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At least 19 recordsLinked to original sources
PubMed2002

Predominance of anger in depressive disorders compared with anxiety disorders and somatoform disorders.

OBJECTIVE: The object of this study was to make a comparison regarding various dimensions of anger between depressive disorder and anxiety disorder or somatoform disorder. METHOD: The subjects included 73 patients with depressive disorders, 67 patients with anxiety disorders, 47 patients with somatoform disorders, and 215 healthy controls (diagnoses made according to DSM-IV criteria). Anger measures--the Anger Expression Scale, the hostility subscale of the Symptom Checklist-90-Revised (SCL-90-R), and the anger and aggression subscales of the Stress Response Inventory--were used to assess the anger levels. The severity of depression, anxiety, phobia, and somatization was assessed using the SCL-90-R. RESULTS: The depressive disorder group showed significantly higher levels of anger on the Stress Response Inventory than the anxiety disorder, somatoform disorder, and control groups (p < .05). The depressive disorder group scored significantly higher on the anger-out and anger-total subscales of the Anger Expression Scale than the somatoform disorder group (p < .05). On the SCL-90-R hostility subscale, the depressive disorder group also scored significantly higher than the anxiety disorder group (p < .05). Within the depressive disorder group, the severity of depression was significantly positively correlated with the anger-out score (r = 0.49, p < .001), whereas, in the somatoform and anxiety disorder groups, the severity of depression was significantly positively correlated with the anger-in score (somatoform disorder: r = 0.51, p < .001; anxiety disorder: r = 0.57, p < .001). CONCLUSION: These results suggest that depressive disorder patients are more likely to have anger than anxiety disorder or somatoform disorder patients and that depressive disorder may be more relevant to anger expression than somatoform disorder.

Adult↗
PubMed2004

Attachment representation and illness behavior in somatoform disorders.

Somatoform disorders are characterized by high health care utilization and conflictual interactions with health care providers. The aim of the present study was to explore whether patterns of insecure attachment are a prominent feature of somatoform disorder. In addition, the links between insecure attachment and health care utilization were evaluated. Thirty-seven patients with an International Classification of Diseases, 10th Revision diagnosis of somatoform disorders and 20 healthy control subjects matched for age, sex, and education were administered the Adult Attachment Interview. Psychological symptoms and health care utilization were assessed using various self-report measures. There was a clearly higher incidence of insecure attachment in the somatoform group compared with the nonclinical control subjects. In the somatoform group, dismissing attachment occurred approximately twice as frequently as the preoccupied pattern of attachment. The results provide evidence for an association between health care utilization and insecure attachment. Insecure attachment in somatoform disorder may underlie problems in interpersonal functioning and in health care behavior.

Adolescent↗
PubMed2005

The relation between anger expression, depression, and somatic symptoms in depressive disorders and somatoform disorders.

BACKGROUND: In previous studies, the relationship between either anger suppression and depression or anger suppression and somatic symptoms was examined. However, the relationship between anger expression, depression, and somatic symptoms was not examined in depressive disorders and somatoform disorders. METHOD: The DSM-IV-diagnosed subjects included 73 patients with depressive disorders and 47 patients with somatoform disorders. The Anger Expression Scale was used to assess the level of anger expression or suppression. The severity of depression was assessed using the Symptom Checklist-90-Revised (SCL-90-R). The Somatization Rating Scale and the SCL-90-R somatization subscale were used to assess the severity of somatic symptoms. Data were collected from March 2000 to March 2001. RESULTS: The results of the path analyses showed that in depressive disorder patients, anger expression had a stronger effect on somatic symptoms through depression than did anger suppression, although both anger expression and anger suppression had a significant indirect effect on somatic symptoms. The depressive disorder group also showed a significant but negative direct effect of anger suppression on anger expression in the path from anger suppression to anger expression to depression to somatic symptoms. However, only anger suppression had an indirect effect on somatic symptoms through depression in somatoform disorder patients. CONCLUSIONS: The results suggest that anger expression might play a more predominant role in depression and somatic symptoms of depressive disorder patients than anger suppression, but only anger suppression might be associated with depression and somatic symptoms of somatoform disorder patients. In addition, incomplete anger suppression followed by anger expression is likely to be associated with depression and somatic symptoms in depressive disorders.

