Somatization and Somatic Symptom Disorder and its overlap with dimensionally measured personality pathology: A systematic review

Comparative analysis of emotional factors in patients with somatic symptom disorder and panic disorder

OBJECTIVE

This study investigated the emotional symptom profiles and treatment responses in patients exhibiting overlapping physical symptoms to compare differences between Somatic Symptom Disorder (SSD) and Panic Disorder (PD).

METHODS

Pharmacotherapy outcomes were analysed in 208 outpatients with SSD (n = 94) and PD (n = 114). Stepwise multivariable logistic regression identified predictors of treatment response, considering variables such as the Clinical Global Impression-Severity (CGI-S), Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory, and State-Trait Anger Expression Inventory. Network analysis explored emotional patterns by estimating network structures for each group.

RESULTS

The overall response rate to pharmacotherapy was 23.6% (49/208), with no significant difference between groups. Baseline CGI-S and BDI-II scores were significant predictors of treatment response in both groups, while social phobia score was a significant predictor in PD. Depression and anxiety were related to physical symptoms in both groups, but anger was significantly associated only in SSD. Network analysis revealed that depression was central to other symptoms in SSD, while anxiety was the core symptom in PD, indicating different emotional drivers between the disorders.

CONCLUSIONS

This study suggests the differences in emotional symptom profiles between SSD and PD. Findings suggest different mechanisms, considering the role of anger in SSD, highlighting the need for more personalised treatments for each disorder.

Risk Assessment of Somatic Symptom Disorder Among Patients Attending a Family Medicine Practice in an Academic Center

The prevalence of somatic symptom disorder (SSD) among primary care patients is a significant concern. Despite advancements in medical services, many patients with unexplained symptoms remain undetected in primary care settings. This underscores the urgent need to improve detection rates and identify relevant factors associated with SSD. The study aimed to assess the prevalence of SSD, and the risk factors associated with its development among adult patients in primary care practice. This cross-sectional study was conducted in September 2023 across seven clinics within the Department of Family and Community Medicine at an academic center. Using a simple sampling technique, 300 adult patients were included. Data were collected through a designed questionnaire that comprised sections on sociodemographic information, medical characteristics, and screening questions for SSD. The study revealed a 38.7% prevalence of SSD, with higher rates observed among younger individuals, females, rural and semi-urban residents, the unemployed, those in toxic relationships, individuals with low socioeconomic status, and those experiencing stress. Multivariate regression analysis identified female sex, abusive relationships, stress, and sleep problems as significant risk factors for SSD. These findings underscore the need for improved detection of SSD in primary care settings to reduce healthcare overuse and enhance patient satisfaction. Addressing SSD requires an understanding of its diverse presentations across demographic and psychosocial factors, highlighting the importance of comprehensive assessments and tailored interventions.

Somatic symptom disorder and the role of epistemic trust, personality functioning and child abuse: Results from a population-based representative German sample

BACKGROUND

A growing body of evidence explored symptom burden of somatic symptom disorder (SSD) and its complex etiology involving psychosocial aspects. Child abuse has been linked to numerous psychopathologies including somatic symptoms as well as impaired personality functioning and disruptions in epistemic trust. This work aims to investigate personality functioning and epistemic trust in the association between child abuse and somatic symptom burden.

METHODS

We conducted structural equation modelling (SEM) using representative data of the German population (N = 2436). Personality functioning (OPD-SQS) was applied as a mediator between retrospectively recalled child abuse (ICAST-R) and somatic symptom burden (SSS-8, SSD-12, 6 month time criterion), while epistemic trust was added as a predictor of personality functioning.

RESULTS

6.8 % (n = 166) of participants self-reported SSD. Prevalence of child abuse (53.6 % vs. 31.7 %; χ2 = 33.44, p < .001) was significantly higher among those with SSD. Child abuse was significantly associated with somatic symptom burden (criterion A: β = 0.23, 95 %-CI: 0.19-0.27, p < .001; criterion B (β = 0.24, 95 %-CI: 0.20-0.28, p < .001) and explained 6 % and 5 % of its variance respectively. Adding personality functioning as a mediator increased the explained variance to 28 % for both somatic symptom burden criterion A and B. Including epistemic trust further increased the explained variance of personality functioning (from 15 to 36 %).

LIMITATIONS

All assessments and results are based on self-report and cross-sectional data.

CONCLUSIONS

Impairments in personality functioning and disruptions in epistemic trust might play an important role in experiencing symptoms of SSD. Both domains thus present new avenues for treatment improvement and further research in patients with SSD.

