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Somatization is a significant problem for clinical medicine. Unlike somatization disorder, which is relatively rare, abridged somatization, a less severe form of somatization, is prevalent in primary care clinics. The authors examined the clinical status and functioning of patients diagnosed with a depression or anxiety disorder comorbid with abridged somatization and compared them with patients diagnosed with a depression or anxiety disorder alone. The authors examined severity of physical functioning and psychopathology in relation to diagnostic status. Patients diagnosed with both abridged somatization and a depression or anxiety disorder were more physically impaired and more anxious than those diagnosed with a depression or anxiety disorder alone. The results suggest that abridged somatization frequently coexists with depression and anxiety and thus complicates the presentation of these disorders.
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PMID:Somatization: a debilitating syndrome in primary care. 1116 Nov 23

1. To distinguish GAD from panic disorder is not difficult if a patient has frequent, spontaneous panic attacks and agoraphobic symptoms, but many patients with GAD have occasional anxiety attacks or panic attacks. Such patients should be considered as having GAD. An even closer overlap probably exists between GAD and social phobia. Patients with clear-cut phobic avoidant behavior may be distinguished easily from patients with GAD, but patients with social anxiety without clear-cut phobic avoidant behavior may overlap with patients with GAD and possibly should be diagnosed as having GAD and not social phobia. The cardinal symptoms of GAD commonly overlap with those of social phobia, particularly if the social phobia is more general and not focused on a phobic situation. For example, free-floating anxiety may cause the hands to perspire and may cause a person to be shy in dealing with people in public, and thus many patients with subthreshold social phobic symptoms have, in the authors' opinion, GAD and not generalized social phobia. The distinction between GAD and obsessive-compulsive disorder, acute stress disorder, and posttraumatic stress disorder should not be difficult by definition. At times, however, it may be difficult to distinguish between adjustment disorder with anxious mood from GAD or anxiety not otherwise specified, particularly if the adjustment disorder occurs in a patient with a high level of neuroticism or trait anxiety or type C personality disorder. Table 2 presents features distinguishing GAD from other psychiatric disorders. 2. Lifetime comorbid diagnoses of other anxiety or depression disorders, not active for 1 year or more and not necessitating treatment during that time period, should not effect a diagnosis of current GAD. On the other hand, if concomitant depressive symptoms are present and if these are subthreshold, a diagnosis of GAD should be made, and if these are full threshold, a diagnosis of MDD should be made. 3. If GAD is primary and if no such current comorbid diagnosis, such as other anxiety disorders or MDD, is present, except for minor depression and dysthymia, or if only subthreshold symptoms of other anxiety disorders are present, GAD should be considered primary and treated as GAD; however, patients with concurrent threshold anxiety or mood disorders should be diagnosed according to the definitions of these disorders in the DSM-IV and ICD-10 and treated as such. 4. Somatization disorders are now classified separately from anxiety disorders. Some of these, particularly undifferentiated somatization disorder, may overlap with GAD and be diagnostically difficult to distinguish. The authors believe that, as long as psychic symptoms of anxiety are present and predominant, patients should be given a primary diagnosis of GAD. 5. Two major shifts in the DSM diagnostic criteria for GAD have markedly redefined the definition of this disorder. One shift involves the duration criterion from 1 to 6 months, and the other, the increased emphasis on worry and secondary psychic [table: see text] symptoms accompanied by the elimination of most somatic symptoms. This decision has had the consequence of orphaning a large population of patients suffering from GAD that is more transient and somatic in its focus and who typically present not to psychiatrists but to primary care physicians. Therefore, clinicians should consider using the ICD-10 qualification of illness duration of "several months" to replace the more rigid DSM-IV criterion of 6 months and to move away from the DSM-IV focus on excessive worry as the cardinal symptom of anxiety and demote it to only another important anxiety symptom, similar to free-floating anxiety. One also might consider supplementing this ICD-10 criterion with an increased symptom severity criterion as, for example, a Hamilton Anxiety Scale of 18. Finally, the adjective excessive, not used in the definition of other primary diagnostic criteria, such as depressed mood for MDD, should be omitted (Table 3). 6. One may want to consider the distinction of trait (chronic) from state (acute) anxiety, but whether the presence of some personality characteristics, particularly anxious personality or Cluster C personality and increased neuroticism, as an indicator of trait [table: see text] anxiety is a prerequisite for anxiety disorders; occurs independently of anxiety disorders; or is a vulnerability factor that, in some patients, leads to anxiety symptoms and, in others, does not, is unknown. 7. Symptoms that some clinicians consider cardinal for a diagnosis of GAD, such as extreme worry, obsessive rumination, and somatization, also are present in other disorders, such as MDD. (ABSTRACT TRUNCATED)
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PMID:Overview and clinical presentation of generalized anxiety disorder. 1122 2

