Rozprawy doktorskie na temat „Somatization disorder”

The purpose of the present study was to compare the factor structure of distress, comprised of depression, anxiety, and somatization, across Turkey and the U.S., and to investigate the metric invariance of the instruments used to measure distress: The Beck Depression Inventory-II, The State Trait Anxiety Inventory Trait subscale, and TheSymptom Check List 90-R Somatization subscale. Data from 778 Turkish and U.S. participants were used for the analyses. It was found that depression, somatization, and anxiety are three distinct but related constructs for both Turkish and U.S. participants. It was also found that BDI-II, STAI-Trait, and SCL-90-R-Somatization do not have metric invariance across the two cultures, and these instruments do not measure the same distress construct across Turkey and U.S. Stated differently, distress as measured by these three instruments has different meanings for Turkish and U.S. participants. According to the results of a freelist analysis, somatic, cognitive, behavioral, and affective reactions to distress were equally salient for Turkish students. In contrast, affective and somatic reactions to distress had more salience for the U.S. participants.Some of the results obtained from the current study contradicted previous findings, while some were consistent. The results were consistent with the way depression, anxiety, and somatization are conceptualized in the DSM-IV (American Psychiatric Association, 1994) as separate constructs, but contradicted Krueger et al.'s findings (2003) and Broom's unitary model of personhood (2000, 2003). Results from the freelist analysis contradicted the previous findings indicating that Turkish individuals are more likely to somatize compared to individuals from the U.S. (Gureje et al., 1997). The methodological differences between the current study and the previous studies (Gureje et al., 1997), such as differences in the instrumentation and the educational levels of the participants, may have caused the observed differences in the findings. The results from the current study should be interpreted in light of its limitations, such as use of convenience sampling, instrumentation, and the effect of potential response biases. Future studies are needed to further investigate the cross-cultural metric invariance and item bias of BDI-II, STAI-Trait, and SCL-90-R-Somatization individually.
Department of Counseling Psychology and Guidance Services

Somatization, the presentation of physical symptoms without an identifiable cause, is among the most common problems in primary medical care. Treatment approaches are typically offered within the medical consultation interview once the medical provider distinguishes between physical and emotional etiology. This dualistic strategy is especially troublesome for patients whose physical complaints cannot be validated and who are recommended for only mental health therapy. The aim of this study was to examine how medical practitioners can instead motivate patients to consider both physical and emotional treatment. An analogue intervention consisting of an enhanced consultation interview was compared to a care as usual consultation interview on the key outcome of motivation to engage in mental health treatment. A total of 129 participants with medically unexplained symptoms were randomly assigned to these two conditions. Motivation to engage in mental health treatment was evaluated with the FMP Questionnaire, Credibility and Expectancy Questionnaire, and the newly developed Motivation to Engage in Therapy questionnaire (MET). Results of ANCOVA revealed significant differences between the two analogue consultation interviews on 3 out of 5 outcome measures. The largest effect was found for the MET followed by the credibility and expectancy subscales (1.6, .9, and .8). This finding suggests that a particular type of discourse between medical provider and patient can lead to increased motivation for holistic care treatment for those with somatization.

The diagnostic category of PTSD does not capture culture-relevant symptomatology, that is, somatization, for Cambodian refugees in the United States. Somatization may function as a buffer against chronic PTSD symptomatology in Cambodian refugees because somatization represents a culture-specific coping strategy for this population. The purpose of the present study is to assess the correlation between somatization and degree of PTSD symptoms. The study also addresses the mental health disparities in the Cambodian refugee population in order to inform the literature on access to better trauma-informed mental health services.

Participants were recruited from community mental health agencies in Oakland, CA and Long Beach, CA. Two "data-gathering" groups of Cambodian refugees (N = 26) were administered a demographic questionnaire, the Harvard Trauma Questionnaire-Revised (HTQ-R) and the Somatoform Dissociation Questionnaire-20 (SDQ-20) in Khmer and English. The correlational relationship between demographic variables was also analyzed in order to explore contextual factors behind the findings of the study's main research question. Recommendations for assessment and treatment of PTSD in Cambodian refugees were then discussed based on the study's findings. Health care utilization by Cambodian refugees was examined and recommendations were suggested for improvement in public policy and health care services.