Neurodevelopmental and personality traits of somatic symptom disorder: A cross-sectional study

Aim

Somatic symptom disorder (SSD) is prevalent in primary healthcare settings and is often challenging to diagnose and treat. This study examined the neurodevelopmental and personality traits of individuals with probable SSD.

Methods

This cross-sectional study utilized anonymous online surveys. In this study, individuals with a score of 23 or higher on the Somatic Symptom Disorder-B Criteria Scale (SSD-12) were defined as having probable SSD, and individuals with no somatic symptoms and who scored 0 were defined as the healthy control (HC) group. We compared groups regarding neurodevelopmental traits, personality traits, depression, and anxiety using self-report questionnaires and analysis of covariance. In addition, we examined the association between neurodevelopmental traits, emotional problems, and SSD in the probable SSD group using structural equation modeling.

Results

A total of 491 people with probable SSD and 532 age- and sex-matched HCs were analyzed. The scores for somatic symptom severity, depression, generalized anxiety, health anxiety, attention deficit/hyperactivity disorder traits, autism spectrum disorder traits, personality traits, and personality disorder traits showed significant differences between the probable SSD group and the HC group. In the probable SSD group, neurodevelopmental traits positively and directly affected emotional problems and SSD.

Conclusion

Most neurodevelopmental and personality traits were associated with probable SSD. When approaching patients suspected of having SSD, clinicians may consider not only somatic symptoms, but also neurodevelopmental traits, personality traits, depression, and anxiety.

Gut microbiotas, inflammatory factors, and mental-behavioral disorders: A mendelian randomization study

BACKGROUND

The Mendelian randomization approach has emerged as a powerful tool, leveraging genetic variations as natural random experiments to minimize confounding and infer causality with unique advantages. Previous research has highlighted the crucial roles of gut microbiotas and inflammatory factors in mental-behavioral disorders, albeit to varying degrees. However, the precise causal relationship between gut microbiotas and mental-behavioral disorders remains elusive, and the potential role of inflammatory factors as mediators in this process is unclear.

METHODS

To investigate the associations between gut microbiotas, inflammatory factors, and mental-behavioral disorders, we pooled data from large-scale genome-wide association studies (GWAS). Our study screened 27 diseases, encompassing nine subtypes of mental-behavioral disorders: neurodevelopmental disorders, eating disorders, sleep disorders, schizophrenia spectrum disorders, stress- and trauma-related disorders, mood and affective disorders, cognitive and executive function disorders, personality and somatization disorders, and addiction disorders. Mendelian randomization(MR) was employed to assess causal relationships between gut microbiotas, inflammatory factors, and these mental-behavioral disorders, with inverse variance weighting (IVW) as the primary statistical method. Furthermore, we explored whether inflammatory factors mediate the relationship between gut microbiotas and mental-behavioral disorders.

RESULTS

Having investigated the intricate interplay among gut microbiota, inflammatory factors, and mental-behavioral disorders, we have identified nine pivotal inflammatory factors that intricately regulate the progression of eight distinct disease subtypes. Noteworthy among these findings, levels of CC motif chemokine ligand 28 (CCL28) and CC motif chemokine ligand 25 (CCL25) are associated with the progression of attention-deficit/hyperactivity disorder (ADHD), interleukin-18 (IL-18) levels are linked to anorexia, IL-12β levels are related to schizophrenia (SZ) progression, IL-8 levels are associated with manic episodes, and IL-10 and monocyte chemoattractant protein-2 (MCP-2) levels are closely related to enduring personality changes(EPC). Additionally, fibroblast growth factor 19 (FGF19) levels are associated with cognitive disorders, while C-X-C motif chemokine ligand 1 (CXCL1) levels are related to executive functioning.

CONCLUSION

Gut microbiotas and mental-behavioral disorders have causal relationships, with inflammatory factors mediating the pathway from gut microbiotas to these disorders.

Out of area placements for people with "Personality Disorder": Making the case for a local intensive psychotherapeutic alternative

OBJECTIVES

The use of Out of Area (OoA) psychiatric placements for people with "Personality Disorder" (PD) is widespread in the UK. An innovative local intensive psychotherapeutic service, adapted to the transdiagnostic presentations of the most complex PD patients, likely to be placed out of the area, was devised in the English County of Devon. This paper reports the findings of a Freedom of Information (FOI) request to commissioners attempting to quantify PD OoA placements in England and the cost offset of the local therapeutic alternative to OoA placements in Devon.

