias, acne, quanto à forma do corpo e ao envelhecimento. No grupo Cosmiatria a maioria dos pacientes já havia se submetido a tratamentos ou cirurgias cosméticas com resultados insatisfatórios. Os achados desse estudo apontam para uma maior prevalência em pacientes dermatológicos, principalmente nos que procuram tratamentos cosméticos, sugerindo que possam ser mais obsessivos e ter pior nível de juízo crítico em relação aos seus sintomas. Considerando a alta prevalência do Transtorno Dismórfico Corporal em pacientes dermatológicos e que os tratamentos cosméticos raramente melhoram seus sintomas, o treinamento dos profissionais para a investigação sistemática, diagnóstico e encaminhamento para tratamento psiquiátrico parece fundamental
Cosmetic concerns are increasingly pervading the contemporary societies, focusing on body shape and the skin perfection. Dermatologists and plastic surgeons are frequently consulted to evaluate and treat these concerns. Therefore it is important to be aware of the Body Dysmorphic Disorder, also known as dysmorphophobia, little studied until recently. This disorder is relatively common sometimes causing impairment involving a distorted perception of the body image characterized by an excessive preoccupation with an imagined or minimal appearance defect. Most of the patients experience some degree of impairment in social or occupational functioning and as a result, their obsessive thoughts, may lead to repetitive behaviors and in severe cases, to attempted suicide. Most individuals have poor insight and they do not acknowledge the defect is minimal or inexistent and seek out cosmetic treatments for a psychiatric disorder. The prevalence of this disorder among general population ranges from 1 to 2 % and in dermatological and cosmetic surgery patients ranges from 2, 9 to 16%. This study assessed the prevalence of Body Dysmorphic Disorder in dermatological patients. Trained interviewers used questionnaires (BDDQ) and semi-structured clinical interviews (SCID) to access patients seeking clinical or surgical cosmetic treatments (Cosmetic group, n=150), seeking dermatology in general (General group, n=150) and a control group of 50 subjects. Three independent psychiatrists assigned the best estimate diagnosis and 32 patients were diagnosed with the disorder (Cosmetic 14%, General 6, 7% and Control 2%). Prevalence differences in the three groups were significant, also for Cosmetic and Control groups. In the logistic regression a higher prevalence has been noticed in the Cosmetic group (when compared with General and Control groups), in patients that are not currently married and with less body mass index. The severity of the symptoms assessed by a validated scale (BDD-YBOCS) was moderate and the obsessions were significantly higher in the Cosmetic group as compared to the General one. Beliefs were assessed by a scale (BABS) and insight were significantly poorer in the Cosmetic group. None of the patients had been previously diagnosed. Psychiatric co-morbidities were frequent, mostly Major Depressive Disorder and Obsessive-Compulsive Disorder. Comparing two patients subgroups with just Body Dysmorphic Disorder and patients with Obsessive-Compulsive Disorder as comorbidity show no differences according to demographic variables, Axis I psychiatric comorbidity, symptoms severity and level of insight. The most frequent dermatological concerns were dyschromias, acne, the shape of the body and ageing. In the Cosmetical group most of the patients have performed clinical or surgical cosmetic treatments with poor results. Our findings provide further support for higher prevalence of Body Dysmorphic Disorder in dermatological patients, mainly those seeking cosmetic treatments and suggests that those patients might be more obsessive and having poorer insight into their symptoms. Taking into account the high prevalence of Body Dysmorphic Disorder in dermatological patients and cosmetic treatments that rarely improve symptoms there are compelling reasons for training professionals to systematically investigate, diagnose and refer these patients to adequate psychiatric treatment

ANTECEDENTES: Sintomas somatoformes são freqüentes e estão associados com sofrimento mental na população geral e em diversos níveis de atenção. Grande parte da interações que subjazem a estas associações são pouco conhecidas ou mesmo desconhecidas. OBJETIVOS E MÉTODOS: A partir de revisão bibliográfica, investigar: a) a história dos quadros clínicos de somatização; b) suas diversas categorias segundo conceitos contemporâneos psiquiátricos e não-psiquiátricos (transtornos somatoformes, transtornos dissociativos-conversivos, síndrome da fadiga crônica, fibromialgia, síndrome do cólon irritável etc.); c) fatores associados e hipóteses etiológicas para estes fenômenos. Através de dados provenientes do Estudo de Área de Captação do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Andrade et al., 1994) - um estudo transversal de morbidade física e psiquiátrica que entrevistou uma amostra representativa dos bairros paulistanos de Vila Madalena e Jardim América - explorar a prevalência e classificação de sintomas físicos relatados, em especial aqueles sem explicação médica (SEM). Avaliar através de regressão logística as associações entre: a) síndromes somatoformes e variáveis demográficas; b) síndromes somatoformes e uso de medicamentos e serviços de saúde; c) sintomas físicos de qualquer tipo (QT) e SEM com variáveis demográficas; e d) sintomas físicos QT e SEM com transtornos mentais. Pesquisar, através de análise de classes latentes de respostas dicotômicas para a presença ou não de 36 sintomas físicos SEM: a) agrupamento de indivíduos em classes (análise de aglomeração, ou cluster); e b) agrupamento de sintomas em dimensões (análise fatorial). Foram realizadas 1.464 entrevistas com o Composite International Diagnostic Interview (CIDI), entrevista estruturada diagnóstica para transtornos mentais, incluindo transtornos somatofomes e dissociativos; e um caderno de variáveis demográficas, doenças físicas crônicas, uso de serviços médicos ou psicológico e consumo de medicamentos. RESULTADOS: Ausência de associação entre síndomes somatoformes e variáveis demográficas. Associação entre síndromes somatoformes e maior uso de serviços de saúde e de medicamentos. Associação de características demográficas com certos sintomas físicos QT e SEM. Sintomas físicos QT e SEM estão associados com transtornos mentais de uma forma geral. Alguns sintomas físicos (desmaios, dispnéia, dores no peito, dores nos membros, formigamento, metrorragia, fraqueza muscular, nó na garganta, poliúria, taquicardia e tonturas) encontram-se associados com vários dos transtornos mentais testados. Os indivíduos se aglomeraram em duas classes, uma pauci- e outra polissintomática; a classe polissintomática se mostrou associada com doenças físicas, transtornos mentais e uso de serviços de saúde. Os sintomas se agruparam em um único fator, indicando a existência de uma dimensão de somatização na população geral.
