The association between neuroticism and self-reported common somatic symptoms in a population cohort

Negative Emotional Reactivity and Somatic Symptoms during Adolescence Predict Adult Health and Wellbeing in Early and Middle Adulthood

Longitudinal research is lacking with respect to how negative emotional reactivity and somatic symptoms during adolescence set the stage for later health. The aim of this longitudinal study was to examine within-person associations between negative emotional reactivity and somatic symptoms during adolescence and their effects on health and wellbeing in adulthood. Participants (N = 1527; 48.3% female) were assessed annually at the age of 12 to 16 years and at the age of 35 and 45 years. Adolescents with frequent somatic symptoms reported higher reactivity. Individual differences in levels and changes of somatic symptoms and reactivity were independently associated with adult health and wellbeing decades later. The findings underscore the importance of considering how individual differences change during adolescent development.

Emotion dynamics and somatic symptoms in everyday life: Ecological momentary assessment in somatic symptom disorder and healthy controls

OBJECTIVE

Negative affectivity (NA) is associated with the emergence and persistence of physical symptoms with unclear organic pathology. This study investigated the temporal dynamics of NA and somatic symptom burden using ecological momentary assessment (EMA) in adults with somatic symptom disorder (SSD) and healthy control participants (HC).

METHODS

Participants underwent a seven-day, smartphone-based EMA, with 6 randomly-stratified time points per day. NA was assessed using a five-item short form of the Positive and Negative Affectivity Scale (PANAS) and somatic symptom burden with two self-constructed items. 22 persons with SSD and 20 HCs were included in multilevel analyses.

RESULTS

Within-person analyses showed a significantly stronger (positive) association of concurrent NA with somatic symptom burden in participants with SSD than in HCs, β = 0.15, SE = 0.04, p = .001. Time-lagged analyses demonstrated that, across groups, NA at a previous time point t-1 significantly predicted somatic symptom burden at the subsequent timepoint t, β = 0.09, SE = 0.03, p = .005, but not in the other direction (somatic symptom burdent-1→ NAt, β = 0.01, SE = 0.04, p = .79). Between-person analyses showed that both inertia (i.e., persistence of negative affective states), d = 0.74, and instability (i.e., magnitude of moment-to-moment fluctuations), d = 0.76 of NA were significantly higher in participants with SSD than in HCs.

CONCLUSIONS

Our findings sustain the idea of (negative) affect-driven modulation in somatic signal processing and suggest that interoceptive and emotional differentiation training can advance the psychotherapeutic treatment of SSD.

The Brain Overwork Scale: A Population-Based Cross-Sectional Study on the Psychometric Properties of a New 10-Item Scale to Assess Mental Distress in Mongolia

Identifying mental distress is a complex task, particularly when individuals experience physical symptoms. Traditional self-report questionnaires that detect psychiatric symptoms using emotional words may not work for these individuals. Consequently, there is a need for a screening tool that can identify both the physical and mental symptoms of mental distress in individuals without a clinical diagnosis. Our study aimed to develop and validate a scale that measures mental distress by measuring the extent of brain overwork, which can be extrapolated as the burden of mental distress. In this population-based cross-sectional study, we recruited a total of 739 adults aged 16–65 years from 64 sampling centers of a cohort in Mongolia to validate a 10-item self-report questionnaire. Internal consistency was measured using McDonald’s ω coefficient. Test–retest reliability was analyzed using intraclass correlation coefficients. Construct and convergent validities were examined using principal component analysis (PCA) and confirmatory factor analysis (CFA). The Hospital Anxiety and Depression Scale (HADS) and the abbreviated version of World Health Organization Quality of Life (WHOQOL-BREF) were used to evaluate criterion validity. Among the participants, 70.9% were women, 22% held a bachelor’s degree or higher, 38.8% were employed, and 66% were married. The overall McDonald’s ω coefficient was 0.861, demonstrating evidence of excellent internal consistency. The total intraclass correlation coefficient of the test–retest analysis was 0.75, indicating moderate external reliability. PCA and CFA established a three-domain structure that provided an excellent fit to the data (RMSEA = 0.033, TLI = 0.984, CFI = 0.989, χ2 = 58, p = 0.003). This 10-item scale, the Brain Overwork Scale (BOS-10), determines mental distress in three dimensions: excessive thinking, hypersensitivity, and restless behavior. All the items had higher item-total correlations with their corresponding domain than they did with the other domains, and correlations between the domain scores had a range of 0.547–0.615. BOS-10 correlated with HADS, whereas it was inversely correlated with WHOQOL-BREF. In conclusion, the results suggest that BOS-10 is a valid and reliable instrument for assessing mental distress in the general population. The scale screens for mental distress that is characterized by subjective symptoms such as excessive thinking, hypersensitivity, and restless behavior. The current findings also demonstrate that the BOS-10 is quantitative, simple, and applicable for large group testing. This scale may be useful for identifying at-risk individuals who may require further evaluation and treatment for mental distress.