The hypothesis of this study that the level of somatization was inversely related to degree of PTSD symptomatology in Cambodian refugees was not supported. The Pearson Correlational Coefficient analysis produced a statistically significant positive relationship (r = .34) between somatization and traumatization in Cambodian refugees as measured by scores on the SDQ-20 and the HTQ-R. The role of specific somatoform symptoms in the chronicity of PTSD symptomatology was explored. The positive correlation found between the SDQ-20 and HTQ-R supported previous research, demonstrating the relationship between somatoform dissociation and higher PTSD symptomatology in Cambodian refugees.

The association between psychogenic knee pain in adolescent girls and parent-child behavior that involves (1) a high degree of control on the part of parents and (2) a high degree of submission on the part of adolescent daughters was investigated. The subjects, between the ages of 13 and 16 years, were patients of five doctors whom they were consulting about chronic knee pain. The doctors categorized each patient as either having "organic evidence" associated with their pain complaint (n=18) or "no organic evidence" (n=12). Each patient completed the Intrex Questionnaire: Short Forms B and C (Benjamin, 1988) which provided a set of data that descibed the daughters' perceptions of .their mothers' and fathers' behavior in relation to them and also the daughters' own behavior in relation to both parents. Similarity of the groups in terms of age, socioeconomic status and severity of pain was confirmed. Between-groups comparisons of the Intrex data yielded two significant differences. Daughters in the psychogenic pain group perceived their mothers as being both more controlling toward and more submissive to their daughters than did daughters in the organic group. Hypothesized differences between the groups regarding fathers' controlling behavior and daughters' submissive behavior were not supported.
Education, Faculty of
Educational and Counselling Psychology, and Special Education (ECPS), Department of
Graduate

Thesis (M.A.)--George Mason University, 2009.
Vita: p. 60. Thesis director: Koraly Perez-Edgar. Submitted in partial fulfillment of the requirements for the degree of Master of Arts in Psychology. Title from PDF t.p. (viewed Oct. 12, 2009). Includes bibliographical references (p. 54-59). Also issued in print.

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.

Bibliography: leaves 233-306. A study of the phenomenon of somatization as it occurs in the primary care setting. The phenomenon was studied in terms of aspects of illness behaviour and risk of psychiatric morbidity. It is suggested that abnormal illness behaviour in the form of somatization may be an important factor in the non-recognition of mild non-psychotic psychiatric illness in the primary care setting. The results of the study indicate that an assessment of the patients' attitudes and beliefs about symptoms, and an exploration of psychosocial issues, may lead to a better understanding of why the patients have sought help, and may lead to early identification and appropriate treatment of somatizing behaviour and the psychiatric morbidity underlying such behaviour.

In Trinidad, negative attitudes towards mental health and unwillingness to access mental health care because of cultural restrictions and stigma deter some women with somatization disorder and experiences of domestic violence from seeking help (Hadeed & El Bassel, 2006; Kassiram & Maharajh, 2010; Maharajh, 2010). Several theoretical explanations for these interrelated issues are discussed in this thesis; grounded in considerations of the influence of culture and ethnicity. Somatization disorder appears to be more prevalent among Asian populations, and has a higher comorbidity with domestic violence within this ethnicity (Bhui, 2002; DSM-IV-TR, 2002; Fernando, 2002; Hardin, 2002) with some even stating that somatization disorder may be a culture bound ailment (Kassiram & Maharajh, 2010; Schrag & Trimble, 2005; Samelius, Wijma, Wingren & Wijma, 2008). In many Asian cultures emotional distress is still stigmatized compared to medical problems, resulting in delayed help-seeking (Hardin, 2002). To date, no research has been conducted regarding the possible links between somatization disorder, domestic violence experiences and help-seeking in Trinidad. This thesis utilized a mixed methods approach to explore the occurrence of somatization disorder and domestic violence among Indo- and Afro-Trinidadian women and their help-seeking choices. Drawing on data gathered from a combination of questionnaires (250; 150 with women and 100 with religious leaders and medical doctors) and interviews (12 participants; employing an Interpretative Phenomenological Approach) the key findings were that Indo-Trinidadian women were three times more likely to have symptoms associated with somatization disorder if they had domestic violence experiences compared to Afro-Trinidadian women. Both Indo-and Afro-Trinidadian women appear to internalize their distress as a means of coping. The women also reported mixed opinions about assistance received from both religious leaders and medical doctors when they sought help for their somatic symptoms and domestic violence experiences. Finally, despite medical doctors being more knowledgeable and reporting that they possessed better resources for assessing and intervening for both somatization disorder and domestic violence compared to religious leaders, they were less inclined to explore these intersecting issues with women patients. These findings are congruent with international research: culture emerged as the crucial component for the manifestation, reporting, and assistance sought for both somatization disorder and domestic violence experiences specifically in Trinidad, West Indies.