BACKGROUND: Somatoform symptoms are frequent and are associated with mental distress in several settings and in the general population. Many of these interactions are not well understood or not understood at all. OBJECTIVE AND METHODS: Based on bibliographical research, to investigate: a) the history of somatization-related illnesses; b) its many categories according to contemporary psychiatric and non-psychiatric concepts (somatoform disorders, dissociative-conversive disorders, chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome etc.); c) associated factors and etiological hypothesis for these phenomena. Using data available from the University of São Paulo Institute of Psychiatry Epidemiologic Catchment Area Study (Andrade et al., 1994) - a cross-sectional survey of physical and psychiatric morbidity which interviewed a representative sample of São Paulo city boroughs of Vila Madalena and Jardim América - to explore the prevalence and classification of reported physical symptoms in general, and specifically those which are medically unexplained (MU). To appraise, using logistic regression, the following associations: a) somatoform syndromes and demographic variables; b) somatoform syndromes and use of medication and health services; c) MU symptom and any type (AT) of symptom with demographic variables; and d) MU and AT physical symptoms with mental disorders. To probe, through latent class analysis of yes or no answers for 36 MU physical symptoms: grouping of subjects in classes (cluster analysis); and b) grouping of symptoms in dimensions (factor analysis). One-thousand, four-hundred and sixty-four interviews were performed using the Composite International Diagnostic Interview (CIDI), structured diagnostic interview for mental disorders, including somatoform and dissociative disorders; and a form of demographic variables, chronic physical diseases, use of medical and psychological services and medication intake. RESULTS: No association between somatoform syndromes and demographic variables. Association between somatoform syndromes and increased use of services and medication intake. Association between demographic variables and certain MU/AT symptoms. Physical symptoms AT/MU are associated with mental disorders, in general. Some physical symptoms (fainting, dyspnea, chest pain, arm or leg pain, tingling, heavy menses, muscle weakness, lump in throat, polyuria, palpitations and dizziness) are associated with many of the studied mental disorders. Subjects were clustered into two classes, with low and high symptom scoring; the high scoring class was associated with physical diseases, mental disorders, use of health services and medication intake. Symptoms were grouped into one single factor, pointing to the existence of a somatization dimension in the general population.

Somatoform disorder is a prevalent mental health disorder in the United States. This disorder costs the United States one billion dollars annually. Medical providers report somatoform disorder is difficult to treat. Previous studies have shown that Cognitive Behavioral Therapy (CBT) is effective at reducing symptoms of somatoform disorder. Unfortunately, little research has been done on treatment outcomes and cost of somatoform disorder, particularly by profession to reduce health care costs for somatoform patients and providers. Administrative data from CIGNA for 149 somatoform disorder cases were analyzed to determine the cost, number of sessions, dropout rates, and recidivism rates for somatoform disorder. These same variables for somatoform disorder were also analyzed by profession for medical doctors, psychologists, master's nurses, master's social workers, marriage and family therapists, and professional counselors. Descriptive statistics showed that the recidivism rates and number of sessions for somatoform disorder is higher than average. Drop-out rates were consistent with the average. Analyses revealed no significant difference in total cost by profession, but did indicate a significant difference in cost per session for medical doctors. Analyses indicate lower level (M.S.) providers have no significant difference in drop-out rates and recidivism rates compared to higher level (Ph.D.) providers.