DESIGN AND METHODS

Data from FOI requests was combined with publicly available sources to assess the scale of OoA placements for people with PD in England. OoA service use and cost data were used to examine the cost offset and effectiveness of the local alternative to OoA placements in Devon. The results found a lack of transparency and excessive use of OoA placements despite UK Government intentions. Data from the local therapeutic service demonstrated cost-effectiveness, reducing OoA placements and increasing the availability of psychotherapeutic services. This paper suggests the number of OoA placements can be reduced for people with severe and complex PD. The local therapeutic service provides a model for future rehabilitation pathways.

Risk of somatic symptom disorder in people with major medical disorders: Cross-sectional results from the population-based Hamburg City Health Study

BACKGROUND

Somatic Symptom Disorder (SSD) is characterized by excessive thoughts, emotions, and behaviors related to physical symptoms irrespective of their etiology. Estimates of SSD frequency assessed via self-report questionnaires range between 6.7% (general population) and 53% (specialized setting). This study aims to examine the frequency of risk of SSD and associated factors in people with Major Medical Disorders (MMD) using cross-sectional data from the population-based Hamburg City Health Study.

METHODS

Risk of SSD was operationalized using the Somatic Symptom Scale-8, the Somatic Symptom Disorder-B Criteria Scale-12, and one item on symptom persistence. People at risk of SSD and not at risk were compared regarding biopsychosocial factors. Factors associated with risk of SSD were identified by hierarchical multiple logistic regression analysis.

RESULTS

N = 1944 people (mean age 64.8 ± 8 years, 43.8% female) reported at least one MMD. Of those, 6.8% [95%, CI 5.6-7.9%] were at risk of SSD and reported greater healthcare utilization and lower health-related quality of life. Logistic regression identified higher age (p=.032), lower education (p=.002), number of somatic comorbidities (p<.001), and elevated neuroticism (p<.001) and depression (p<.001) scores as factors associated with risk of SSD, with an explained variance of Nagelkerke R2=0.45.

CONCLUSION

The observed frequency of risk of SSD in people with MMD does not point towards an excessive symptom burden in this sample. However, those at risk experience significant psychosocial burdens and increased healthcare utilization, highlighting a vulnerable subgroup prone to SSD.

Five-factor personality traits and functional somatic disorder: A systematic review and meta-analysis

INTRODUCTION

Functional Somatic Disorders (FSD) is an umbrella term for various conditions characterized by persistent and troublesome physical symptoms, that are not better explained by other psychiatric or somatic conditions. Personality traits may play a crucial role in FSD, but the link is not fully understood. This study presents a systematic review and meta-analysis examines the relationship between the Five-Factor Model (FFM) of personality traits and FSD.

METHODS

The review was based on the PRISMA statement, and drew data from systematic searches in PsycInfo, PubMed, and Embase. To be eligible for inclusion, studies had to include eligible FSD groups and control groups and to assess FFM traits. Data were analyzed using random effects models. Sub-group and sensitivity analyses as well as meta-regression were used to explore the heterogeneity and robustness of findings.

RESULTS

In total 6841 records were screened and 52 included. FSD cases scored higher on neuroticism (k = 46, Hedge's g = 0.72, [95 % CI, 0.61: 0.83]) and lower on extraversion (k = 31, g = -0.41, [-0.55:-0.28]) and agreeableness (k = 15, g = -0.22, [-0.36:-0.09]) than healthy/unspecified controls. FSD cases scored higher on neuroticism (k = 9, g = 0.26 [0.08:0.44]) and agreeableness (k = 4, g = 0.43 [0.28:0.59]) than somatic controls, but did not differ on extraversion (k = 6, g = -0.17 [-0.45:0.11]). No significant differences were found for conscientiousness and openness. For psychiatric controls, meta-analysis was only possible for neuroticism (k = 3,= -0.61, [-1.98:0.77]). Findings displayed significant heterogeneity but no publication bias.

CONCLUSIONS

This review reveals significant associations between FFM traits and FSD, providing insight into the etiology, classification, and management of FSD.

Personality Disorders and Clinical Disorders: The Challenge of Comorbid Autism Spectrum Disorder (ASD), Eating Disorders (EDs), Posttraumatic Stress Disorder (PTSD), or Somatic Symptom Disorder (SSD)

PURPOSE OF THE REVIEW

The purpose of this review is to report on prevalence of co-occurrence, possible etiologic mechanisms, and course and treatment implications of each of these challenging clinical disorders (Autism Spectrum Disorder, Eating Disorders, Posttraumatic Stress Disorder) comorbid with Personality Disorders.