Despite a wealth of literature on the aetiology of somatic distress or somatization, somatic theory has failed to expand beyond a dualistic epistemology of causation. Within the primary health context where medically unexplained symptoms are characteristically articulated as literal, symbolic gestures of internal psychological processes, individuals' subjective accounts of somatic distress are reduced to objective phenomena and thus articulated on the grounds of absence. Within this context, the body as a lived, meaningful, perceiving subjectivity is silenced in favour of the corpse, thus rendering the somatizing individual's lived and subjective experience, expression and knowledge of somatic distress inaccessible. Instead, the somatizing individual is positioned within a domain of perturbed silence - a domain in which the professional's turning away or retreat from engaging somatization on the grounds of unique, subjective and corporeal experience, positions the patient/client as a passive, silent recipient whose somatic expressions as lived are overlooked. This study attempts to initiate a theoretical focus of departure from existing articulations of somatic distress through the development of a theoretical and epistemological framework that addresses some of the tensions inherent to contemporary somatic theory. In so doing, it employs embodiment philosophy and narrative methodology as a basis for a preliminary and critical investigation into a relatively neglected area of somatization research.
KMBT_363
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Orientador: Guita Grin Debert
Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Filosofia e Ciencias Humanas
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Resumo: A pesquisa teve como objetivo inicial apreender as re-configurações dos saberes e práticas médico-psiquiátricas, no contexto atual de expansão da procura e oferta desses serviços e de uma rebiologização nas explicações destes saberes. Paradoxalmente os "fenômenos não explicados organicamente" constituem um grande desafio ao campo e são descritos frequentemente pelo fenômeno de "somatização", nome dado a um programa de pesquisa e atendimento à  população e objeto dessa pesquisa. Se no referido contexto o trato a estes sofrimentos a partir de uma visão organicista e unidirecional mostra-se insuficiente, a incorporação de psicoterapias e da psicanálise no tratamento cotidiano da clientela também não se mostra isenta de dificuldades e dilemas. Buscou-se compreender também como a própria classificação e elaboração do diagnóstico e prognóstico são realizadas segundo as representações e visão de mundo dos profissionais do programa, estreitamente coadunada com a visão psicologizante de Pessoa, configurando universos de valor diversos que são fundamentais de serem apreendidos para melhor compreensão e reflexão das questões e dificuldades em jogo no atendimento
Abstract: The aim of this research is to capture the re-configurations of the several kinds of medical and psychiatric knowledge and practices in the current context of demand and offer enlargement of those services and also of a re-biologization of the explanations related to this kind of knowledge. In a paradoxical way, the phenomena which are not explained in an organic way constitutes themselves a great challenge and are often described by the "somatization" phenomenon, name attributed to a research and support program to the population, and also the purpose of this study. If in the context mentioned, the treatment of these sufferings from an organicist and unidirectional point of view proves to be insufficient, an incorporation of psychotherapies and psychoanalysis in the daily treatment of clients also presents difficulties and dilemmas. We tried to understand how the very classification and elaboration of diagnosis and prognosis are made according to the representations and perspectives of the professionals of the program, strictly linked to their psychological view of the world, setting up universes with different values which have to be captured in order to find a better understanding about the issues and difficulties in the treatment
Mestrado
Mestre em Antropologia Social