Child sexual abuse (CSA) is associated with greater vulnerability to victimization in adulthood. Such experiences may have a cumulative effect. This study compared the adjustment of 633 women experiencing revictimization, multiple adult victimizations, single adult victimization, CSA only, or no victimization. Somatization, depression, anxiety, interpersonal sensitivity, hostility, and post-traumatic stress disorder (PTSD) symptomatology were examined. Results support the cumulative effect of trauma but do not indicate differential effects for child to adult revictimization. Women with revictimization and multiple adult assaults reported more difficulties compared to women with only one form of adult abuse or no victimization. Women with CSA only reported similar symptoms as revictimized women and women with multiple adult assaults reported higher levels of distress than nonabused women and appeared somewhat more likely to experience anxiety and PTSD-related symptoms as compared to women with only adult abuse. Women with adult assault only and no abuse reported similar levels of distress.
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PMID:The revictimization of child sexual abuse survivors: an examination of the adjustment of college women with child sexual abuse, adult sexual assault, and adult physical abuse. 1123 59

Relations among measures of trait anxiety, depression, panic, somatization, alcohol use, drug use, and treatment for depression were investigated because, typically, studies (a) addressed relations among subsets of only 2 or 3 of the measures and (b) dealt almost exclusively with narrow samples of the population representing extremes on 1 or 2 of the measures. In this study, relations among all 7 measures were assessed with participants representing a wide range of scores on all the measures. The 369 participants (155 men, 214 women) were sampled from the general population. Three replications of the same study consistently yielded hypothesized positive intercorrelations among all 7 scales. Factor 1 (Anxiety-Depression) included Trait Anxiety, Depression, and Panic scales. Factor 2 (Substance Abuse) included Drug Use, Alcohol Use, Treatment for Depression, and Somatization scales. Factor 2 highlighted self-medication as a defining characteristic of somatizers and corroborated findings showing that substance abuse is often a precursor to treatment for depression-like symptoms that can be ameliorated with abstinence. Factors 1 and 2 were significantly intercorrelated (r = .41, df = 367, p < .05), showing a 17% shared variance in two common groupings of psychological dysfunction (anxiety-depression, substance abuse) in the general population. Thus, depending on socioeconomic and demographic variables, a third common form of dysfunction in the general population is represented by a combination of anxiety-depression plus substance abuse.
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PMID:General relations among drug use, alcohol use, and major indexes of psychopathology. 1123 42

This study investigated whether a pain sample and pain simulators could be distinguished on the Pain Patient Profile (P3). Forty patients with a pain condition completed the P3 under normal instructions, while 20 students responded under instructions to feign a pain disorder but to attempt to avoid detection. The simulators did not differ on the P3 Validity Scale compared with the pain group, but scored significantly higher than the pain group on the P3 clinical scales (Depression, Anxiety, Somatization). The simulators were more likely to obtain an abnormal score (T score > 55) on all of the clinical scales. The Depression scale had highest positive and negative predictive power and correctly classified 80% of the participants. The P3 may be a useful screening tool for assessing those feigning pain but requires further research.
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PMID:Pain patient profile and the assessment of malingered pain. 1124 70

Most of patients with mental disorders are cared for in the primary care sector, rather than in the mental health sector. Self-report questionnaires can be used as screening instruments to identify mental disorders in primary care. The 12-item General Health Questionnaire (GHQ-12) is a widely used screening questionnaire for common mental disorders. Unfortunately, the GHQ-12 generates many false presumptive positives and forces the employer to expend resources on confirmatory testing. Therefore, the aim of the present report was to investigate a two-stage questionnaire screening design in a primary care setting. The GHQ-12 was used as an initial screening test followed by the Symptom Checklist (SCL-90-R). A randomly selected sample of adult outpatients (N = 408) from 18 primary care offices was screened using the two questionnaires. A structured diagnostic interview and an impairment rating were used as standards. Subjects were classified into true-positives and false-positives based on their GHQ-12 score and the clinical interview. Logistic regression and receiver operating characteristic analysis were performed to determine whether the SCL-90-R increased accuracy in screening for mental disorders by discriminating between true-positive and false-positive cases. The SCL-90-R subscales Depression, Obsessive-Compulsive, and Somatization were identified as factors associated with the GHQ-12 classification. Therefore, a significant improvement in screening performance of the GHQ-12 is obtained by combination of the test results. The approach may reduce artifact due to high scoring tendencies not associated with psychological disorder.
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PMID:Improving screening for mental disorders in the primary care setting by combining the GHQ-12 and SCL-90-R subscales. 1124 54