RECENT FINDINGS

These comorbidities often increase the symptom severity, worsen the course and outcome, and increase the risk of self-harm and suicidal behavior. For EDs and PTSD, existing therapies may prove somewhat helpful but novel approaches are needed and under investigation in the context of comorbid PDs and ASD, EDs and PTSD to address common underlying diatheses. Treatments for these comorbid disorders need to incorporate interventions addressing suicide risk, emotion dysregulation, be trauma-informed and attend to patient engagement. Future research should prioritize studying the course and outcome of ASD comorbid with PDs, novel therapies for EDs comorbid with PDs; refining the concept of Complex PTSD and commencing study of SSD comorbid with PDs.

Unravelling inter-relations within and between psychodynamic constructs and psychopathology using network analysis

Psychodynamic constructs and psychopathology are closely inter-related, but more detailed insight is needed. We investigated these complex inter-relations using network analysis. A Gaussian graphical model in a sample of N = 2232 psychotherapeutic inpatients was estimated. Self-administered questionnaires to assess interpersonal relations (Inventory of Interpersonal Problems-32), psychodynamic conflicts (Operationalized Psychodynamic Diagnosis-Conflict Questionnaire), personality functioning (Operationalized Psychodynamic Diagnosis-Structure Questionnaire-Short Form, Inventory of Personality Organization-Short Form), and psychopathology (Brief Symptom Inventory) were utilized. We investigated the network structure, identified the most inter-related psychodynamic constructs and the psychodynamic constructs with the strongest inter-relations to psychopathology, and explored the clustering of all included constructs. Active and passive conflict processing modes were negatively inter-related in most conflicts. Passive conflict processing modes were more strongly related to psychopathology than active ones in all conflicts, apart from the care versus autarky conflict. Identity diffusion shared the strongest inter-relations within psychodynamic constructs. The psychodynamic constructs that were most strongly related to psychopathology were impairments in self-perception and the passive self-worth conflict. Psychopathology and psychodynamic constructs formed distinct clusters. Our results emphasize the relevance of personality functioning within psychodynamic constructs and in relation to psychopathology.

Exploring Associations of Somatic Symptom Disorder with Personality Dysfunction and Specific Maladaptive Traits

INTRODUCTION

According to ICD-11, personality disorders (PDs) are defined by the severity of self and interpersonal dysfunction in terms of personality functioning (PF) and an optional assessment of specific maladaptive personality trait expressions. Also, somatoform disorders are replaced by somatic symptom disorder (SSD). This study examines associations using the novel diagnostic criteria of SSD in an unselected primary care sample, PF, and maladaptive traits in patients with and without SSD.

METHODS

An anonymized cross-sectional study was conducted. A questionnaire including SSD-12 (Somatic Symptom Disorder B Criteria Scale-12) and PHQ-15 (Patient Health Questionnaire-15), LPFS-BF 2.0 (Level of Personality Functioning Scale - Brief Form) and PID-5BF+M (Modified Personality Inventory for DSM-5 - Brief Form Plus) was used. A bifactor (S-1) model was calculated with PF (reference for general factor) and personality traits (specific factors) to estimate associations between PF, specific maladaptive personality traits, and SSD. Differences in personality scales between SSD and non-SSD patients were calculated with the Mann-Whitney U test.

RESULTS

A total of 624 patients in six general practices participated (mean age 47 years; 60.4% female). SSD-12 and PHQ-15, respectively, showed significant associations with PF (γ = 0.51; γ = 0.48; p < 0.001), negative affectivity (γ = 0.50; γ = 0.38, p < 0.001) and psychoticism (γ = 0.29; γ = 0.28; p < 0.010). Besides, SSD-12 was significantly associated with disinhibition (γ = -0.38; p < 0.010) and anankastia (γ = -0.16; p < 0.010). Patients with SSD showed significantly impaired PF and maladaptive traits in all scales (p < 0.001).

CONCLUSION

Impaired PF explains moderate to large amounts of the SSD symptoms and maladaptive personality traits negative affectivity, psychoticism, disinhibition, and anankastia show specific associations beyond PF. An in-depth understanding of these relations might be helpful to improve doctor-patient communication and treatment in SSD.

How are poor sleepers with other clinical conditions affected by maladaptive personality traits? A neural network-based analysis

Background

Psychopathology research mainly focused on the cross-sectional and longitudinal associations between personality and psychiatric disorders without considering the moment-to-moment dynamics of personality in response to environmental situations. The present study aimed to both cluster a young sample according to three mixed clinical conditions (poor sleep quality, depression, and somatization) and to predict the derived clusters by maladaptive personality traits and sex differences using a deep machine learning approach.