Complaints of dyspnea and their associations with personality traits in patients referred to psychotherapy in a day hospital

BACKGROUND

Breathing difficulties are present in different medical conditions, yet seem to be underresearched in psychiatric patients.

AIM

Assessment of prevalence of dyspnea complaints and their associations with personality traits in patients with neurotic or personality disorders referred to psychotherapy.

METHODS

Retrospective chart review of medical records of 2450 patients with diagnoses F4-F6 (ICD-10). Analyses of associations between dyspnea reported in a symptom checklist SCL-O and pathological scores in the Neurotic Personality Questionnaire were carried out using univariate and multivariate regression analyses with ORs and 95%CI estimated with licensed STATISTICA 13 (StatSoftPL) software, and R version 4.1.0, RStudio version 1.4.1717 software.

RESULTS

Dyspnea was reported by 46.3% women and 36.6% men (14.5% and 10.1% respectively assessed it as severely burdensome). Univariate regression analysis revealed several significant associations between reporting dyspnea or its extreme intensity and pathological scores in the NPQ. Multivariate regression analyses in women confirmed the importance of impulsiveness and exaltation for dyspnea occurrence, and feeling of being dependent on the environment, demobilization, and narcissistic attitude for its extreme intensity. In men impulsiveness, sense of being in danger, irrationality, and ponderings were associated with the presence of dyspnea, and sense of being in danger and envy with its extreme intensity.

CONCLUSIONS

Complaints of dyspnea were pretty frequent. Several personality traits measured by the NPQ questionnaire were predictors of their occurrence and feeling of extreme burden.

Nonproductive thoughts, somatic symptoms and well-being in adolescence: testing the moderator role of age and gender in a representative study

Background

Previous findings suggest a female preponderance in nonproductive thoughts -rumination and worry-, but studies on gender differences in the strength of the relationship between nonproductive thoughts, somatic symptoms and subjective well-being are scarce. Our aim was to test whether gender and age would moderate these associations.

Methods

1572 adolescents were involved in this representative cross-sectional study (770 boys; mean age = 15.39; SD = 2.26 years). Nonproductive thoughts were measured by Nonproductive Thoughts Questionnaire for Children (NPTQ-C), somatic symptoms were assessed by Somatic Complaint List (SCL), while Mental Health Continuum-Short Form (MHC-SF) was used to measure subjective well-being. To assess the moderation effects of age and gender on the relationship between nonproductive thoughts, somatic symptoms and well-being, four multiple indicator multiple causes (MIMIC) models were defined.

Results

Our results suggested that higher rates of nonproductive thoughts predicted a higher level of somatic symptoms and a lower level of subjective well-being. The analyses revealed that although nonproductive thoughts were strongly and equally associated with somatic symptoms among boys and girls, age was a significant moderator. Gender also moderated the relationship between nonproductive thoughts and subjective well-being.

Conclusions

Our results support the importance of nonproductive thoughts in somatic symptoms and highlight that the strength of the relationship is similar across both genders but could be dependent upon age. The findings also shed light on the decreased well-being of girls, especially with elevated level of nonproductive thoughts.

Traits and Distorted Symptom Presentation: a Scoping Review

Are personality traits related to symptom overreporting and/or symptom underreporting? With this question in mind, we evaluated studies from 1979 to 2020 (k = 55), in which personality traits were linked to scores on stand-alone validity tests, including symptom validity tests (SVTs) and measures of socially desirable responding (SDR) and/or supernormality. As to symptom overreporting (k = 14), associations with depression, alexithymia, apathy, dissociation, and fantasy proneness varied widely from weak to strong (rs .27 to .79). For underreporting (k = 41), inconsistent links (rs − .43 to .63) were found with narcissism, whereas alexithymia and dissociation were often associated with lower SDR tendencies, although effect sizes were small. Taken together, the extant literature mainly consists of cross-sectional studies on single traits and contexts, mostly offering weak correlations that do not necessarily reflect causation. What this field lacks is an overarching theory relating traits to symptom reporting. Longitudinal studies involving a broad range of traits, samples, and incentives would be informative. Until such studies have been done, traits are best viewed as modest concomitants of symptom distortion.

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

OBJECTIVE

Difficulties in the assessments of Somatoform Disorders (SD) and Personality Disorders (PD) regarding operationalization, arbitrary thresholds, and reliability led to a shift from categorical to dimensional models in the DSM-5. Empirical research data postulates a continuous level of severity in both groups of diseases. The aim of this systematic review was to investigate the overlap between somatization and personality pathology.