Abstract Somatization is a widespread phenomenon causing subjective suffering and disability. The aim of the study was to assess somatization disorder (SD) and somatization symptoms among young adult population and their associations with sociodemographic factors, alexithymia and temperament as well as psychiatric comorbidity. Various suggestions have been presented to operationalize somatization but none of them has been shown to be superior to others. In this study two definitions were used: SD by DSM-III-R classification diagnostic criteria and "somatization" meaning four or more symptoms of the 35 symptoms of DSM-III-R SD criteria. The study population was a subsample of the Northern Finland Birth Cohort 1966 (NFBC 1966), consisting of cohort members living in Oulu (N = 1,609) on January 1st 1997. The NFBC 1966 is a general population birth cohort of 12,058 live-born children covering 96.3% of all deliveries in the catchment area. The best-estimated procedure was used for assessment of psychiatric morbidity including SD and somatization. Data were collected from the Finnish Hospital Discharge Register and from all available outpatient and inpatient records. Data on education were gathered from Statistics Finland. Other sociodemographic variables, alexithymia and temperament scores were drawn from questionnaires of the field study conducted in 1997 and from earlier follow-up studies. The prevalence of SD was 1.1% (N = 18). Of the subjects 6.1% (N = 97) had somatization. The female-to-male ratio was 5:1 and 6:1, respectively. SD was not recognized by any of the treating physicians, at least not documented in case notes. The observed occurrences of SD and somatization were at a level comparable with earlier international population studies. Somatization did not associate with depression or alexithymia, and neither could a characteristic temperament profile be recognized. Somatization was associated with psychological distress. These results indicate a need for training physicians to recognize SD and somatization and its comorbidity. This will have implications both for psychiatry and other medical specialties regarding collaboration and underlines the importance of liaison-psychiatry at general hospitals. The results suggest a need for more studies about the etiology and development of SD and somatization
Tiivistelmä Somatisaatio on yleinen ilmiö, josta aiheutuu subjektiivista kärsimystä ja toimintakyvyn laskua. Tämän tutkimuksen tarkoitus oli arvioida somatisaatiohäiriön ja somatisaatio-oireilun yleisyyttä nuorilla aikuisilla sekä näiden ilmiöiden yhteyttä sosiodemografisiin tekijöihin, aleksitymiaan, temperamenttiin ja psykiatriseen sairastavuuteen. Somatisaation käsitteellistämiseksi on esitetty useita vaihtoehtoja mutta mikään niistä ei ole osoittautunut muita paremmaksi. Tässä tutkimuksessa käytetiin kahta määritelmää: DSM-III-R -diagnoosiluokituksen mukaista somatisaatiohäiriön diagnoosia tai somatisaatio-oireilua, jossa esiintyy neljä tai useampia DSM-III-R:n 35 somatisaatiohäiriön oireesta. Tutkimusaineiston muodostivat Pohjois-Suomen vuoden 1966 syntymäkohortin ne jäsenet, jotka asuivat Oulussa 1. tammikuuta 1997 (N = 1,609). Alkuperäinen kohortti koostuu 12,058 elävänä syntyneestä tutkittavasta, mikä kattaa 96.3 % kaikista synnytyksistä Pohjois-Suomessa. Niin kutsutun best-estimated -menettelyn avulla arvioitiin tutkittavien psykiatrista sairastavuutta mukaan lukien somatisaatiohäiriö ja -oireilu. Tietoa kerättiin sairaaloiden poistoilmoitusrekisteristä. Avohoidon sairauskertomustieto koottiin kattavasti. Koulutusasteesta saatiin tieto Tilastokeskukselta. Muita sosiodemografisia tekijöitä, aleksitymiaa ja temperamenttia arvioitiin vuoden 1997 kenttätutkimuksen ja aiempien seurantatutkimusten tietojen avulla. Somatisaatiohäiriön esiintyvyys oli 1.1 % (N = 18). Somatisaatio-oireita todettiin 6.1 % (N = 97) tutkittavista. Naisten osuus oli somatisaatiohäiriössä 5:1 ja somatisaatio-oireilussa 6:1. Osoittautui, että lääkärit eivät tunnistaneet somatisaatiohäiriötä, ainakaan sitä ei oltu kirjattu sairauskertomuksiin. Havaitut somatisaatiohäiriön ja -oireilun esiintyvyydet ovat sopusoinnussa aiempien kansainvälisten tutkimusten kanssa. Somatisaatio-oireilu ei liittynyt masennukseen tai aleksitymiaan eikä somatisaatio-oireilusta kärsiville tutkittavilla todettu tyypillistä temperamenttiprofiilia. Somatisaatio liittyi psyykkiseen stressiin. Johtopäätöksenä voidaan todeta, että lääkäreille tulisi tarjota koulutusta somatisaatiohäiriön ja -oireilun tunnistamisessa. On tärkeää tunnistaa somatisaatio ja siihen liittyvä oheissairastavuus. Havainnot korostavat yleissairaaloiden yhteistyöpsykiatrian ja muiden erikoisalojen yhteistyön merkitystä somatisaatiosta kärsivien potilaiden tutkimuksessa ja hoidossa. Somatisaatiohäiriön ja -oireilun etiologian ja kehittymisen selvittämiseksi tarvitaan uusia tutkimuksia

Moždani udar predstavlja drugi uzrok smrti u celom svetu i neurološku bolest sa najvećim stepenom invaliditeta. Za povoljan ishod moždanog udara veoma je važno sprečavanje i lečenje somatskih kompikacija (SK), pri čemu je njihova učestalost i značaj za oporavak pacijenata potcenjena, a uticaj na ishod moždanog udara zanemaren. Ciljevi istraživanja su bili da se utvrdi učestalost pacijenata sa somatskim komplikacijama u akutnoj fazi moždanog udara; zatim da se utvrdi učestalost svake pojedinačne somatske komplikacije: pneumonije, urinarnih infekcija, duboke venske tromboze, tromboembolije pluća, dijarealnog sindroma i akutnog koronarnog sindroma; zatim da se utvrde faktori rizika za nastanak svake pojedinačne SK, kao i da se utvrdi uticaj SK na ishod bolesti - iskazan kroz njihovu povezanost sa funkcionalnim statusom, dužinom hospitalizacije i mortalitetom