Methods

A sample of 839 adults aged 18-40 years (64% female) from the west of Iran were clustered according to the mixed clinical conditions using the cluster analysis techniques. An Artificial Neural Network (ANN) modeling is used to predict the derived clusters by maladaptive personality traits and biological gender. A receiver operating characteristic (ROC) curve was used to identify independent variables with high sensitivity specific to the derived clusters.

Results

The cluster analysis techniques suggested a fully stable and acceptable four-cluster solution for Depressed Poor Sleepers, Nonclinical Good Sleepers, Subclinical Poor Sleepers, and Clinical Poor Sleepers. The ANN model led to the identification of one hidden layer with two hidden units. The results of Area under the ROC Curve were relatively to completely acceptable, ranging from.726 to.855. Anhedonia, perceptual dysregulation, depressivity, anxiousness, and unusual beliefs are the most valuable traits with importance higher than 70%.

Conclusion

The machine learning approach can be well used to predict mixed clinical conditions by maladaptive personality traits. Future research can test the complexity of normal personality traits connected to mixed clinical conditions.

Psychological risk factors of somatic symptom disorder: A systematic review and meta-analysis of cross-sectional and longitudinal studies

OBJECTIVE

Current diagnostic concepts of somatic symptom disorder (SSD) in DSM-5 and bodily distress disorder (BDD) in ICD-11 require certain psychological criteria, but researchers have called for further specification. Therefore, in a first step, this systematic review and meta-analysis aimed to summarize the current evidence on psychological factors associated with SSD/BDD and/or disorder-relevant clinical outcomes such as symptom severity and impairment.

METHODS

Psychological factors were systematically searched using Pubmed, Cochrane Library and Psycinfo via EBSCO. Studies providing original data in English or German, after 2009 were included. Cross-sectional, cohort and case-control studies investigating at least one psychological factor in individuals with SSD/BDD in the context of disorder-relevant outcomes were included.

RESULTS

Forty-three eligible studies (n = 3760 patients) in SSD (none in BDD) provided data on at least one psychological factor, 37 in case-control format, 10 cross-sectional and 5 longitudinal. Meta-analyses of the case-control studies found patients with SSD to be more impaired by depression (SMD = 1.80), anxiety (SMD = 1.55), health anxiety (SMD = 1.31) and alexithymia (SMD = 1.39), compared to healthy controls. Longitudinal results are scarce, mixed, and require refining, individual studies suggest self-concept of bodily weakness, anxiety and depression to be predictive for persistent SSD and physical functioning.

CONCLUSION

This review provides a detailed overview of the current evidence of psychological factors in relation to SSD/BDD. Future studies on SSD and BDD should include under-studied psychological factors, such as negative affect, fear avoidance, or emotion regulation. More longitudinal studies are needed to assess the predictive value of these factors.

Frontal alpha asymmetry is associated with chronic stress and depression, but not with somatoform disorders

Cardinal characteristics of somatoform disorders (SFDs) are worry of illness, and impaired affective processing. We used relative frontal alpha asymmetry (FAA), a method to measure functional lateralization of affective processing, to investigate psychobiological correlates of SFDs. With alpha activity being inversely related to cortical network activity, relative FAA refers to alpha activity on the right frontal lobe minus alpha activity on the left frontal lobe. Less relative left frontal activity, reflected by negative FAA scores, is associated with lower positive and greater negative affectivity, such as observed in depression. Due to its negative affective component (illness anxiety), we expected to find less relative left frontal activity pattern in SFDs, and positive associations with self-reported chronic stress and depression symptoms. We recorded resting-state EEG activity with 64 electrodes, placed in a 10-10 system in 26 patients with a primary SFD, 23 patients with a major depressive disorder and 25 healthy control participants. The groups did not differ in FAA. Nevertheless, across all participants, less relative left frontal activity was associated with chronic stress and depression symptoms. We concluded that FAA may not serve as an indicator of SFDs. As the relationship of FAA and depressive symptoms was fully mediated by chronic stress, future studies have to clarify whether the association between FAA and chronic stress may represent a shared underlying factor for the manifestation of mental health complaints, such as depression.