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

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Care experience in Programa de Atendimento e Estudos de Somatização do Departamento de Psiquiatria da UNIFESP/ HSP and scientific literature show that somatizing patients tend to establish an expensive relationship to hospital organization, increasing material and emotional costs. From the case study of Hospital São Paulo (HSP) and the Universidade Federal de São Paulo (UNIFESP), this work analyzed, qualitatively, which factors these organization’s culture offer to its community to allow them to build and to integrate social representations on psychic and somatic issues. Through psycossociologic methods analyses, it was noted that these organizations do not provide a culture that would help its members to deal with the anguish roused by the medical task, while dealing with somatization disorder patients. This task usually waves the possibility of death, determining hypochondria as its main anguish.
A experiência do Programa de Atendimento e estudos de Somatização do Departamento de Psiquiatria da UNIFESP/HSP e a literatura científica mostram que os pacientes somatizadores tendem a estabelecer com a organização hospitalar uma relação muito dispendiosa, tanto do ponto de vista da relação que mantem com seus profissionais quanto com relação ao volume de recursos materiais que consomem. a partir do estudo de caso do Hospital São Paulo e da Universidade Federal de São Paulo, o presente estudo analisou qualitativamente que elementos a cultura das organizações oferece a seus membros para que eles construam, coletivamente, representações sociais acerca do psíquico e do somático, e que elementos oferece para que tais representações sejam integradas, articuladas ou cindidas coletivamente por seus membros. Tendo concluído, através da análise das instâncias propostas pela metodologia psicossociológica, que as organizações analçisadas não dispõem de uma cultura que favoreça, através das representaçoes sociais, a articulação e integração psíquica das angústias despertadas pela tarefa médica em geral, e tampouco pelas angústias despertadas pelos pacientes somatizadores. Tarefa que constantemente acena a possibilidade da morte, determinando como angústia central despertada, a hipocondria.

O termo \"Psicossomática\" utilizado para designar a inter-relação entre sintomas físicos e fatores emocionais nas diversas patologias variou durante anos provocando confusões. Os diversos tratamentos médicos podem elevar gastos nos serviços de saúde. O presente estudo busca caracterizar a demanda de pacientes do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) no período de 1996 a 2004 cujo diagnóstico é Doença Psicossomática. A coleta de dados foi realizada em prontuários médicos, no Serviço de Arquivo Médico (SAME), com a categoria diagnóstica F 45 que, de acordo com o CID-10, significa Transtorno de Somatização; essa categoria foi utilizada como palavra chave no banco de dados. Na busca pelos prontuários foram encontrados 397, porém apenas 136 registravam o diagnóstico F 45, amostra do presente estudo. A coleta foi dificultada devido às letras ilegíveis e à falta de dados nos prontuários relacionados aos itens do instrumento de coleta. A população constitui-se pela maioria nascida no Estado de São Paulo com 43% da amostra, desses 14% nasceram em Ribeirão Preto-SP e 29% nasceram em outras cidades do Estado; são moradores do Estado de São Paulo 48%, desses 26% moram em Ribeirão Preto e 22% moram em outras cidades do Estado; 74,2% dos indivíduos são do sexo feminino; 87% têm cor de pele branca; 57% têm 1º grau incompleto; 70% professam a religião católica. Quanto ao estado civil, tem-se que 57% dos indivíduos são casados/amasiados; 52,96% possuem filhos; 32% dos indivíduos vivem com uma pessoa na mesma casa; 43,4% exercem a ocupação do lar e 14% dos indivíduos possuem como fator estressor problemas de saúde. Os indivíduos atendidos na Unidade de Emergência, em sua maior parte, comparecem numa freqüência de até cinco vezes (35%); os atendidos nos ambulatórios do HC, em sua maioria, comparecem numa freqüência de 20 vezes (49%). Os internados possuem a freqüência de zero a cinco vezes com 57% dos indivíduos. O local com o maior número de atendidos é a Unidade de Emergência com 43% dos indivíduos da amostra. Os dados encontrados caracterizam a população de indivíduos portadores de Transtorno de Somatização como: mulheres, casadas ou amasiadas, de baixa renda, sem filhos, do lar, com faixa etária entre 43 e 53 anos, de cor branca, com 1º grau de escolaridade incompleta, católicas, que moram com uma pessoa na mesma casa, nascidas em outras cidades do Estado de São Paulo, residentes em Ribeirão Preto e que freqüentam a Unidade de Emergência sem seguir um tratamento médico. Dessa forma, esses pacientes com Transtorno Psicossomático, isto é, pacientes com Transtorno de Somatização, contribuem para elevar os custos e a demanda dos Serviços de Saúde. Se esses indivíduos fossem atendidos de acordo com suas necessidades individuais, as filas de espera poderiam diminuir e suas condições de saúde poderiam ser melhores.
The term \"Psychosomatics\", used to designate the interrelation between physical symptoms and emotional factors in different diseases has varied over time, provoking confusion in medical treatments, and has increased health service expenses. This study aims to characterize the demand of patients who attended the Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School (HCFMRP-USP) between 1996 and 2004, and were diagnosed as Psychosomatic Disease. Data were collected in medical files at the Medical Filing Service (SAME), which contained the diagnosis category F 45. According to the ICD-10, this means Somatization Disorder. This category was used as a key word in the file search. We found 397 files, only 136 of which contained registries of the F45 diagnosis and constituted the study sample. Data collection was impaired by unreadable handwriting and lack of data about items for data to be surveyed. The population consists of a majority born in the State of São Paulo (42%), 29% born in other cities in the same state and 14% in Ribeirão Preto; most participants (26%) live in Ribeirão Preto, while 22% live in other cities in the same state; 74.2% of individuals are women; 87% of the sample are white; 57% have not finished primary education and 70% proclaim themselves Catholic. As to civil status, 57% of participants are married or have a fixed partner; 52,96% have children; 32% of individuals live with one person in the same house, 43.4% are housewives, and 14% of individuals possess health problems as a stressor. Most of the participants (35%) attended at the Emergency Unit make up to five visits; individuals attended at the HC outpatient clinics mostly (49%) make 20 visits. Hospitalized patients make between zero and five visits, with 57% of the sample. The Emergency Unit attends the largest number of patients (43%). These data characterize the patient population with Somatization Disorder as: women, married or with a fixed partner, low income, without children, housewives, age range between 43 and 53 years, white, unfinished primary education, Catholic, live with one person in the same house, born in other cities of the State of São Paulo and living in Ribeirão Preto, and visit the Emergency Unit without receiving further medical follow-up treatment. Thus, patients with psychosomatic disorder, that is, patients with somatization disorder, contributing to high health system costs and also generate high care demands. If this population s needs were adequately attended to, waiting lines could decrease and these individuals could improve their health conditions.