pacijenata. Istraživanje je sprovedeno kao prospektivno i obuhvatilo je 403 pacijenta hospitalizovanih zbog akutnog moždanog udara na Klinici za neurologiju Kliničkog centra Vojvodine u periodu od godinu dana. Pacijenti su podeljeni u dve grupe, gde su prvu grupu sačinjavali pacijenti sa registrovanom jednom ili više somatskih komplikacija (n = 162), a drugu su činili pacijenti koji nisu imali somatske komplikacije (n = 241). Evaluacija pacijenata obuhvatila je registrovanje sociodemografskih karakteristika, ličnu i porodičnu anamnezu, karakteristike moždanog udara, neurološki status na prijemu i otpustu, funkcionalni status na prijemu i otpustu, laboratorijske analize krvi i urina na prijemu, vrstu i vreme nastanka pojedinačne somatske komplikacije, sve relevantne dijagnostičke metode za postavljenje dijagnoze i definisanje potencijalnih faktora rizika. Somatske komplikacije se češće javljaju kod starijih osoba, prosečne starosti 72,9 godina, kod osoba ženskog pola i kod pacijenata sa hemoragijskim moždanim udarom. Somatske komplikacije registrovane su kod 40,2% pacijenata, pri tome urinarnu infekciju imalo je 20,3% pacijenata, pneumoniju 16,3%, infarkt miokarda 4,7%, plućnu tromboemboliju 3,4%, duboku vensku trombozu 2,4% i dijarealni sindrom 2,9% pacijenata. Nezavisni prediktori pneumonije su disfagija, narušeno stanje svesti, hronična opstruktivna bolest pluća, mRS veći od 3. Prediktori urinarnih infekcija su: podatak o rekurentnim urinarnim infekcijama, ženski pol, starost preko 70 godina, mRS veći od 3 i NIHSS skor veći od 16. Kao nezavisni prediktori plućnog tromboembolizma dobijeni su duboka venska tromboza, narušeno stanje svesti i gojaznost, dok se jedinim nezavisnim prediktorom dijarealnog sindroma pokazala starost pacijenta preko 70 godina. Prediktori akutnog koronarnog sindroma su: starost veća od 70 godina i hemoragijski moždani udar. Pacijenti sa SK, na kraju hospitalnog lečenja imaju značajno lošiji funkcionalni status u odnosu na pacijente bez somatskih komplikacija. Somatske komplikacije statistički značajno produžavaju hospitalizaciju. Kod četvrtine pacijenata (25,9%) sa somatskim komplikacijama u akutnoj fazi moždanog udara registrovan je letalni ishod. Najveći procenat smrtnih ishoda kod pacijenata sa somatskim komplikacijama registrovan je kod pacijenata sa infarktom miokarda (63,2%), a najmanji kod pacijenata sa urinarnom infekcijom (18,3%).
Stroke is the second cause of death worldwide and neurological disease with the highest level of disability. For a favorable outcome of stroke, the prevention and treatment of somatic complications are of great importance, while their frequency and the importance of the recovery of patients are underestimated, and the influence on the outcome of stroke is neglected. The aims of the study were: to determine the frequency of patients with somatic complications in the acute phase of stroke; to determine the frequency of each somatic complication: pneumonia, urinary infections, deep venous thrombosis, lung thromboembolism, diarrheal syndrome, and acute coronary syndrome; to identify risk factors for the emergence of each somatic complication, as well as to determine the effect of those complications on the outcome of the disease - expressed through their association with the functional status, length of hospitalization and mortality of patients. The study was conducted as a prospective and included 403 patients hospitalized due to acute stroke at the Clinic for Neurology of the Clinical Center of Vojvodina for a period of one year. Patients were divided into two groups; the first group included patients with one or more somatic complications registered (n = 162), and the second group consisted of patients without any somatic complication (n = 241). Patient evaluation included registration of socio-demographic characteristics, personal and family history, stroke characteristics, neurological and functional status at the time of admission and discharge, laboratory analysis of blood and urine at admission, type and time of emergence of each somatic complication, all relevant diagnostic methods for setting diagnosis and defining potential risk factors. Somatic complications are more common in older people (the average age of 72.9 years) in females and in patients with hemorrhagic stroke. Somatic complications were reported in 40.2% of patients, 20.3% of patients had urinary infection, 16.3% pneumonia, 4.7% myocardial infarction, 3.4% pulmonary thromboembolism, deep venous thrombosis 2.4% and diarrheal syndrome 2.9% of patients. Independent predictors of pneumonia were dysphagia, impaired state of consciousness, chronic obstructive pulmonary disease, mRS higher than 3. Predictors of urinary infections were: data on recurrent urinary tract infections, female sex, age over 70 years, mRS higher than 3 and NIHSS score higher than 16. As independent predictors of pulmonary thromboembolism, deep venous thrombosis, impaired state of consciousness and obesity were obtained, while the only independent predictor of diarrheal syndrome proved to be the age of the patient over 70 years. Predictors of acute coronary syndrome were: age over 70 years and haemorrhagic stroke. Patients with somatic complications at the end of hospital treatment had significantly worse functional status compared to patients without somatic complications. Somatic complications statistically significantly prolong hospitalization. A quarter of patients (25.9%) with somatic complications in the acute phase of the stroke had a lethal outcome. The highest percentage of deaths in patients with somatic complications was registered in patients with myocardial infarction (63.2%) and the lowest was registered in patients with urinary tract infections (18.3%).

