The association of sexual and physical abuse with somatization: characteristics of patients presenting with irritable bowel syndrome and non-epileptic attack disorder

Different traumatic experiences are associated with different pathologies

We tested the hypothesis that different traumatic experiences will contribute in variable degree to different mental pathologies. A total of 223 young adult non-patients were assessed with the help of self-reports. The role of six different trauma experiences (broken home, dysfunctional family, family violence, child sexual abuse, child severe sexual abuse and adult sexual abuse) in six different conditions/pathologies (alexithymia, depression, somatization, borderline, overall physical health and overall mental health) was tested in a series of multivariate analyses of variance and of Roy-Bargmann stepdown analyses. The hypothesis was confirmed: Individual traumatic experiences were indeed associated with different pathologies. Specifically, sexual abuse predicted borderline pathology, severe child sexual abuse somatization, and dysfunctional or broken family depression. Family violence was associated with worse overall mental health and alexithymia, whereas no trauma variable could be identified to be associated with overall physical health. Most of these individual relationships were reported in the literature, based on results obtained in different clinical samples. Our results were won in a sample of young non-patients controlling for overlap between pathologies.

Psychological mechanisms of medically unexplained symptoms: an integrative conceptual model

Theories of medically unexplained illness based on the concepts of dissociation, conversion, and somatization are summarized. Evidence cited in support of these theories is described and the conceptual strengths and shortcomings of each approach are considered. It is argued that each of these approaches adds to the understanding of unexplained illness but that none is able to provide a comprehensive explanation of the phenomenon. An integrative conceptual model of unexplained illness based on cognitive psychological principles is then presented. This model attempts to combine existing theoretical approaches within a single explanatory framework, extending previous theory by explaining how compelling symptoms can exist in the absence of organic pathology. The clinical and empirical implications of the model are then considered.

The perceived health status of people with psychologically derived non-epileptic attack disorder and epilepsy: a comparative study

While a wealth of literature describes the short and longer term impact of living with epilepsy, there is, in contrast, very little information about the impact of psychologically derived non-epileptic attack disorder (PNEAD). In the absence of any physical disease, some clinicians may assume that this group requires little help. However, evidence suggests that there maybe a significant impact. Therefore, this study has set out to document the effects on perceived health status of PNEAD. We compared 97 people with PNEAD with a sample, case matched for age and gender, of 97 people who had been previously diagnosed with epilepsy. A questionnaire was administered to both groups requesting information about their perceived overall health (SF-36) and their clinical and demographic status. PNEAD patients described a significantly poorer profile of perceived health compared with the epilepsy group. People with PNEAD have substantially impaired perceived health status, to the extent of feeling in poorer health than people with organically explained epilepsy. Clinical interventions are necessary that can improve their perceived health.

Developmental predictors of somatic symptoms in adolescents of parents with HIV: a 12-month follow-up

Adolescents of parents with HIV provide a test for proposed risk factors for somatic symptoms. This study prospectively examined family and developmental predictors of somatic symptoms in a high-risk community sample. A longitudinal latent variable model predicted adolescent somatization scores from the Brief Symptom Inventory 12 months after baseline assessment of 211 parent-adolescent pairs. In this cohort, somatic symptoms during adolescence persisted over time (p <.001) and were predicted by female gender (p <.05). In addition, (1). parental distress over pain predicted adolescent somatic symptoms at baseline and follow-up (p <.001), (2). adolescents who experienced their parents as highly rejecting reported more somatic symptoms at follow-up (p <.001), and (3). school problems correlated with somatic symptoms (p <.001), as well as parental rejection (p <.001), at baseline. These findings underscore potential relationships among parental illness, parent-child relationships, and somatic distress. Adolescents with school problems are particularly vulnerable, at least in the short run. These data support a family-based approach to treatment programs for adolescents with increased levels of somatic distress.

Childhood family dysfunction and associated abuse in patients with nonepileptic seizures: towards a causal model

OBJECTIVE

A history of childhood sexual abuse is thought to characterize patients with nonepileptic seizures (NES). We tested the hypotheses: 1) that history of sexual abuse is more prevalent in patients with NES than in controls with epilepsy; 2) that such abuse is associated with NES, not directly but because it is a marker of family dysfunction; and 3) that family dysfunction and abuse are, in turn, linked to NES because they increase a general tendency to somatize.

METHODS

We compared 81 patients with NES with 81 case-matched epilepsy patients, using questionnaires to elicit recollections of sexual, physical, and psychological abuse and family atmosphere and to quantify current somatization.