METHODS

Until July 2020, we conducted a systematic literature search with PubMed, Web of Science and SCOPUS. We specifically reviewed current empirical data on the Alternative Model of Personality Disorders (AMPD) and Somatic Symptom Disorder (SSD) and SD. Data was drawn out using predefined data panels. Results were reflected in the context of the Hierarchical Taxonomy of Psychopathology (HiTOP) model. Risk of bias was assessed due to blinding, randomization, selective reporting, incomplete data, and attribution bias.

RESULTS

A total of eight studies (N = 2979) met the inclusion criteria. Whereas categorical measures revealed mixed results, positive correlations between SD/SSD and dimensionally measured personality functioning were present in four studies (N = 1741). In three studies (N = 2025) correlations between SD/SSD and neuroticism/negative affectivity (d = 0.22-1.041) were present. Moreover, harm avoidant (d = 0.526 - 0.826) and self-defeating traits (d = 0.892) revealed significant associations with somatization.

CONCLUSIONS

Dimensional personality assessments are highly neglected in patients with SSD and warrant further research. However, in line with the HiTOP model, there is tentative evidence that somatization can be described as an independent personality trait, which shows most striking overlaps with self-pathologies (Criterion A) and the trait of negative affectivity (Criterion B).

Cortico-striatal-thalamic loop as a neural correlate of neuroticism in the mind-body interface

OBJECTIVE

Although brain structural studies have demonstrated the neural correlates of neuroticism, the outcomes are not easily identified because of the various possible brain regions involved, low statistical power (low number of subjects), and brain structural measures available, such as mean diffusivity (MD), which are more suitable than standard regional measures of grey and white-matter volume (rGMV, rWMV) and fractional anisotropy (FA). We hypothesized that neuroticism neural correlates could be detected by MD and differentially identified using other measures. We aimed to visualize the neural correlates of neuroticism.

METHODS

A voxel-by-voxel regression analysis was performed using the MD, rGMV, rWMV, or FA value as the dependent variable and with neuroticism scores based on the NEO-FFI and its confounding factors as independent variables in 1207 (693 men and 514 women; age, 20.7 ± 1.8, 18-27 years), non-clinical students in a cross-sectional study.

RESULTS

MD in the cortico- (orbitofrontal cortex, anterior cingulate cortex, and posterior insula) striatal- (caudate and putamen) thalamic loop regions, including the right posterior limb of the internal capsule, were positively associated with neuroticism using the threshold-free cluster enhancement method with a family-wise error-corrected threshold of P < 0.0125 (0.05/4, Bonferroni correction for four types of MRI data [MD, rGMV, rWMV, and FA]) at the whole-brain level.

CONCLUSIONS

An increased MD has generally been associated with reduced neural tissues and possibly area function. Accordingly, this finding helps elucidate the mechanism of somatization in neuroticism because the regions related to neuroticism are considered neural correlates of somatoform disorders.

The Prevalence and Determinants of Being Offered and Accepting Operational Management Services-A Cohort Study

In Germany, employers are obliged to offer “operational integration management” (OIM) services to employees returning from long-term sick leave. OIM aims to improve employees’ workability and to prevent future sick leave or early retirement. This study examined (i) to what extent OIM services are offered to eligible employees, (ii) to what extent offers are accepted and (iii) the determinants of both outcomes. We used data from a cohort of employees eligible for OIM. Thirty-four potential determinants were assessed in 2013 (i.e., the baseline) using participant reports. In 2015 (i.e., the follow-up), participants were asked (a) whether they had ever been offered OIM services by their employer, and (b) whether they had accepted that offer (i.e., the outcomes). We estimated relative risks by multivariable binomial regression to identify predictors based on backward elimination. In total, 36.0% of the participants were offered OIM services and 77.2% of them accepted that offer. The likelihood of an OIM offer at follow-up was elevated in participants with mental impairment, cancer or long-term absenteeism and increased with organizational justice, neuroticism, and company size. The likelihood of accepting that OIM offer was positively associated with mental impairment and decreased with increasing company size.

Self-care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology

Self-care is essential in the long-term management of chronic heart failure. Heart failure guidelines stress the importance of patient education on treatment adherence, lifestyle changes, symptom monitoring and adequate response to possible deterioration. Self-care is related to medical and person-centred outcomes in patients with heart failure such as better quality of life as well as lower mortality and readmission rates. Although guidelines give general direction for self-care advice, health care professionals working with patients with heart failure need more specific recommendations. The aim of the management recommendations in this paper is to provide practical advice for health professionals delivering care to patients with heart failure. Recommendations for nutrition, physical activity, medication adherence, psychological status, sleep, leisure and travel, smoking, immunization and preventing infections, symptom monitoring, and symptom management are consistent with information from guidelines, expert consensus documents, recent evidence and expert opinion.