Are you how you eat? Aspects of self-awareness in eating disorders

Eating disorders (ED) are severe psychiatric disorders characterized by dysfunctional behaviors related to eating or weight control, with profound impacts on health, quality of life, and the financial burden of affected individuals and society at large. Given that these disorders involve disturbances in self-perception, it is crucial to comprehend the role of self-awareness in their prevalence and maintenance. This literature review presents different self-awareness processes, discussing their functioning across different levels of complexity. By deconstructing this concept, we can gain a better understanding of how each facet of self and personality relates to the symptoms of these disorders. Understanding the absence or impairment of self-awareness in ED holds significant implications for diagnosis, treatment, and overall management. By recognizing and comprehending the characteristics of self-awareness, clinicians can develop tailored interventions and evidence-based treatments for individuals with ED. Furthermore, this narrative review underscores the importance of considering temperament and personality factors in the context of ED, as temperament traits and personality characteristics may interact with self-awareness processes, influencing the development and maintenance of ED. Ultimately, the results highlight the pressing need for further research on the development of effective interventions and support strategies grounded in the aspects of self-awareness mechanisms for individuals affected by these disorders.

Comorbidities between temporomandibular disorders and somatization in young adults: exploring links with personality, emotional, and sleep disturbances

OBJECTIVE

The comorbidities between temporomandibular disorders (TMDs) and somatization and their associations with personality traits, emotional disorders, and sleep disturbances were investigated.

STUDY DESIGN

Adults aged 18 to 24 years completed an electronic survey encompassing TMD symptoms (5Ts), Patient Health Questionnaire-15, Big Five Personality Inventory-10, Depression Anxiety Stress Scales-21, and Pittsburgh Sleep Quality Index. Data were assessed using non-parametric tests/correlation analysis and logistic regression analysis (α = 0.05).

RESULTS

The sample comprised 365 participants, of whom 22.2% and 19.5% were 5Ts-negative without and with somatization, respectively, and 18.1% and 40.3% were 5Ts-positive without and with somatization, respectively. Significant differences in neuroticism, distress, depression, anxiety, stress, and sleep quality were observed between 5Ts-negative participants with somatization and 5Ts-positive participants with somatization compared with 5Ts-negative participants without somatization and 5Ts-positive participants without somatization. Distress, anxiety, stress, and sleep were moderately correlated with somatic but not TMD symptoms (rs = 0.45-0.52).

CONCLUSIONS

Irrespective of whether they had TMDs, participants with somatization exhibited heightened levels of neuroticism and emotional and sleep disturbances.

All the Same? Different Measures of Personality Functioning Are Similar but Distinct. A Comparative Study from a Psychodynamic Perspective Using Exploratory Graph Analysis

Personality functioning (PF) is a central construct in many theories of personality pathology. Based on psychodynamic theories, two screening questionnaires to assess PF are widely used: The Inventory of Personality Organization-16 item version and the Operationalized Psychodynamic Diagnosis-Structure Questionnaire Short Form. This study aimed to explore the similarities and differences of the two questionnaires in a large clinical sample of N = 1636 psychotherapeutic inpatients. Correlation analyses were conducted to examine the associations between the global scores and between the subscales. The study further used Exploratory Graph Analysis (EGA) to explore the dimensionality of the items. The stability of estimates was evaluated using a bootstrap version of EGA (bootEGA). The results indicated that the two questionnaires are highly correlated, yet not multicollinear, and moderate to large correlations were found between their subscales. EGA revealed six dimensions that fairly represented the original subscales. BootEGA showed that the dimensions and items were stable, except for one item that did not load sufficiently on any dimension. The findings suggest that although the questionnaires are highly correlated, their subscales tap into distinct domains of PF. We discuss implications stemming from these findings for clinical and scientific practice.

A head-to-head comparison of eight unique personality systems in predicting somatization phenomenon

BACKGROUND

If somatization is an independent personality trait, it is not clear whether it is specific to the temperament or maladaptive spectrum of personality. We aimed at the head-to-head comparison of temperament and maladaptive systems and spectra of personality to predict both somatization and somatic symptom and related disorders (SSRD).

METHODS

The samples included 257 cases with SSRD (70.8% female) and 1007 non-SSRD (64.3% female) from Western Iran. The Personality Inventory for DSM-5 (PID-5), Personality Diagnostic Questionnaire-4 (PDQ-4), Temperament and Character Inventory (TCI), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A), Affective and Emotional Composite Temperament Scale (AFECTS), and Positive Affect and Negative Affect Model (PANAS) was used to data collection. A somatization factor plus temperament and maladaptive spectra of personality were extracted using exploratory factor analysis. Several hierarchical linear and logistic regressions were used to test the predictive systems and spectra.