Adult↗
PubMed1987

Somatoform disorders.

Somatoform disorders are characterized by physical complaints which have no organic basis and are commonly seen by both generalists and specialists. A case report and clinical descriptions of the major somatoform disorders are presented and recommendations for clinical management made.

Adult↗
PubMed2002

Pain in somatoform disorders: is somatoform pain disorder a valid diagnosis?

OBJECTIVE: Investigate the validity of DSM-IIIR somatoform pain disorder (SPD) by comparing subgroups of somatoform disorder patients on several measures of psychopathology. METHOD: A total of 144 patients with unexplained physical symptoms were referred from non-psychiatric departments. Among these, 127 patients with somatoform disorders were identified, classified according to the Structured Clinical Interview for DSM (SCID) diagnostic interview, and rated with scales for somatization, anxiety, depression and personality traits. RESULTS: Patients presenting pain did not differ significantly from patients presenting non-pain symptoms on measures of symptoms and personality traits. Correspondingly, patients with SPD did not differ significantly from patients with conversion disorder (CD), while patients with Somatization disorder (SD) had higher scores on most scales for psychopathology and personality disorder. CONCLUSION: Significant diagnostic and symptomatic overlap was found between SPD and CD, and although the statistical power of the study was modest, the study questions the validity of the current definition of SPD.

Adolescent↗
PubMed1988

Somatoform disorder in a psychiatric setting. Systematic comparisons with depression and anxiety disorders.

Somatoform disorder (SD) is recognized as an important clinical entity in general medicine although its psychiatric nature is insufficiently appreciated. Its prevalence and descriptive validity among psychiatric patients have not been investigated. These two aspects of SD are examined by comparing it with depressive and anxiety disorders, both of which include somatic symptoms and often are confounded with it. A semistructured evaluation procedure applied in a naturalistic clinical setting yielded a diagnosis and ratings of a large array of symptoms. The relative rarity of SD stands out, as well as the unique way in which it tends to be used in diagnostic formulations of psychiatric patients seeking evaluation and care. These results may reflect these patients' reluctance to seek psychiatric care and to define their problems as mental, as well as the bias of clinicians working in psychiatric settings geared to looking for traditional psychopathology. The distinguishing symptoms of SD vis-à-vis depressive and anxiety syndromes are outlined. These symptoms suggest that SD patients resemble depressives, but harbor traits that reflect personality and interpersonal difficulties. However, rater bias may have influenced these results as well.

Adult↗
PubMed2006

The biopsychosocial approach to adolescents with somatoform disorders.

Somatoform disorders are presented in the first article in this issue of Adolescent Medicine Clinics because the physical symptoms that cause the adolescent to present for diagnosis and treatment reflect the interaction of the psyche and the soma in ways that are poorly understood. Because of dualistic conceptualizations that are encouraged by technology such as MRI, CT scans and other technologically advanced tools, patients who have these conditions often suffer. As noted by Cassell [35], "suffering is experienced by persons, not merely by bodies, and has its source in challenges that threaten the intactness of the person as a complex social and psychological entity." Clinicians who care for adolescents who have somatic complaints also suffer when they are unable to provide relief of an adolescent's suffering. Cassell [36] noted that "physicians are less skilled at what were once thought to be the basic skills of doctors-discovering the history of an illness though questioning and physical examination, and working toward healing the whole person." The biopsychosocial approach offers a means of working toward healing the whole person, and the focus of this article is on practical solutions to difficult challenges that are presented by adolescents and their families.

Adolescent↗
PubMed1992

The epidemiology and treatment of depression when it coexists with somatoform disorders, somatization, or pain.