Psychosocial factors and indoor environmental quality in respiratory symptom reports of pupils: a cross-sectional study in Finnish schools

OBJECTIVES

Poor indoor environmental quality (IEQ) in schools is related to higher respiratory symptoms of pupils, but little is known about the importance of other factors. This study examined the associations between different psychosocial factors and other pupils' individual and allergic characteristics, beyond school IEQ, and reporting of respiratory symptoms in pupil-administered and parent-administered questionnaires.

SETTING

All primary and secondary schools in two areas of Helsinki, Finland.

PARTICIPANTS

Primary school pupils (grade 3-6, n=8775, 99 school buildings) and secondary school pupils (grade 7-9, n=3410, 30 school buildings) reported their respiratory symptoms, as well as psychosocial factors and individual characteristics. Parents of primary school pupils (grade 1-6, n=3540, 88 school buildings) also filled in questionnaires, but the response rate was low (20% in 2017 and 13% in 2018).

MAIN OUTCOME MEASURE

Respiratory symptoms were reported in relation to the school environment and in general (without such relation) by pupils or parents.

RESULTS

Worry about IEQ and low school satisfaction, and asthma and hay fever were related to higher reporting of respiratory symptoms in three samples. The variance between schools in respiratory symptoms was low (intraclass correlation=0.6%-2.4%). Psychosocial factors, especially worry about school's IEQ, explained more of the variance between schools in symptoms than IEQ among secondary school pupils and parents, but not among primary school pupils for symptoms in general. Worry about IEQ also modified the associations between IEQ and respiratory symptoms, but only in parental reports.

CONCLUSION

In addition to IEQ, psychosocial factors and pupils' individual and allergic characteristics were related to higher reporting of respiratory symptoms in all three samples. Psychosocial factors explained more variance between schools than IEQ, although it was 2.4% at most. Other factors beyond IEQ should be considered when interpreting symptom reporting in indoor air questionnaires.

Somatic Symptom Perception From a Predictive Processing Perspective: An Empirical Test Using the Thermal Grill Illusion

OBJECTIVE

In a predictive processing perspective, symptom perceptions result from an integration of preexisting information in memory with sensory input. Physical symptoms can therefore reflect the relative predominance of either sensory input or preexisting information. In this study, we used the thermal grill illusion (TGI), which applies interlaced warm and cool temperatures to the skin to create a paradoxical heat-pain experience. Assuming that the TGI compared with single-temperature stimulation relies more importantly on an active integration process of the brain to create this paradoxical sensation, we tested the hypothesis whether a manipulation of the expectations during TGI would have more impact than during single-temperature stimulation.

METHODS

Sixty-four participants received different temperature combinations (16/16°C, 40/40°C, 16/40°C) with neutral, positive ("placebo"), and negative ("nocebo") instructions. Subjective stimulus intensity was rated, and neuroticism and absorption (openness to absorbing and self-altering experiences) served as potential moderating factors.

RESULTS

The TGI condition was rated highest. Overall, negative instructions increased (p < .001, d = 0.58), whereas positive instructions did not significantly change the TGI intensity perception (versus neutral; p = .144, d = 0.19). In the TGI condition, increased modulation of pain was observed with higher neuroticism (β = 0.33, p = .005) and absorption (β = 0.30, p = .010).

CONCLUSIONS

Whereas negative instructions induced a nocebo effect, no placebo effect emerged after positive instructions. The findings are in line with the predictive processing model of symptom perception for participants with higher levels of neuroticism and absorption.

The association between natural outdoor environments and common somatic symptoms

There is growing evidence that urban natural outdoor environments (NOE) may positively impact health by reducing stress and stress-related symptoms. However, there is limited research investigating this link across a range of NOE indicators. This cross-sectional study investigated the association between neighbourhood NOE (availability, use, and satisfaction with NOE) and common somatic symptoms and the role of potential mediators. Data were analysed from 3481 adults from Barcelona (Spain), Doetinchem (Netherlands), Kaunas (Lithuania) and Stoke-on-Trent (United Kingdom). NOE data were obtained through self-reported data and environmental measurements. Common somatic symptom data were self-reported. Mixed effects regression models were used for analysis, with models adjusted for potential sociodemographic confounders. Higher satisfaction with neighbourhood NOE was associated with lower prevalence of common somatic symptoms (exp(β) 0.97; 95% CI 0.96, 0.98); an association partially mediated by mental health, social cohesion and air quality concern. A longer time spent in NOE was associated with lower prevalence of common somatic symptoms in low socioeconomic status neighbourhoods (exp(β) 0.98; 95% CI 0.96, 1.00). A higher number of neighbourhood green spaces (300m buffer) was associated with higher prevalence of common somatic symptoms (exp(β) 1.03; 95% CI 1.00, 1.05). No statistically significant associations were found for other NOE indicators. Study findings suggest that higher satisfaction with NOE may be associated with lower prevalence of common somatic symptoms, with mental health, social cohesion and concern about air quality playing partial mediating roles. Little evidence was found of an association between objective NOE measurements and common somatic symptoms, underlining the importance of perceptions of NOE for conferring health benefits.