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Universidade Estadual Paulista J?lio de Mesquita Filho
The study analyzed the psychometric properties of the Scale of Assessment of Body Dymorphic Disorder - SA-BDD. Were estimated the content validity, construct validity, validity of criterion and internal consistency of the instrument. The sample was integrated by three groups: G1: 30 patients diagnosed with BDD (F = 70% and M = 30%), G2: 400 college students (F = 74.5% and M = 25.5%) and G3: 10 professionals of Psychology (N = 4), Psychiatry (N = 2), Dentistry (N = 2) and Plastic Surgery (N = 2) with clinical experience between 8 and 31 years. The SA-BDD is a 35- item instrument answered by a 4-point Likert scale ranging from 1 (fully disagree) to 4 (totally agree). Originally, items were developed to evaluate three dimensions, described in the literature as typical of the BDD: 1. Concern with a defect in appearance, 2. Suffering and loss of social and/or occupational functioning, and other, 3. Concern is not better explained by other disorders such as anorexia. Items of the first version of the scale were reformulated and divided into groups of items with 4 statements regarding each level of intensity. Five (5) more items of groups were also developed to increase the number of items for differential diagnosis (dimension 3). A theoretical analysis of the 40 groups of items, carried out by independent judges, gave measure of the content validity of the scale. Judges have not agreed on five items. The scale was then applied to G1 and G2. The factor analysis with Varimax rotation pointed to a one-dimension solution, consisting of 28 items, loading above 0.53, bringing together two of the theoretical dimensions: "Concern with a defect in appearance and suffering and loss of social and or occupational functioning, and others." The validity of criterion, carried out by the Mann- Whitney U test showed that 30 of the 35 items are sensitive to discriminate individuals diagnosed with BDD from individuals without this diagnosis. The scale showed an excellent internal consistency with Cronbach's alpha equal to 0.97. It was concluded that 28 items should be retained for a new version of the instrument (SA-BDD-28), which showed good content validity, construct validity, validity of criterion and reliability. Considerations regarding the one-dimensional solution and suggestions for further study are made.
O estudo analisou as propriedades psicom?tricas da Escala de Avalia??o do Transtorno Dism?rfico Corporal EA-TDC. Foram estimadas a validade de conte?do, validade de construto, a validade de crit?rio e a consist?ncia interna do instrumento. Contou-se com tr?s amostras de participantes: G1: 30 pacientes diagnosticados com TDC de ambos os sexos (F=70% e M=30%); G2: 400 estudantes universit?rios de ambos os sexos (F=74,5% e M=25,5%); e G3: 10 profissionais das ?reas de Psicologia (N=4), Psiquiatria (N=2), Odontologia (N=2) e Cirurgia Pl?stica (N=2), com experi?ncia cl?nica entre 8 e 31 anos. A EA-TDC ? um instrumento composto de 35 itens que devem ser respondidos por meio de uma escala Likert de 4 pontos, que variam entre 1 (discordo plenamente) e 4 (concordo plenamente). Originalmente, foram desenvolvidos itens para avaliar tr?s dimens?es, descritas na literatura como t?picas do TDC: 1. Preocupa??o com um defeito na apar?ncia; 2. Sofrimento e preju?zo no funcionamento social, ocupacional e outros; 3. Preocupa??o n?o ? melhor explicada por outros transtornos, como a anorexia. Os itens desta vers?o da Escala foram reformulados em itens com 4 alternativas de resposta cada referente ao grau de intensidade. Foram criados tamb?m mais 5 itens para ampliar o n?mero de itens referentes ao diagn?stico diferencial (dimens?o 3). Em rela??o ? validade de conte?do verificou-se a pertin?ncia dos 40 itens ao construto, por meio da an?lise te?rica de ju?zes. Cinco itens n?o obtiveram concord?ncia de no m?nimo 80% entre os ju?zes e foram eliminados. A escala foi ent?o aplicada no G1 e no G2. A an?lise fatorial com rota??o varimax apontou para uma solu??o unidimensional, composta de 28 itens com cargas superiores 0,53, que se agruparam em um ?nico fator (F1). Este reuniu duas das dimens?es te?ricas em uma ?nica: Preocupa??o com um defeito na apar?ncia e Sofrimento e preju?zo no funcionamento social, ocupacional e outros . A validade de crit?rio, por meio da prova U de Mann-Whitney, mostrou que 30 dos 35 itens da escala s?o sens?veis para discriminar os indiv?duos diagnosticados com TDC dos indiv?duos sem o diagn?stico do transtorno. Dentre eles encontravam-se os 28 j? apontados pela an?ise fatorial. Submetidos a an?lise de consist?ncia interna, os 28 itens resultaram em alpha de Cronbach igual a 0,97. Concluiu-se que estes 28 itens deveriam ser retidos para a constitui??o de uma nova vers?o do instrumento (EA-TDC- 28), por deterem validade de conte?do, validade de construto, validade de crit?rio e precis?o. Considera??es em rela??o ? unidimensionalidade e sugest?es de continua??o dos estudos referentes a EA-TDC-28 s?o realizadas.