RESULTS

All personality systems jointly predict both somatization and SSRD with a slightly higher contribution for temperament systems. When the temperament and maladaptive spectra were compared, both spectra above each other significantly predicted both somatization (R2 = .407 versus .263) and SSRD (R2 = .280 versus .211). The temperament spectrum explained more variance beyond the maladaptive spectrum when predicting both the somatization factor (change in R2 = .156 versus .012) and SSRD (change in R2 = .079 versus .010).

CONCLUSION

All temperament and maladaptive frameworks of personality are complementary to predicting both somatization and SSRD. However, the somatization is more related to the temperament than the maladaptive spectrum of personality.

Alexithymia in Patients with Somatization Difficulties and Tinnitus-Related Distress: A Systematic Review

Chronic tinnitus, the perception of sound without an external source, can significantly affect individuals' well-being. As an often medically unexplained symptom, chronic tinnitus can present as a "somatoform" or "functional" difficulty. Some evidence has pointed to alexithymia as a transdiagnostically relevant risk factor for both symptom clusters. Using a two-part rapid review-searching within EBSCO, Embase by Ovid, PubMed, Web of Science-we summarize psychological studies regarding alexithymia, i.e., difficulties in recognizing and expressing emotions and (1) somatoform conditions and (2) chronic tinnitus. For the former (inclusion criteria: (1) adult human beings with different kinds of somatization, (2) longitudinal study designs, (3) publication between 2001 and 2021, (4) full-text in English or German) we identified eight studies that revealed significant links between alexithymia and somatoform conditions. Psychotherapy improved alexithymia in most studies. Additionally, alexithymia was associated with broader treatment outcomes such as improvements in pain intensity, gastrointestinal symptoms, and patient-therapist alliance. The 'Risk Of Bias In Non-randomized Studies-of Interventions' tool (ROBINS-I) and 'Revised Cochrane risk-of-bias tool for randomized trials' (RoB 2) were used for risk of bias assessment. Summarizing all available studies on alexithymia and chronic tinnitus, we identified three studies. Inclusion criteria were: (1) adult human beings with chronic tinnitus, (2) publication between 2001 and 2021, (3) full-text in English or German. Risk of bias was assessed by the 'JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies'. The available studies suggested a high rate of alexithymia (65.7%) in patients with chronic tinnitus. Tinnitus-related distress was significantly associated with alexithymia in two studies, one of which, however, found no differences in alexithymia between patients with bothersome versus non-bothersome tinnitus. Conversely, one study reported high levels of alexithymia in patients with low levels of tinnitus-related distress. Overall, alexithymia may be a transdiagnostic psychological indicator of somatization phenomena, which might include some chronic tinnitus presentations. Psychotherapy likely improves alexithymia as well as somatoform symptom presentations.

Construct and criterion validity of the HiTOP spectra to predict dimensional and categorical somatization in a large non-western sample

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a phenotypic data-driven framework for the classification of psychopathology. We tested the construct and criterion validity of the HiTOP spectra measured by the Personality Inventory for DSM-5 (PID-5) using exploratory structural equation modeling (ESEM) and hierarchical regressions both to predict somatic symptom and related disorders (SSRD) and a somatization factor. The case-control study used hierarchical logistic regressions to distinguish 257 cases with SSRD from 1007 healthy controls by both the maladaptive and the temperament factors. The extracted factors were also used in hierarchical linear regressions to predict the dimensional somatization factor. The seven temperament factors explained more variance above and beyond the five maladaptive factors when predicting SSRD (pseudo R2 = 0.169 to 0.266 versus 0.125 to 0.196; change in pseudo R2 = 0.055 to 0.087 versus 0.011 to 0.017). The temperament factors also explained more variance above and beyond the maladaptive factors when predicting the somatization factor (R2 = 0.392 versus 0.269; change in R2 = 0.146 versus 0.023). Although the HiTOP spectra measured by PID-5 are significant structures related to the categorical and dimensional measurements of somatoform, our findings highlight potential problems with both the construct and criterion validity of the HiTOP spectra.