How are you doing? The person-specificity of daily links between neuroticism and physical health

OBJECTIVE

The mind and body function in tandem across days and development, and in unique ways for individuals, but most work on the relation between personality and physical health is cross-sectional, assuming homogeneity across time and people. For instance, although neuroticism is associated with poor health, the direction of the relation and whether it characterizes all people all of the time is unclear. The goal of this study is to fill knowledge gaps concerning the person-specific, day-to-day neuroticism-health link.

METHODS

A 75-occassion intensive longitudinal study was conducted in which 119 adults reported daily on 12 indicators of neuroticism and 3 symptoms of physical health. Person-specific network analyses, conducted using the multiple solutions version of group iterative multiple model estimation (GIMME-MS), were used to determine the presence, valence, daily lag, and direction of relations among the daily variables. Network features were compared within and between individuals.

RESULTS

Person-specific networks were heterogeneous. Participants were significantly more likely to have networks in which physical symptoms predicted indicators of neuroticism compared to the reverse; this was particularly true for next-day relations, and for women. Exploratory analyses suggested that participants with a disproportionate amount of these health-to-neuroticism relations scored high on conscientiousness.

CONCLUSIONS

Person-specific network mapping of ecologically-valid intensive longitudinal data revealed heterogeneity in day-to-day relations between indicators of neuroticism and physical health, with long-term implications for personalized healthcare. There was some consistency, however, in that "body" symptoms were more likely to predict "mind" features across people.

To know or not to know? Mentalization as protection from somatic complaints

Somatization processes are usually associated with a lack of insight or with emotional unawareness, especially in adolescents where the ability for self-reflection is beginning to mature. However, the extent to which different levels of insight explain variations in somatization remains understudied. This study aimed to evaluate whether high-level emotional awareness (comprehension) but not low-level awareness (only attention) is needed to psychologically cope with suffering, thus leading to lower somatization. Specific predictions were: 1) High attention along with High comprehension will be associated with significantly lower frequency of somatic complaints than other combinations (Low attention and Low comprehension, or High attention but Low comprehension); 2) In absence of comprehension, no attention will be more optimal than attention only, because only-attention might work as an amplificatory of suffering without the possibility of processing it. Self-reports of meta-cognitive processes, somatization, and control variables were obtained from 264 adolescents from a non-clinical population (54.5% female; aged 12-18, M = 14.7, SD = 1.7). In line with expectations, results revealed significant differences in the effects of insight positions on somatization: Attention+Comprehension (M = 4.9, SE = 0.9) < Nothing (M = 7.1, SE = 0.3) < Only attention (M = 8.9, SE = 0.7). Compared to Nothing, Attention+comprehension was associated with significantly reduced somatic complaints (B = -2.2, p = 0.03, 95% CI -4,1 to 0.2). However, Only attention was associated with increased somatic complaints compared to the other two conditions (B = 1.8, p = 0.03, 95% CI 0.2 to 3.4; B = 4, CI 95% 1.6-6.3, p = 0.001, respectively). This highlights the role of higher-order awareness (i.e., comprehension or clarity) in the processing of suffering and stresses its value in the adaptive coping of emotional distress.

Validating psychosocial pathways of risk between neuroticism and late life depression using a polygenic score approach

Neuroticism is a stable and heritable personality trait that is strongly linked to depression. Yet, little is known about its association with late life depression, as well as how neuroticism eventuates into depression. This study used data from the Wisconsin Longitudinal Study (WLS; N = 4,877) to examine the direct and indirect effects of neuroticism on late life depression at 3 points in the life course-ages 53, 64, and 71-via stressful life events (i.e., independent and dependent) and social supports measured across adulthood and into later life. Neuroticism was assayed using multiple methods, including self-report measures (phenotypic model) and a polygenic score (polygenic model) informed by a meta-analytic genome-wide association study. Results indicated that the phenotypic model of neuroticism and late life depression was partially mediated via dependent stressful life events experienced after the age of 53 and by age 64 social support. This association was replicated in the polygenic model of neuroticism, providing key evidence that the findings are robust. No indirect effects emerged with respect to age 53 social support, age 71 social support, adult dependent stressful life events (experienced between age 19 and 52), and adult and late life independent stressful life events in either the phenotypic or polygenic models as they pertained to late life depression. Results are consistent with previous findings that individuals with high neuroticism may be vulnerable to late life depression through psychosocial risk factors that are, in part, attributable to their own personality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The associations between objective and subjective health among older adults with type 2 diabetes: The moderating role of personality