A Psicossomática se constituiu como campo de saber tendo como uma de suas principais influências as contribuições de Freud a respeito da relação entre mente e corpo. Desde Alexander até os teóricos de orientação psicanalítica mais atuais, a questão da somatização, no sentido lato, vem sendo discutida e, apesar das divergências teóricas, o que sempre está em pauta nas somatizações é o comprometimento da capacidade de simbolização do sujeito frente às vicissitudes da vida. Essa mesma característica é central nas neuroses atuais, de forma que há possível associação entre a somatização e a neurose atual. Dessa forma, os objetivos principais são verificar se esse comprometimento na capacidade de simbolização está presente e como se apresenta em sujeitos com somatização e em sujeitos com neurose atual. Para se realizar o estudo, foram eleitos dois transtornos que são representantes das categorias acima citadas: nas somatizações, vamos pensar a partir dos transtornos somatoformes, utilizando a subcategoria dos transtornos neurovegetativos somatoformes, elegendo a Síndrome do Intestino Irritável; e nas Neuroses Atuais, o Transtorno de Pânico (Neurose de Angústia). Os resultados vão permitir uma comparação, a partir da capacidade de simbolização, entre essas duas categorias e a verificação de maiores relações entre ambas, assim como relação com alexitimia, pensamento operatório e personalidade tipo A, características geralmente associadas a esses tipos de pacientes. A pesquisa foi feita a partir de estudos bibliográficos e psicodiagnóstico dos sujeitos da pesquisa, com entrevista semi-dirigida, aplicação de pranchas do TAT, escalas de alexitimia (TAS e OAS) e entrevista para Personalidade tipo A. Foram utilizados três sujeitos com Síndrome do Intestino Irritável e dois com Transtorno de Pânico. Nos sujeitos da pesquisa, quando aparece comprometimento na capacidade de simbolização, as histórias no TAT são mais curtas, descritivas, concretas, com introdução de nenhum ou poucos elementos externos à prancha, dificuldade na resolução de conflito, personagens pouco integrados, ausência de referências afetivas ou afetividade negativa, prejuízo da integração do ego, com predomínio de pensamento do tipo operatório. Pensar o comprometimento da capacidade de simbolização em pacientes com somatização a partir do pensamento operatório faz sentido, visto que os sujeitos apresentaram tal forma de pensamento, embora apresentem variações significativas na intensidade e frequência de funcionamento metal do tipo operatório. Contudo, definir o paciente com somatização ou com neurose atual necessariamente como alexitímico é insuficiente, visto que nem todos apresentaram tal característica. Pela análise de dados dos sujeitos, há pacientes os quais o comprometimento na capacidade de simbolização funciona como defesa psíquica diante da angústia, de forma a prejudicar a integração do ego em razão de manter um funcionamento mental mais estável; e há os que esse comprometimento é característico do funcionamento mental. Compreendendo o funcionamento psicológico que há por trás das somatizações o comprometimento da capacidade de simbolização e as formas como se configura na dinâmica psíquica do sujeito como defesa psíquica ou como característica do funcionamento mental pode-se estabelecer métodos de abordagens e técnicas psicoterápicas mais eficientes e condizentes com pacientes com somatizações
The Psychosomatic constituted itself as a field of knowledge has as one of his major influences the contributions of Freud on the relationship between mind and body. From Alexander to the psychoanalytic theoristis more current, the issue of somatization in the broadest sense, has been discussed and, despite the theoretical differences, is always at hand in somatization the impaired ability of symbolization of the subject facing the vicissitudes of life. This same feature is central to the actual neurosis, so that there is a possible association between somatization and actual neurosis. Thus, the main objectives are to determine if that impairment in the ability of symbolization is present and how shown in subjects with somatization and in subjects with actual neurosis. To perform the study, two disorders that are elected representatives of the categories mentioned above: in somatization, we think from the somatoform disorders, using the subcategory of somatoform autonomic dysfunction, electing the Irritable Bowel Syndrome, and in Actual Neurosis, the Panic Disorder (Anxiety Neurosis). The results will allow a comparison, from the capacity for symbolization, between these two categories and the verification of relations between the two, as well as compared with alexithymia, operational thinking and type A personality, characteristics associated with these types of patients. The survey was conducted from bibliographic studies and psychodiagnostic research subjects, with semi-directed interview, application of TAT cards scales of alexithymia (TAS and OAS) and interview for Type A Personality. We used three subjects with Irritable Bowel Syndrome and two with Panic Disorder. In the research subjects, when it appears impairment in the ability of symbolization, the TAT stories are shorter, descriptive, concrete, with few or no introduction of foreign elements to the board, difficulty in conflict resolution, low integrated characters, no references affective or negative affectivity, impaired ego integration, with a predominance of thought like operatory. Thinking the impaired ability of symbolization in patients with somatization from operational thinking makes sense, because the subjects had this way of thinking, although they have shown significant variations in intensity and frequency of operation of the metal type operatory. However, defining the patient with somatization or actual neurosis necessarily as alexithymic is insufficient, since not everyone had such a feature. For the data analysis of the subjects, there are patients who compromise the ability to symbolizing as psychic defense in the face of anguish, in order to undermine the integration of the ego to maintain a more stable mental functioning, and there are that this commitment is characteristic of mental functioning. Understanding the psychological functioning that is behind the somatization - the impaired ability of symbolization - and the ways to configure the psychic dynamics of the subject - such as defense or as a psychological characteristic of mental functioning - can establish methods of psychotherapeutic approaches and techniques more efficient and consistent with patients with somatization

Bakgrund: Som vårdgivare möter vi ofta patienter med psykosomatiska symtom och sjukdomar, patienter med fysiska symtom som saknar tydlig organisk förklaring. Inom primärvården har cirka 30% av patienterna medicinskt oförklarliga symtom. Tidigare forskning har visat att vårdgivare känner sig osäkra och otillräckliga när de handlägger patienter med psykosomatiska symtom. Det tycks vara svårt att veta hur man ska bemöta denna patientgrupp och hjälpa dem att uppnå god hälsa. Syfte: Syftet med litteraturstudien var att beskriva hur vuxna patienter med psykosomatiska symtom upplevde mötet med och bemötandet av sin vårdgivare samt beskriva de inkluderade artiklarnas datainsamlingsmetod. Metod: En beskrivande litteraturstudie baserades på tio vetenskapliga artiklar. Artiklarna söktes fram i databaserna PubMed och Cinahl. Ansatsen på de inkluderade artiklarna var både kvalitativ och kvantitativ. Artiklarna har noggrant granskats i syfte att finna skillnader och likheter. Resultat: Patienter som fick känslomässigt stöd, förklaringar, togs på allvar och var delaktiga i beslut var de som kände mest välbefinnande och tillfredsställelse med vårdgivaren och det bemötande de fick. De patienter som möttes av oengagerade vårdgivare, blev ifrågasatta och upplevde ett motstånd, kände att de var en börda för sjukvården. De inkluderade artiklarnas datainsamlingsmetoder var intervjuer och enkäter. Slutsats: Resultatet visade att många patienter med psykosomatiska symtom sökte bekräftelse. Kommunikation var viktigt för att dessa patienter skulle känna trygghet och förtroende. Genom vidare forskning och viss förändring i omhändertagandet av dessa patienter, skulle sjuksköterskan kunna bidra med denna trygghet i större utsträckning.