RESULTS

Although each form of abuse was more prevalent in NES patients, only child psychological abuse uniquely distinguished NES from epilepsy. However, its association with NES was explained by family dysfunction. A general tendency to somatize explained part of the relationship of abuse to NES.

CONCLUSIONS

Abuse therefore seems to be a marker for aspects of family dysfunction that are associated with--and may therefore cause--somatization and, specifically, NES.

Abuse, dissociation, and somatization in irritable bowel syndrome: towards an explanatory model

This study tested a preliminary model of the role of dissociation and somatization in linking abuse to irritable bowel syndrome (IBS). Outpatients with IBS (N = 64) or bowel symptoms explained by physical disease (N = 61) completed questionnaires to assess recollections of abuse as children or adults and current dissociation, somatization, and emotional distress. By comparison with physically diseased patients, patients with IBS recalled more sexual abuse as children and adults, more physical abuse as children, and more psychological abuse as adults. They were more anxious and depressed, and somatized and dissociated more. Analyses indicated a causal chain linking, in turn, abuse, dissociation, somatization, and IBS. The results are consistent with a model in which childhood abuse is linked to IBS because it causes a tendency to dissociate, and because dissociation causes a general increase in physical symptoms. Future research should identify factors that explain why a generally increased level of physical symptoms should, in some patients, lead specifically to IBS.

Somatoform symptoms, anxiety, and depression in the context of traumatic life experiences by comparing participants with and without psychiatric diagnoses

The present study examines somatoform symptoms, anxiety and depression in connection with traumatic life experiences by comparing participants with and without psychiatric diagnoses. Significant group differences in the quantity of somatoform symptoms and the degrees of anxiety and depression could be found between participants with and without psychiatric diagnoses. Experience of sexual abuse leads to significantly more somatoform symptoms. Experience of repeated physical abuse as an additional factor significantly increased the depression score in all groups. This study reveals that the type of somatic complaint allows a prediction of the kind of traumatic life experience suffered. Physical abuse may be predicted by discomfort in and around the precodium, loss of appetite and stomach discomfort or a churning feeling in the stomach. Sexually abused participants reported significantly more anal pain, bad taste in the mouth or an excessively coated tongue, sexual indifference, and urinary retention. The findings of this study also revealed an association between depression, anxiety and somatoform symptoms and the type of traumatic life experience. The experience of physical and sexual abuse was found to be the most highly discriminative function.

Neuroticism, alexithymia, negative affect and positive affect as predictors of medically unexplained symptoms in primary care

BACKGROUND

Somatization has been defined in a number of ways. Despite their differences, these definitions have one element in common, namely the presence of somatic symptoms that cannot be explained (adequately) by organic findings.

OBJECTIVE

The primary objectives of the dissertation were to gain a better insight into the concept of somatization, and to study (prospectively) the relationship between neuroticism and alexithymia, two personality traits that have been shown to be related to somatization, the affective state dimensions positive and negative affect (or psychological distress) and medically unexplained symptoms.

METHOD

A selective review was conducted regarding conceptual and methodological issues related to somatization. A total number of 318 patients, presenting to their primary care physician with medically unexplained symptoms, participated in the prospective study. Both at baseline and at 6-month follow-up a number of measures were filled out with respect to somatization, neuroticism, alexithymia, negative and positive affect, anxiety and depression.

RESULTS

The concept of somatization was clarified, thereby making use of the distinction between presenting and functional somatization. The personality traits neuroticism and alexithymia were found to have an indirect influence on symptom reports. Both the cross-sectional and follow-up data pointed to the importance of positive and negative affect as determinants of (changes in) number of symptoms (over time). Negative affect, together with the alexithymia dimension measuring difficulty identifying feelings, predicted symptom persistence.

CONCLUSIONS

The theoretical as well as therapeutic implications of the present paper may give an impetus to new research in the domain of somatization.

The role of hypnosis in the detection of psychogenic seizures

In this preliminary clinical investigation, hypnosis was used in the differential diagnosis of epileptic versus psychogenic seizures (PS). Eight patients with a clinical profile suggesting the presence of PS were given a hypnotic suggestion in which they had to go back in time to the exact moment of their last seizure. They were then asked to concentrate their attention on any unusual feeling or bodily sensation. All 8 patients presented a PS during the age regression protocol. In 6 cases, independent testimony from family members corroborated the morphological similarity of the induced attack and the ones presented in their natural environment. Also, the seizures ended abruptly after a command was given to stop them. A control group of 5 epileptic subjects did not present any signs of discomfort or seizure behavior during the hypnotic protocol. It is argued that a simple procedure as the one described in this investigation can be useful as a diagnostic tool in the differentiation of epileptic from PS attacks.