This PhD thesis is based on the Spanish sample of the International “Cultural and Psychosocial Influences on Disability” (CUPID) study. This multicentre study is coordinated by Professor David Coggon at the University of Southampton (UK) and the project focuses on 47 occupational groups (nurses, office workers and manual workers) from 18 countries. At the beginning, it was planned that each participating country would include the three occupational groups mentioned before. However, the Spanish sample of the study was composed only by nurses and office workers; due to logistic reasons, it was not possible to access local postal workers who carried out sorting mail tasks. This dissertation aims to assess the importance of health beliefs, mental health, and somatising tendency as predictors of incidence and persistence of musculoskeletal pain and to investigate if these psychological risk factors primarily influence the development and persistence of pain, or whether their impact is more on the disability that musculoskeletal pain causes. Dataset was collected in the workplace, both at baseline (between November 2007 and February 2010), and again after a follow-up interval of 12 months, at four hospitals (Badalona Serveis Assistencials, Consorci Sanitari Integral, Consorci Hospitalari Parc Taulí and Parc de Salut Mar) and a university (Universitat Pompeu Fabra) in Barcelona. To be included in the study, participants had to be aged 20–59 years and been in their current job for ≥12 months. Written informed consent was obtained from all who agreed to take part, and the Parc de Salut Mar Ethics Committee of Barcelona and the Health and Safety Committee of each participating centre approved the study. The baseline and follow-up questionnaires were originally drafted in English, translated into Spanish, and then checked by independent back-translation. Participants were asked at baseline about socio-demographic and lifestyle characteristics, current working conditions, health beliefs concerning pain, mental health, somatising tendency and musculoskeletal pain in the past month and past year at six different anatomical areas (back, neck, and shoulders, elbows, wrists/hands, and knees). Pain was classed as disabling if it made ≥1 specified everyday activities difficult or impossible. At 12-month follow-up, pain in the past month and associated disability was again ascertained. Log binomial and multilevel multinomial logistic regression models were used to explore associations of baseline risk factors with pain outcomes at follow-up.
Esta tesis doctoral está basada en la muestra española del Estudio Internacional “Cultural and Psychosocial Influences on Disability” (CUPID) Este estudio multicéntrico es coordinado por el Profesor David Coggon de la Universidad de Southampton (Reino Unido), y el proyecto se centra en 47 grupos ocupacionales (enfermeras, trabajadores de oficina y trabajadores manuales) de 18 países. Al principio estaba previsto que cada país participante incluiría los tres grupos de trabajo antes mencionados. Sin embargo, la muestra española del estudio CUPID está compuesta sólo por enfermeras y trabajadores de oficina; por razones logísticas, no fue posible acceder a los trabajadores de correos que realizaban tareas de clasificación de correo. Esta tesis doctoral tiene como objetivo evaluar la importancia de las creencias sobre la salud, salud mental, y la tendencia a somatizar como predictores de la incidencia y persistencia de dolor músculo-esquelético y para investigar si estos factores de riesgo psicológicos influyen principalmente en el desarrollo y la persistencia del dolor, o si su impacto es más en la discapacidad que provoca el dolor músculo-esquelético. El conjunto de datos del estudio se recogió en el lugar de trabajo, tanto al inicio del estudio (entre Noviembre de 2007 y Febrero de 2010), como después de un intervalo de seguimiento de 12 meses, en cuatro hospitales (Badalona Serveis Assistencials, Consorci Sanitari Integral, Consorcio Hospitalario Parc Taulí y el Parc de Salut Mar) y una universidad (Universitat Pompeu Fabra) en Barcelona. Para ser incluidos en el estudio, los participantes debían tener entre 20 a 59 años y haber estado en su puesto de trabajo por lo menos los últimos 12 meses. Se obtuvo consentimiento informado escrito en todos aquellos que aceptaron participar, y proyecto fue aprobado por el Comité de Ética del Parc de Salut Mar en Barcelona y el Comité de Seguridad y Salud de cada centro participante. Tanto los cuestionarios basales como del seguimiento fueron redactados originalmente en Inglés, traducido al español, y luego retro-traducido al inglés. Los participantes fueron entrevistados al inicio del estudio sobre sus características socio-demográficas y de estilo de vida, condiciones de trabajo actuales, salud mental y tendencia a somatizar, creencias sobre la salud aplicables al dolor y la presencia de dolor músculo-esquelético en el último mes y en el último año en seis zonas anatómicas diferentes (espalda, cuello, hombros, codos, muñecas/manos y rodillas). El dolor fue clasificado como discapacitante si se reportaban 1 o más actividades cotidianas difíciles o imposibles de realizar. A los 12 meses de seguimiento, se volvió a entrevistar a los participantes sobre la presencia de dolor en el último mes y la discapacidad asociada. Se utilizaron modelos de regresión log-binomial y logística multinomial multinivel para explorar las asociaciones de los factores de riesgo basales con el dolor al seguimiento.