Adverse childhood experiences and personality functioning interact substantially in predicting depression, anxiety, and somatization

Etiological theories on the development of psychopathology often incorporate adverse childhood experiences (ACE) as an important contributing factor. Recent studies suggest personality functioning (PF; i.e., stability of the self and interpersonal relationships) as an important transdiagnostic construct that could be useful in better understanding when persons with ACE do (not) develop psychopathological symptoms. A representative sample of N = 2363 was assessed by questionnaires on ACE, PF (Level of Personality Functioning Scale-Brief Form 2.0), and current symptoms of depression, anxiety, and somatization (Brief Symptom Inventory 18). The interaction between ACE and PF on symptoms was investigated using multiple group models and Bayesian structural equation modeling. ACE were positively associated with psychopathology and PF impairments. The interaction effect between ACE and PF explained incremental variance in current symptoms, ranging from 26% for somatization to 49% for depression with the complete model explaining up to 91% of the latent variance in psychopathology. Our findings indicate a diathesis-stress model with PF as a resource or resilience that may buffer against the development of symptoms in the face of adversity. Treatments of depression and anxiety targeting self and interpersonal functioning therefore may lead to improvements in resilience and relapse prevention. [Correction added on 15 March 2023, after first online publication: Level of Personality Functioning Scale-Brief Form has been replaced to Level of Personality Functioning Scale-Brief Form 2.0 ].

Case report: New insights into persistent chronic pelvic pain syndrome with comorbid somatic symptom disorder

Chronic pelvic pain syndrome (CPPS) is generally defined as pain in the pelvic area that persisted for 3-6 months or longer. The pain can be constant or episodic and functionally disabling. Any dysfunction of the central nervous system can lead to central sensitization, which enhances and maintains pain as well as other symptoms that are mediated by the central nervous system. It occurs in subgroups of nearly every chronic pain condition and is characterized by multifocal pain and co-occurring somatic symptoms. Somatic symptom disorder (SSD) is defined as a condition in which having one or more somatic symptoms, such as excessive worries, pressure, and catastrophic events. These symptoms can be very disruptive to a patient's life and can cause significant distress. SSD cases with severe symptoms frequently undergo repeated medical investigations and the symptoms often lead patients to seek emergency medical treatment and consult with specialists repeatedly, which is a source of frustration for patients and clinicians. Here we report a case that Asian female with persistent CPPS with comorbid SSD, who got in trouble for up to 8 years. This case reminds clinicians to pay excessive attention to the diagnosis of CPPS with comorbid SSD after recovery from acute COVID-19, with hope of raising awareness in the identification of SSD and present new insight into appropriate treatment for each woman who suffers from it.

Psychological Characteristics Associated with Post-Treatment Physical Status and Quality of Life in Patients with Brain Tumor Undergoing Radiotherapy

Radiotherapy (RT) is a mainstay of treatment for brain tumors. To minimize the risk of side effects while maximizing the therapeutic effects, personalized treatment plans, consisting mainly of genomics, radiomics, and mathematical modeling, are increasingly being used. We hypothesize that personality characteristics could influence treatment outcomes and thus could be used to help personalize RT. Therefore, the aim of this study was to identify the psychological characteristics associated with post-treatment physical status and quality of life (QoL) in patients with brain tumors undergoing RT. Two psychological tests-the Eysenck Personality Questionnaire and the State-Trait Anxiety Inventory-were administered prior to RT. Physical parameters before and after RT were also assessed through the following tests: hand grip strength, Timed Up and Go test, 6 Min Walk Test, and Functional Independence Measure. The Functional Assessment of Cancer Therapy-General (FACT-G) was used to assess QoL. The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) was administered to assess fatigue. Neuroticism was significantly associated with low FACT-G Physical Well-Being scores. Psychoticism was associated with an improvement in physical fitness scores after RT. These findings suggest that personality traits should be considered when designing a personalized radiotherapy plan.

[The invisible pregnancy: Clinical characteristics and perspectives about denial of pregnancy]

Denial of pregnancy is a public health problem due to maternal, fetal, and neonatal morbidity, affecting both physical and mental health. It generally involves an absence of the physical signals associated with pregnancy such as abdominal swelling, amenorrhea, weight gain, or even perception of fetal movements. Despite the potential consequences for mother and child, there is still little data on its clinical features and the neurocognitive mechanisms involved. In this paper, we provide an update on the clinical, socio-demographic, and psychopathological characteristics of pregnancy denial based on contemporary scientific literature. We first define denial of pregnancy by referring to the history of the concept, previous definitions, and nosographic classifications. We then detail the clinic of denial by distinguishing the physical and psychological symptoms of this disorder, then the socio-demographic, gynecological, and psychiatric characteristics. We describe the consequences of denial on the mother, infant, and the dyad, referring to situations of cryptic neonaticide. Finally, we show the importance of perinatal neuroscience research on maternal interoception to understand the mechanisms involved in denial of pregnancy, and improve their medical management in clinical practice.