Entwicklungspsychopathologie rekurrierender Bauchschmerzen und somatoformer Störungen

Zusammenfassung. Der Beitrag untersucht aus einer entwicklungspsychopathologischen Perspektive die störungs- und entwicklungsbezogenen Assoziationen zwischen rekurrierendem Bauchschmerz und somatoformer Störung sowie komorbiden Angststörungen bzw. Depression. Dazu werden eingangs Pfade des Übergangs von Störungsbildern der Eltern auf das Kind (Transmission) sowie die Stabilität bzw. Variabilität rekurrierender Bauchschmerzen und somatoformer Störungen vom Kindesalter zum Erwachsenenalter untersucht. Ein entwicklungspsychopathologisches Phasenmodell zeigt eine Sequenz von vier Etappen der Störungsentwicklung auf. Als Mediatoren eines ungünstigen Verlaufs werden Lernprozesse, Faktoren der kognitiv-behavioralen Schmerz- und Beschwerdeverarbeitung, beschwerdebezogene Copingstrategien sowie dysfunktionale Interaktionsmuster innerhalb der Familie sowie in der Arzt-Patient-Beziehung analysiert. Entwickelt sich eine Komorbidität mit einer Angststörung oder Depression, so zeigen diese Patienten störungsbedingt ein zusätzlich erhöhtes Risiko der verzerrten Verarbeitung abdomineller Beschwerden und Schmerzen.

Psychological characteristics of women presenting with breast pain

OBJECTIVE

Extensive evidence links unexplained physical symptoms in adults with childhood abuse. This study investigated a possible link between unexplained breast pain, recalled childhood abuse and emotional and somatic distress.

METHODS

Consecutive female out-patients presenting with breast pain were categorised as treatment-resistant (n=20), newly diagnosed and requesting treatment (n=37), or newly diagnosed but reassured and not seeking treatment (n=32) and compared with pain-free patients with breast lumps (n=31).

RESULTS

All breast pain groups were more anxious and depressed, somatised more and recalled a higher incidence of emotional abuse by comparison with breast lump patients. Logistic regression confirmed that emotional abuse and anxiety were independently associated with breast pain.

CONCLUSION

Clinical management of patients who present breast pain should be sensitive to the evidence that pain is a marker of emotional abuse in some women and is associated with widespread somatic and emotional distress.

Victimization in chronic fatigue syndrome and fibromyalgia in tertiary care: a controlled study on prevalence and characteristics

The authors studied the prevalence and characteristics of different forms of victimization in 95 patients suffering from chronic fatigue syndrome (CFS) or fibromyalgia (FM) compared with a chronic disease group, including rheumatoid arthritis (RA) and multiple sclerosis (MS) patients, and a matched healthy control group. The authors assessed prevalence rates, nature of victimization (emotional, physical, sexual), life period of occurrence, emotional impact, and relationship with the perpetrator by a self-report questionnaire on burdening experiences. CFS and FM patients showed significantly higher prevalences of emotional neglect and abuse and of physical abuse, with a considerable subgroup experiencing lifelong victimization. The family of origin and the partner were the most frequent perpetrators. With the exception of sexual abuse, victimization was more severely experienced by the CFS/FM group. No differences were found between healthy control subjects or RA/MS patients, and between CFS and FM patients. These findings support etiological hypotheses suggesting a pivotal role for chronic stress in CFS and FM and may have important therapeutic implications.

Perceptions of parents' health status and relationship to somatic preoccupation

OBJECTIVES

This study was designed to examine the potential relationship of family factors to somatic preoccupation.

METHOD

A total of 116 internal medicine patients completed research booklets exploring perceptions of parents' health, childhood trauma, borderline personality symptomatology [Personality Diagnostic Questionnaire-Revised (PDQ-R)], and somatic preoccupation (Bradford Somatic Inventory).

RESULTS

Simple correlations revealed that most of the relationships between somatic preoccupation and remaining study variables were statistically significant (e.g., poor parental health status correlated to somatic preoccupation). Using path analysis, poor perception of mother's health demonstrated an indirect effect on somatic preoccupation via borderline personality symptomatology, whereas, poor perception of father's health demonstrated an indirect effect on somatic preoccupation via childhood trauma. Neither parents' health status demonstrated direct effects on somatic preoccupation.

CONCLUSIONS

There appear to be parent gender differences in the mediation of the relationship between poor parental health status and somatic preoccupation in the offspring. The implications of these findings are discussed.