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.

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

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.

In this dissertation, the author provides an account of his therapeutic interaction and experience, as an intern clinical psychologist, in working with a patient in psychotherapy who was eventually diagnosed with a “factitious disorder”. This study descriptively addresses how the therapeutic interaction impacted upon the therapist’s thinking of the process both diagnostically and in terms of therapeutic goals. This study consists of a single case, qualitative research design. It concerns the interactions and experiences of the therapist with a specific patient (diagnosed with a factitious disorder) in the context of a multidisciplinary academic hospital setting. The study aims to be predominantly descriptive of this therapy, and as such employs the psychological phenomenological method of Giorgi (1985) in order to provide a specific description of the situated structure of the therapy. As such, this study is able to contribute to the sparse psychological and therapeutic information available on factitious disorders. There are few detailed accounts of actual therapeutic interactions – specifically from a psychological perspective – for patients diagnosed with factitious disorders. The specific description of the situated structure of the therapy is also compared to the available literature on factitious disorders. Although the aim of this study was not evaluative in nature, the author does provide some tentative comments on the aetiology and therapeutic considerations for factitious disorders – with regards to this particular case. The author suggests a strong link to personality and character deficits underlying factitious behaviour. The author further suggests the importance of acknowledging the “sick role”; allowing for “face-saving” strategies; providing consistency (on behalf of the therapist); and the setting of rigid, overt, therapeutic boundaries in the psychotherapeutic treatment of factitious disorders.
Dissertation (MA (Clinical Psychology))--University of Pretoria, 2005.
Psychology
unrestricted