This article reviews the relationship between depressive disorders and somatoform disorders, somatization, and pain. These disorders and symptoms are clinically interrelated, yet the nature of the interrelation is not well understood. This review of the literature from 1975 through mid-year 1990 addresses the epidemiology and treatment of these conditions and/or symptoms when they occur together. When robust criteria are used to determine which publications are included, only 14 are available that address depressive disorders, somatoform disorders, and somatization. Similarly, there are only 13 that address depressive disorders and pain. Taken together, these studies indicate that 1) in somatization disorder patients, there is a high prevalence of depression; 2) in patients with major depression, there are substantial levels of hypochondriacal and somatizing symptoms; 3) that depression in the face of coexisting somatization disorder can be successfully treated; 4) in chronic pain patients, there is a high prevalence of depressive disorders; 5) in patients with major depression, pain is a frequent complaint; 6) and finally, that pain improves with the treatment of depression. What is most striking from this review, however, is the very limited number of studies that address these important problems. This lack of research-based data calls for new aggressive research efforts in this area.

Antidepressive Agents↗
PubMed1984

An adoption study of somatoform disorders. II. Identification of two discrete somatoform disorders.

linical heterogeneity among women with prominent somatization was studied in a population of 859 adopted women in Sweden. We distinguished two groups of "somatizers" who differ in both the diversity of their somatic complaints and the frequency of their periods of disability. Type 1 or high-frequency somatizers have a high frequency of psychiatric, abdominal, and back complaints. Type 2 or diversiform somatizers have less frequent disability, but a greater diversity of complaints per occasion than do other somatizers. Diversiform somatizers have psychiatric chief complaints or backache in a lower proportion of their sick periods than either high-frequency somatizers or nonsomatizers. Quantitative measures of frequency and diversity were derived in a series of discriminant analyses. The distribution of scores on these measures indicated that high-frequency somatization and diversiform somatization were discrete disorders with little clinical overlap and rare intermediate cases. This demonstration of two discrete types of somatizers was confirmed in a replication sample.

Adolescent↗
PubMedDate not supplied

Clinical pictures and classification of somatoform disorders in dermatology.

Somatoform disorders in dermatology are a heterogeneous group from a biopsychosocial point of view. Among the clinical patterns we find, for example, pruritus, pain, paresthesia as well as feelings of disfiguration, eco-syndromes, erythrophobia or psychogenic pseudoeffluvium. The multiple clinical symptoms are usually accompanied by psychosocial disorders, these are subjective complaints by the patient which cannot be medically objectified. The relevant somatoform disorders in dermatology can be differentiated as somatisation disorders, hypochondriacal disorders, somatoform autonomous disorders, persistent somatoform pain disorders and "other somatoform disorders". A precise differential-diagnostic division is necessary in order to initiate adequate therapy strategies. With this overview article, we would like to make an updated classification recommendation for dermatology and present experiences in therapy.

Humans↗
PubMed1998

Prevalence of somatoform disorders in a psychiatric population: an Italian nationwide survey. Italian Collaborative Group on Somatoform Disorders.

The survey involved 50 centres comprising both hospital and community psychiatric care services throughout Italy. Overall, 2620 patients were recruited, and of those 2002 (76%) completed the Somatoform Disorders Schedule (SDS), a CIDI-derived interview. The NOS somatoform disorders (SDs) diagnosis appeared to be the most common (60%) (and they showed the highest number of co-morbid diagnoses), followed by pain disorders (8%). The prevalence of undifferentiated somatoform and hypochondriactal disorders was 1.6%: older age groups showed a tendency towards higher rates of the latter. In general, the study found that a significant percentage of patients with SDs are referred to psychiatric services, but mainly because of other psychopathological problems: in fact, somatic complaints are cross-sectionally present in different psychiatric nosological categories. This study also emphasizes some limitations of the current classification of SDs.

Adult↗
PubMedDate not supplied

Alexithymia in DSM-IV disorder: comparative evaluation of somatoform disorder, panic disorder, obsessive-compulsive disorder, and depression.