Background: As healthcare providers we often meet patients with psychosomatic symptoms and diseases, patients with physical symptoms who lack clear organic explanation. In primary care, approximately 30% of patients have medically unexplained symptoms. Previous research has shown that healthcare providers feel insecure and insufficient when handling patients with psychosomatic symptoms. It seems difficult to know how to respond to this patient group and help them achieve good health. Aim: The aim of the literature study was to describe how adult patients with psychosomatic symptoms experienced the encounter with and the treatment of their healthcare providers, and to describe the data collection methods of the included articles. Method: A descriptive literature study based on ten scientific articles. The articles were searched in the PubMed and Cinahl databases. The included articles were designed both qualitative and quantitative. The articles have been carefully reviewed in order to find differences and similarities. Result: Patients who received emotional support, explanations, were taken seriously and participated in decisions were those who felt most well-being and satisfaction with the care and the response they received. Patients who were met by uncommitted healthcare providers, and were questioned and experienced a resistance from their providers, were those who felt that they were a burden on healthcare. Data collection methods in the included articles were interviews and questionnaires. Conclusion: The result showed that many patients with psychosomatic symptoms sought confirmation. Communication was important for these patients to feel safe and confident. Through further research and some change in the treatment of these patients, the nurse could contribute to this safety to a greater extent.

Drawing on historicized illness studies by scholars such as Sally Shuttleworth, Athena Vrettos, Elaine Showalter and others, I identify the ways in which Victorian illnesses (specifically hysteria) correlate with the fantastic in Wuthering Heights and Villette. To frame this argument, I apply twenty-first-century terminology of somatoform disorders to these illnesses to expose the connections between the moments of hesitation in Todorov’s theory of the fantastic and the characters’ isolation (from self and others), illnesses, and (in)ability to recover. In my discussion, I analyze the use of modalization and conditional phrasing by Emily and Charlotte Brontë to create a grammar of fantastic illness. I propose that framing hysteria through both somatoform disorders and the fantastic allows for a greater understanding of the cultural construction of illness.

by Wong Chi-ming.
Thesis (M.Phil.)--Chinese University of Hong Kong, 1994.
Includes bibliographical references (leaves 62-69 (2nd gp.)).
ABSTRACT --- p.ii
ACKNOWLEDGEMENTS --- p.iii
TABLE OF CONTENTS --- p.iv
LIST OF TABLES --- p.vi
LIST OF FIGURES --- p.viii
LIST OF APPENDICES --- p.ix
Chapter CHAPTER I - --- INTRODUCTION --- p.1
Definition of Somatization --- p.2
A Model of Somatization --- p.5
Somatization in the Correctional Setting --- p.8
The Study --- p.12
Chapter CHAPTER II- --- METHOD --- p.14
Subjects --- p.14
Measures --- p.15
Pilot Study --- p.21
Main Study --- p.21
Chapter CHAPTER III - --- RESULTS --- p.23
Validity of Protocols --- p.23
Descriptive Statistics and the Sociodemographic and Custodial Profile of the Subjects --- p.23
Reliability of Scales Used in this Study --- p.26
Data Transformation --- p.26
Principal Components Analyses of Variables on Psychological Distress and Somatization --- p.28
Predictors of Somatization --- p.30
Differences among Subjects with Different Levels of Somatization and Psychological Distress --- p.35
Differences among Somatizers Who Attribute Differently --- p.47
Chapter CHAPTER IV - --- DISCUSSION --- p.51
Somatization and Psychological Distress Among Prisoners --- p.51
Other Correlates of Somatization among Prisoners --- p.51
Patterns of Somatization under Different Levels of Psychological Distress --- p.55
"Comparison between ""True"", ""Facultative"", and ""Initial"" Somatizers" --- p.56
Management Implications --- p.58
Chapter CHAPTER V - --- CONCLUSION AND LIMITATION --- p.60
REFERENCES --- p.62
APPENDICES --- p.70

The problem of somatization in primary care medicine has received considerable attention from researchers in the past few years. Somatizing patients visit the physician frequently with a variety of physical symptoms for which no organic cause can be found. Many researchers consider the current classifications of somatization disorder and undifferentiated somatoform disorder to be arbitrary and inadequate for describing the range of somatizing patients seen in medical settings. An important clinical research goal would be to identify and describe relatively distinct homogeneous subgroups if they exist Cluster analytic techniques, which have been used for classification problems in medicine and psychiatry, have been controversial due to inadequate theoretical basis. Methods have been developed for a statistical test for the presence of cluster structure, employing an internal criterion measure and Monte Carlo simulation of a null distribution. Different clustering outcomes can be compared using bootstrapping. Although these approaches offer solid statistical credibility they have not been widely used in clinical research The purpose of this study was to investigate the efficacy of four hierarchical agglomerative clustering techniques for a clinical research problem. The use of a statistical test for cluster structure is presented. All four methods provided solutions with evidence to support the presence of distinct clusters. Five stable clusters were identified and concordance among the 'best' solutions from each method was high. Bootstrapping techniques were used for parameter estimation and comparison of the clustering methods. The group average method gave the best overall performance when all patients were to be classified. The centroid method performed well when a few outliers could remain unclassified. Ward's minimum variance and complete link methods appeared to be more seriously affected by the presence of outliers and unequal cluster size. Nevertheless, cluster analytic methods provided a reasonable means of identifying empirical subtypes of somatizers in this study
acase@tulane.edu

An overview of the existing body of knowledge on the most widely researched areas of childhood leukaemia was presented and it was argued that a conceptual shift is required to achieve a more comprehensive understanding of the problem. This conceptual shift encompassed an ecosystemic approach. This study was conducted within a holistic systemic epistemology. A qualitative approach employing a case study method to provide rich descriptions of the context in which two leukaemia sufferer's symptoms were embedded.