BACKGROUND

Objective and subjective health are two powerful constructs which predict morbidity and mortality across a range of conditions including Type 2 Diabetes (T2D). Studies, however, suggest that these two constructs do not necessarily correlate, as some people with poor objective health perceive their health as good, while other people with good objective health perceive their health as poor. We seek to examine the role of personality as a moderator of the associations between objective and subjective health among older adults with T2D, who are likely to experience poor objective and subjective health due to their chronic medical condition.

METHODS

Cross-sectional study of 368 individuals with T2D (72 ± 4 years, 42% women), participating in the Israel Diabetes and Cognitive Decline Study. Personality was conceptualized using the five-factor model (agreeableness, conscientiousness, extraversion, neuroticism, openness). Objective health was operationalized by T2D-related clinical status, cognitive function, and motor ability. Subjective health was assessed using a single self-report question. Hayes' process macro was used for the moderation analyses.

RESULTS

The objective-subjective health associations were stronger among individuals with increased neuroticism (proportion of days covered: p = 0.02; cognitive function: p = 0.003; hand grip: p = 0.02; 3-m walk: p = 0.04) as well as decreased openness (cognitive status: p = 0.04) and agreeableness (3-m walk: p = 0.02).

DISCUSSION

Personality traits, and specifically neuroticism, can modify the associations between objective and subjective health in older adults with T2D. Findings contribute to the understanding of health as a multidimensional construct that encompasses medical and psychological aspects, especially among older adults with a chronic illness.

Investigating the Link Between Pathological Narcissism and Somatization

Although the self-image distortions and sensitivities of pathological narcissism have been theorized to contribute to somatization, limited empirical research has been devoted to this issue. The present study was developed to test the hypothesis that pathological narcissism contributes to somatic symptoms through increased hypervigiliance to physical sensations. A community sample of 248 adults completed measures of pathological narcissism, somatosensory amplification, somatic symptoms, and depression. Mediation analysis was conducted, controlling for depression, using 99% bootstrapped confidence intervals to examine the indirect effect of pathological narcissism on somatic symptoms via somatosensory amplification. Although pathological narcissism was not directly related to somatic symptoms, a significant indirect effect was observed for pathological narcissism on somatic symptoms via somatosensory amplification. This finding suggests that pathological narcissism contributes to physical hypersensitivity, in turn influencing perceptions of somatic distress. The role of narcissistic dysfunction in somatization indicates the importance of further research and potential clinical consideration.

Neuroticism and Somatic Complaints: Concomitant Effects of Rumination and Worry

Background: Neuroticism is associated with inflated somatic symptom reporting. Worry and rumination are a cognitive concomitant of neuroticism and potentially mediate the neuroticism–somatic complaint relationship. Aims: The present study examined the degree to which worry and rumination mediated the relationship between neuroticism and somatic complaints. Method: A sample of 170 volunteers, recruited via convenience sampling, took part. Participants completed a series of self-report measures: the Eysenck Personality Questionnaire Revised-Short Form, Penn State Worry Questionnaire, the Ruminative Response Scale and the Somatic Symptom Scale-8. Results: Analysis revealed significant positive correlations between neuroticism, rumination and worry. Neuroticism, rumination and worry also correlated positively with somatic complaints. Using structural equation modelling, a mediational model indicated that rumination fully mediated the relationship between neuroticism and somatic complaints. Conclusions: Findings are consistent with the symptom perception hypothesis and have implications for healthcare in terms of managing individuals who present with multiple somatic complaints. Future research would benefit from adopting a longitudinal approach to test how rumination interacts with neuroticism and somatic complaints over time.