La présente étude en anthropologie médicale propose d’examiner la dimension socioculturelle des désordres fonctionnels gastro-intestinaux (DFGI) en considérant l’expérience de six familles québécoises francophones où un pré-adolescent souffre de symptômes associés à un DFGI. Le regard anthropologique qui nous a permis d’appréhender ces expériences de douleur s’appuie principalement sur les travaux issus de la psychiatrie transculturelle, de même que sur les influences de l’anthropologie du corps et de la phénoménologie. À travers ce regard, la somatisation est considérée comme une forme de communication de la douleur, modulée de manière importante par le contexte socioculturel et représentative d’une certaine souffrance sociale. Ce langage ponctué d’idiomes de détresse et de métaphores permet aux individus d’exprimer leur souffrance et de mobiliser un soutien social efficace pour la prendre en charge. Dès lors, le corps doit être perçu comme un corps vécu; comme un lieu de marquage du social, mais également comme un instrument de positionnement social et une frontière où des mouvements d’appartenance et de divergence sont exprimés. Par l’exploration, dans chacune de ces familles, des différentes manières de décrire les symptômes, de les interpréter et d’y réagir, nous avons procédé à la reconstruction d’histoires particulières pour voir comment ces symptômes venaient s’inscrire dans la biographie individuelle et familiale. À travers l’analyse de la construction du sens de la douleur et des pratiques adoptées pour la contrôler, la douleur abdominale nous est apparue comme intimement liée à l’expérience sociale et la médicalisation comme une base pour une meilleure appréhension de cette douleur. Par ses maux de ventre, l’enfant exprime ses limites corporelles et sociales. À l’intérieur de la famille, l’expression de cette limite peut être parfois dérangeante, confrontante, et même entraîner des rapports conflictuels. C’est ainsi qu’est « négociée » une approche appropriée à la douleur qui redéfinit les rôles de chacun par rapport à cette dernière. Le ventre devient le médiateur qui permet le compromis nécessaire au « vivre ensemble » ou au « vivre dans le monde ». À l’issue de ii cette négociation qui implique la participation du médecin traitant, les rapports sont parfois reconstruits et la relation au monde et aux autres peut devenir différente.
This study in medical anthropology is an exploration of the sociocultural dimension of functional gastrointestinal disorders (FGID) considering the experience of six frenchspeaking families of Québec where a pre-teenager suffers from symptoms associated with FGID. The anthropological perspective that allowed us to approach these experiences of pain is based mainly on work from tanscultural psychiatry, as well as on the influences of the anthropology of the body and phenomenology. Through this view, somatization is considered to be a form of communication of distress, modulated in an important way by sociocultural context and reflecting social suffering. This language punctuated with idioms of distress and metaphors allows individuals to express their suffering and to mobilize an efficient social support. From then on, the body must be seen as a lived body; as a place of social marking, but also as an instrument of social positioning and a border where movements of belonging and divergence are expressed. By exploring, in each of these families, different ways of describing the symptoms, interpret them and respond to them, we proceeded to the reconstruction of particular stories to find how these symptoms were part of the individual’s and family’s biography. Through the analysis of how those families make sense of the pain and adopte practices to control it, abdominal pain appeared to us as intimately linked to social experience and the medicalization as a basis for a better apprehension of this suffering. While telling his or her pain, the child is also expressing his or her bodily and social boundaries. Within the family, the expression of this limit can sometimes be disturbing, confrontational, even lead to conflict. Thus was “negociated” an appropriate approach to pain that redefines the roles of each in relation to it. The abdomen becomes the mediator who allows the compromises needed to “live together” or to “live in the world”. Following this “negociation” that involves the participation of the attending physician, bonding within the family is sometimes positively transformed and the relation to the world and to the others can become different.