Psychology
M.A. (Psyhcoloy)

The thesis deals with attributional styles and their research in patients with psychosomatic disorder. The text is divided into a theoretical part and an empirical part. The term psychosomatic disorder is defined in the theoretical part. The essential links between psychosomatic disorder, stress and cognitive processes are mentioned. Selected attribution theory and the concepts of attributional styles, then make up the majority theory. In the empirical part, there are hypotheses defined using three psychodiagnostic methods tested on a set of people with psychosomatic disorder and compared with the healthy population. Key words: attribution attribution theory attributional style psychosomatic disorder/psychosomatic illness somatoform disorders

Trabalho de Projeto do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina
As perturbações de sintomas somáticos estão entre os distúrbios psiquiátricos mais prevalentes nos Cuidados de Saúde Primários. A somatização pode ser considerada não só um importante fenómeno clínico, como também um problema socioeconómico, conduzindo a consideráveis custos diretos e indiretos. O principal objetivo da presente dissertação residiu na realização de uma revisão holística do estado da arte no que se refere ao processo de somatização. Assim, foram abordadas as reflexões, as perspetivas e os contributos teóricos propostos por vários autores para a sua conceptualização e compreensão etiológica. Para a elaboração do artigo, foram pesquisadas publicações relativas à temática em reflexão na base de dados MEDLINE, sendo selecionadas aquelas que se consideraram enquadradas no seu âmbito.Após o estudo aprofundado do tema concluiu-se que o conceito de somatização permanece um fenómeno complexo e mal compreendido, o que poderá ser parcialmente devido à relação intrincada entre o mal-estar psicológico e o mal-estar somático. O sistema de cuidados de saúde orientado por um modelo biomédico, com um foco direcionado para a doença somática, e uma gestão da sintomatologia através de investigações biomédicas e tratamentos somáticos, pode representar um potente reforçador da somatização.O desenvolvimento de sintomas somáticos, quer seja secundário a problemas psicológicos, sociais ou biomédicos, acarreta consequências sociais e psicológicas. Estes sintomas poderão ter um efeito na homeostasia da família, da vida profissional e da rede social do paciente, bem como nos seus mecanismos de coping. O modelo biopsicossocial defende que os sintomas somáticos são considerados idiomas de mal-estar enquadrados nas componentes biológica, psicológica e/ou social da sua vida. Por conseguinte, o fortalecimento da componente psicossocial no tratamento possibilitará uma diminuição da sobreutilização dos cuidados de saúde pelos pacientes somatizadores. O estudo da fisiopatologia e o contributo da neuroimagiologia poderão promover uma ponte entre as explicações psicológicas e físicas para os sintomas somáticos, constituindo elementos promissores no estudo da somatização.
Somatic symptom disorders are among the most prevalent psychiatric disorders in Primary Health Care. Somatization can be considered not only an important clinical phenomenon, but also a socio-economic problem, leading to considerable direct and indirect costs. The main objective of this dissertation was to carry out a holistic review of the state of the art regarding the somatization process. Thus, the reflections, the perspectives and the theoretical contributions proposed by several authors for its conceptualization and the etiological understanding were approached.For the elaboration of the article, publications related to the topic in reflection were searched in the MEDLINE database, being selected those that were considered within its scope.After the in-depth study of the topic, it was concluded that the concept of somatization remains a complex and poorly understood phenomenon, which may be partially due to the intricate relationship between psychological and somatic distress. The health care system, guided by a biomedical model, with a focus on somatic disease, and the management of symptoms through biomedical investigations and somatic treatments, can represent a powerful reinforcer of somatization.The development of somatic symptoms, whether secondary to psychological, social or biomedical problems, has social and psychological consequences. These symptoms may influence the homeostasis of the patient's family, professional life and social network, as well as on their coping mechanisms.The biopsychosocial model argues that somatic symptoms are considered languages of distress framed in the biological, psychological and/or social components of their life. Therefore, strengthening the psychosocial component in the treatment will enable a reduction in the overuse of health care by the somatizing patients.The study of the pathophysiology and the contribution of neuroimaging may promote a bridge between the psychological and physical explanations for somatic symptoms, constituting promising elements in the study of somatization.