Design, rationale and feasibility of a multidimensional experimental protocol to study early life stress

There is a rapidly accumulating body of evidence regarding the influential role of early life stress (ELS) upon medical and psychiatric conditions. While self-report instruments, with their intrinsic limitations of recall, remain the primary means of detecting ELS in humans, biological measures are generally limited to a single biological system. This paper describes the design, rationale and feasibility of a study to simultaneously measure neuroendocrine, immune and autonomic nervous system (ANS) responses to psychological and physiological stressors in relation to ELS. Five healthy university students were recruited by advertisement. Exclusion criteria included chronic medical conditions, psychotic disorders, needle phobia, inability to tolerate pain, and those using anti-inflammatory medications. They were clinically interviewed and physiological recordings made over a two-hour period pre, during and post two acute stressors: the cold pressor test and recalling a distressing memory. The Childhood Trauma Questionnaire and the Parental Bonding Index were utilised to measure ELS. Other psychological measures of mood and personality were also administered. Measurements of heart rate, blood pressure, respiratory rate, skin conductance, skin blood flow and temporal plasma samples were successfully obtained before, during and after acute stress. Participants reported the extensive psychological and multisystem physiological data collection and stress provocations were tolerable. Most (4/5) participants indicated a willingness to return to repeat the protocol, indicating acceptability. Our protocol is viable and safe in young physically healthy adults and allows us to assess simultaneously neuroendocrine, immune and autonomic nervous system responses to stressors in persons assessed for ELS.

Self-Harm Thoughts Postpartum as a Marker for Long-Term Morbidity

Introduction

Postpartum depression predisposes to maternal affective and somatic disorders. It is important to identify which women are at an increased risk of subsequent morbidity and would benefit from an intensified follow-up. Self-harm thoughts (SHTs), with or without other depressive symptomatology, might have prognostic value for maternal health beyond the postpartum period.

Aim

This study is to investigate the somatic and psychiatric morbidity of postpartum women with SHTs, with or without other depressive symptoms, over a 7-year follow-up period.

Materials and methods

The subjects for this study are derived from a population-based Swedish cohort of women who gave birth at Uppsala University Hospital (May 2006–June 2007) and who answered the Edinburgh Postnatal Depression Scale (EPDS) at 5 days, 6 weeks, and 6 months postpartum. Three groups were included: women reporting SHTs (SHT group, n = 107) on item 10 of the EPDS; women reporting depressive symptoms, i.e., EPDS ≥ 12 at 6 weeks and/or 6 months postpartum, without SHTs (DEP group, n = 94); and randomly selected controls screening negatively for postpartum depression (CTL group, n = 104). The number of diagnostic codes for somatic and psychiatric morbidity according to the International Statistical Classification of Diseases and Related Health Problems system, and the number of medical interventions were retrieved from medical records over 7 years following childbirth and were used as the outcome measures, together with any prescription of antidepressants and sick leave during the follow-up.

Results

The SHT group had the highest psychiatric morbidity of all groups and more somatic morbidity than controls. Affective disorders were more common in the SHT and the DEP groups compared with controls, as well as antidepressant prescriptions and sick leave. One-fifth of women with SHTs did not screen positive for depressive symptoms; nevertheless, they had more somatic and psychiatric morbidity than the control group.

Conclusion

Women reporting thoughts of self-harm in the postpartum period are at an increased risk of somatic and psychiatric morbidity during a follow-up of 7 years after delivery, and this increased risk may not be fully attributed to depressive symptoms. Results underline the importance of screening for self-harm symptoms postpartum and point to a need for individualized follow-up.

An Examination of Personality Traits Associated with Autonomous Sensory Meridian Response (ASMR)

Autonomous Sensory Meridian Response (ASMR) is a perceptual condition in which the presentation of particular audio-visual stimuli triggers intense, pleasurable tingling sensations in the head and neck regions, which may spread to the periphery of the body. These triggering stimuli are often socially intimate in nature, and usually involve repetition of movements and/or sounds (e.g., hearing whispering, watching someone brush her hair). Reports of ASMR experiences first appeared in online communities in 2010; since this time, these communities have expanded, with some groups consisting of over 100,000 members. However, despite the apparent prevalence of ASMR, there is currently no research on the personality characteristics that co-occur with this condition. In the current study, 290 individuals with ASMR and 290 matched controls completed the Big Five Personality Inventory (BFI; John et al., 1991); participants with ASMR also completed a questionnaire related to their ASMR phenomenology. Individuals with ASMR demonstrated significantly higher scores on Openness-to-Experience and Neuroticism, and significantly lower levels of Conscientiousness, Extraversion, and Agreeableness compared to matched controls. Further, ratings of subjective ASMR intensity in response to 14 common ASMR stimuli were positively correlated with the Openness-to-Experience and Neuroticism dimensions of the BFI. These results provide preliminary evidence that ASMR is associated with specific personality traits and suggest avenues for further investigation.

Pathological narcissism and somatic symptoms among men and women attending an outpatient mental health clinic

OBJECTIVE

To explore the relationship between types of pathological narcissism and somatic symptoms among psychiatric outpatients.