The purpose of this study was a direct comparative evaluation of alexithymia in patients with somatoform disorder, panic disorder, obsessive-compulsive disorder, and depression, taking into account the multidimensionality of the alexithymia construct. The authors administered the Structured Clinical Interview for DSM-IV (SCID) and the Toronto Alexithymia Scale (TAS-20) to a sample of 234 subjects. Panic disorder, but no other diagnosis, was significantly related to lower TAS-20 total scores (P=0.000). Regarding TAS-20 subfactors, Factor 1 was significantly associated with somatoform disorder (P=0.006) and depression (P=0.002), Factor 2 was significantly associated with depression (P=0.025), and Factor 3 was significantly associated with obsessive-compulsive disorder (P=0.001), whereas panic disorder showed a significant negative correlation with Factor 3 (P=0.001). The relationships of the three subfactors with various DSM-IV diagnoses and sociodemographic variables emphasize the multidimensionality of alexithymia.

Adult↗
PubMed2004

Somatoform disorders in general practice: prevalence, functional impairment and comorbidity with anxiety and depressive disorders.

BACKGROUND: General practitioners play a pivotal part in the recognition and treatment of psychiatric disorders. Identifying somatoform disorders is important for the choice of treatment. AIMS: To quantify the prevalence of, and functional impairment associated with, somatoform disorders, and their comorbidity with anxiety/depressive disorders. METHOD: Two-stage prevalence study: a set of questionnaires was completed by 1046 consecutive patients of general practitioners (aged 25-80 years), followed by a standardised diagnostic interview (SCAN 2.1). RESULTS: The prevalence of somatoform disorders was 16.1% (95% CI 12.8-19.4). When disorders with only mild impairment were included, the prevalence increased to 21.9%. Comorbidity of somatoform disorders and anxiety/depressive disorders was 3.3 times more likely than expected by chance. In patients with comorbid disorders, physical symptoms, depressive symptoms and functional limitations were additive. CONCLUSIONS: Our findings underline the importance of a comprehensive diagnostic approach to psychiatric disorders in general practice.

Adult↗
PubMedDate not supplied

Effect of comorbid anxiety, depressive, and personality disorders on treatment outcome of somatoform disorders.

Comorbid mental disorders of DSM-IV axis I and axis II have repeatedly been found to be a negative predictor for the treatment of axis I disorders, although recent contrary findings exist. Little is known about the effect of comorbidity on the therapy outcome of somatoform disorders. We compared three types of comorbidity, (1) personality disorders (PDs), (2) major depression (MDD) and anxiety (ANX) disorders, and (3) PDS and MDD and ANX, with regard to their relevance for the treatment outcome of somatoform disorders. One hundred twenty-six inpatients were assessed at least 4 weeks before admission to treatment, upon admission, and again at discharge. Somatoform, hypochondriacal, and depressive symptomatology, dysfunctional cognitions about body and health, dysfunctional social relationships, and other clinical characteristics were measured. Diagnostic assessments were based on the DSM-IV. Our findings suggest that none of the three types of comorbidity influence the therapy outcome of somatoform disorders or have a modifying effect on the level of psychopathology.

Analysis of Variance↗
PubMed1997

Multisomatoform disorder. An alternative to undifferentiated somatoform disorder for the somatizing patient in primary care.

BACKGROUND: For clinical or research use in primary care, the DSM-IV diagnostic criteria for somatization disorder are too restrictive, while the criteria for undifferentiated somatoform disorder are overly inclusive. In this article, we examine the validity of multisomatoform disorder, defined as 3 or more medically unexplained, currently bothersome physical symptoms plus a long (> or = 2 years) history of somatization. METHODS: Data from the Primary Care Evaluation of Mental Disorders Study of 1000 patients from 4 primary care sites were analyzed. The outcomes assessed were 6 domains of health-related quality of life, using the 20-item Short-Form General Health Survey; self-reported disability days and health care use; satisfaction with care; and physician-rated difficulty of the encounter. RESULTS: Multisomatoform disorder was diagnosed in 82 (8.2%) of the 1000 patients who were enrolled in the Primary Care Evaluation of Mental Disorders Study. Compared with mood and anxiety disorders, multisomatoform disorder was associated with comparable impairment in health-related quality of life, more self-reported disability days and clinic visits, and greater clinician-perceived patient difficulty. CONCLUSIONS: Multisomatoform disorder may be a valid diagnosis and potentially more useful than the DSM-IV diagnosis of undifferentiated somatoform disorder. Also, because multisomatoform disorder has a large and independent effect on impairment, its diagnosis should not be precluded simply because of a coexisting mood or anxiety disorder.