This paper examines the psychometric properties of the Children's Somatization Inventory (CSI) in 600 10-12-year old children in Kyiv, Ukraine, replicating and extending the original findings from a sample in Nashville, Tennessee (J. Garber et al. 1991). The Kyiv children had significantly lower CSI total scores and reported significantly fewer symptoms than the American children. The Kyiv mothers, however, reported significantly more somatization symptoms in their children than did the American mothers. A factor analysis of the children's data yielded four similar factors encompassing pseudoneurologic, cardiovascular, gastrointestinal, and pain/weakness symptoms. Consistent with the findings from the Nashville study, the CSI was significantly related to the children's self-reports of health and depressive and anxiety symptoms and to maternal reports of child depression and anxiety symptoms. In addition, although more children with the highest CSI scores (25+) reported various illness experiences than those with 0-1 symptoms, no differences were found in the school absentee records. Thus, the results were congruent with the findings of the Nashville study, indicating that the CSI reliably measured somatization in this Ukrainian sample.
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PMID:Ukrainian application of the Children's Somatization Inventory: psychometric properties and associations with internalizing symptoms. 1132 31

A sample of chronic pain patients (N = 40) was described with reference to defence mechanisms, interpersonal problems, psychological symptoms and bodily conditions. The relationships between pain intensity and different psychological and bodily indexes were examined. The defence mechanisms of somatization and denial measured by the Minnesota Multiphasic Personality Inventory (MMPI) characterized the sample. Interpersonal relations were typically overly nurturant, exploitable, non-assertive and socially avoidant according to the circumplex version of Inventory of Interpersonal Problems (IIP-C). Somatization, obsession, depression and anxiety were the highest symptom scales on the Symptom Check-List 90, revised (SCL-90-R). The Comprehensive Body Examination (CBE) produced moderate findings mainly reflecting stiffness, and the intensity of pain was medium high. The MMPI psychosomatic pattern, the combined IIP-C index consisting of the elevated subscales, and the elevated subscales on SCL-90-R were all moderately correlated with pain intensity. Contrary to our prediction, the global bodily stiffness score was unrelated to pain.
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PMID:Psychological functioning and bodily conditions in patients with pain disorder associated with psychological factors. 1145 70

Expert ratings and confirmatory factor analyses were used to develop an alternative system for scoring the Child Behavior Checklist (CBCL; T. M. Achenbach, 1991) to measure specific dimensions corresponding to current conceptualizations of child symptomatology. Data were from a nonclinic and 2 independent clinic samples. Subscales measuring Anxiety, Attention Problems/Hyperactivity, Conduct Problems, Depression, Oppositional Defiant, Social Problems/Immaturity, and Somatization were created. Logistic regressions were conducted to evaluate the diagnostic efficiency and discrimination of the new and original approaches to scoring the CBCL. Some of the new subscales demonstrated better sensitivity, positive predictive power, and discriminant validity than the original CBCL subscales; however, subscales from both approaches demonstrated low sensitivity. Results support the use of the new subscales for specific research purposes.
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PMID:Rationally and empirically derived dimensions of children's symptomatology: expert ratings and confirmatory factor analyses of the CBCL. 1155 Jul 36

The experience of pain is related not only to tissue damage and physical illness, but also to mental phenomena including depression, anxiety and somatization. Somatization is common among chronic pain patients and presents special problems in management and treatment. Somatoform patients are often given inappropriate diagnoses, treated for non-existent depressive disorders, and exposed to multiple, superfluous investigations. Psychological models of chronic pain and somatization are presented, and treatment issues including psychotherapy and the use of antidepressants are discussed.
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PMID:Somatization and chronic pain. 1168 62


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