Adolescent↗
PubMed2004

[Effects and cost-effectiveness analysis of inpatient treatment for somatoform disorders].

Patients with somatoform disorders represent an expensive problem group of the healthcare system characterized by inappropriately high medical costs. This paper describes a controlled inpatient treatment study using a cognitive-behavioral approach. The aim of this treatment program was to improve the patients' symptomatology and their psychosocial functioning, as well as reducing unnecessary medical costs. We treated 172 patients with somatoform disorders (DSM-IV) and compared them with 262 patients of a waiting control list. An additional control group consisted of 123 patients with other mental disorders. Direct and indirect illness-related costs for the two-year periods before and after treatment were re-calculated using objective data provided by the health insurance companies. The results show a marked improvement in the areas of bodily complaints, health anxieties, dysfunctional beliefs towards body and health, depression and psychosocial impairments. The medical costs in the post-treatment period decreased by 1,098 euro (-36.7 %) for inpatient and 382 euro (-24.5 %) for outpatient treatments. Indirect costs due to days lost from work were 6,702 euro (-35.3 %) lower than during the two-years before treatment. The treatment costs had amortized after 21.5 months. We identified a subgroup of high-utilizing somatoform patients for which per patient savings of 32,174 euro (-63.9 %) were found. These results confirm that the cognitive-behavioral approach is effective in improving complaints as well as reducing the health-economical burden of somatoform disorders.

Adult↗
PubMed1999

Major mental disorders in Addis Ababa, Ethiopia. III. Neurotic and somatoform disorders.

This report presents estimates of the lifetime and point (one-month) prevalence of phobic anxiety, dissociative, other anxiety and somatoform disorders based on a survey conducted in Addis Ababa between September and December of 1994. An Amharic version of the CIDI was used to collect data from a random community sample of 1420 individuals aged 15 and above. Phobic anxiety disorders were found to be the most common of all anxiety disorders, with lifetime prevalence of 4.8%. The lifetime prevalence for dissociative disorders was 0.8% and for other anxiety disorders it was 2.7%. The prevalence of somatoform disorders was 3.1%. The lifetime prevalence for all the above neurotic and somatoform disorders was 10.8%. Point prevalence estimates (percent) for the disorders were as follows: phobic anxiety disorders, 4.4; other anxiety disorders, 1.2; dissociative disorders, 0.4; and somatoform disorders, 2.5. After adjusting for several potential confounders, women had over a two-fold risk of having neurotic and somatoform disorders compared to men, odds ratio (OR), 95% confidence interval (CI) = 2.38 (1.78, 3.12). Age was also inversely associated with the disorders. Those aged 60 and above had a 60% lower risk compared to those aged 15-24 years, OR (95% CI): 0.41 (0.20, 0.81). The 25% decreased risk for the employed, compared to the unemployed, was also not statistically significant. Education, marital status, and ethnicity were not significantly associated with neurotic and somatoform disorders.

Adolescent↗
PubMed2005

[Selected aspects relative to somatoform disorders].

This article addresses somatoform disorders, which remain a challenging problem in contemporary psychiatry. Inadequate responses to stressors play a significant role in their development. The term "somatoform disorders" refers to illnesses that were previously termed "psychosomatic". This article defines disorders according to the ICD-10 classification while highlighting important differences between this and the DSM-IV classification. The article reviews expert opinions concerning somatoform disorders, particularly in regard to somatization, hypochondriasis and autonomic dysfunction in these conditions. Attention is drawn to the relationship between somatoform disorders and other psychiatric conditions including depression, anxiety disorders and personality disorders as well as to actual non-psychiatric illnesses. The influence of cultural background, sex and age is discussed. Difficult clinical conditions such as fibromyalgia and Münchhausen syndrome are also considered.

Anxiety↗