METHODS

Patients (N = 95) completed measures of somatic symptoms, narcissistic grandiosity and vulnerability, and psychiatric symptoms. Relationships among variables were analysed using t-tests and correlations, controlling for psychiatric distress.

RESULTS

Somatic symptoms were positively associated with two types of narcissistic dysfunction. Among women there was a positive association between somatic symptoms and narcissistic vulnerability, but not grandiosity. Among men, somatic symptoms were positively associated with narcissistic grandiosity, but not vulnerability.

CONCLUSIONS

The connection between narcissistic pathology and somatic symptom severity appears to differ based on gender. Further research is needed to confirm and extend this preliminary finding.

Personality traits and emotional patterns in irritable bowel syndrome

The review focuses on those personality traits (neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness), constructs (alexithymia and distressed - Type D personality) and emotional patterns (negative and positive) that are of particular concern in health psychology, with the aim to highlight their potential role on the pathogenesis, onset, symptom clusters, clinical course, and outcome of irritable bowel syndrome (IBS). Personality traits and emotional patterns play key roles in affecting autonomic, immune, inflammatory, and endocrine functions, thus contributing not only to IBS clinical expression and symptomatic burden, but also to disease physiopathology. In this sense, psychological treatments should address those personality traits and emotional features that are constitutive of, and integral to IBS. The biopsychosocial model of illness applied to IBS acknowledges the interaction between biological, psychological, environmental, and social factors in relation to pain and functional disability. A holistic approach to IBS should take into account the heterogeneous nature of the disorder, and differentiate treatments for different types of IBS, also considering the marked individual differences in prevalent personality traits and emotional patterns. Beyond medications, and lifestyle/dietary interventions, psychological and educational treatments may provide the optimal chance of addressing clinical symptoms, comorbid conditions, and quality of life in IBS patients.

Association of psychological, cognitive, and functional variables with self-reported executive functioning in a sample of nondemented community-dwelling older adults

Subjective executive functioning (EF) measures provide valuable information about real-world difficulties, although it is unclear what variables actually associate with subjective EF scores. We investigated subjective EF in 245 nondemented, community-dwelling older adults (aged 70 and above) from the Einstein Aging Study. Partial correlational analyses controlling for age were performed between the nine Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A) clinical scales and objective EF tests, self-reported mood and personality, and informant-reported activities of daily living. The significance level was set at p < .006 for all analyses (two-tailed). Most notably, higher worry/oversensitivity, physiological anxiety, and fear of aging were significantly associated with increased EF difficulties on all nine BRIEF-A scales. Additionally, increased EF difficulties on five or more BRIEF-A scales were significantly associated with lower conscientiousness, higher neuroticism, and higher depressive symptom scores. The only objective neuropsychological test that significantly correlated with increased EF difficulties (on four BRIEF-A scales) was a measure of practical judgment. Overall, results indicate that interpretation of subjective EF scores must account for self-report of mood and personality. Moreover, the BRIEF-A only minimally taps objective EF as measured by performance-based measures. We discuss the theoretical and practical implications of these findings.

Short report: Functional somatic symptoms are associated with perfectionism in adolescents

OBJECTIVE

The aim of this study is to investigate the influence of perfectionism on functional somatic symptoms (FSSs) in adolescents. It was hypothesized that perfectionism predicts higher levels of FSSs cross-sectionally and longitudinally, and that anxiety and depression mediate this relationship.

DESIGN

This prospective population-based study was part of the Dutch Tracking Adolescents' Individual Lives Survey (N=2230; 50.8% girls). Data from 1878 participants attending the third (T3) or fourth (T4) assessment wave were used (mean age T3: 16.2 (SD:0.7); mean age T4: 19.0 (SD:0.6)). Multiple regression and mediation analyses were performed in Mplus.

MAIN OUTCOME MEASURES

FSSs, perfectionism (i.e. the feeling one has to be perfect), anxiety and depression were assessed with the Youth Self-Report at the third and fourth wave.

RESULTS

Perfectionism was associated with a higher level of FSSs in adolescents, both cross-sectionally (B=0.11, 95%-CI: 0.08-0.14) and longitudinally (B=0.05, 95%-CI: 0.02-0.08). There was a small indirect effect of perfectionism on FSSs trough anxiety and depression (B=0.02, 95%-CI: 0.003-0.03, k(2)=0.02).

CONCLUSION

The results suggest that perfectionism predicts the course of FSSs with a small indirect effect of perfectionism on FSSs trough anxiety and depression. Further research is needed to clarify which aspects of perfectionism are particularly responsible for this effect.

Associations between emotional instability, coping, and health outcomes among patients with non-cardiac chest pain

The main aim of this study was to examine the relationship of emotional instability with illness worry and perceived limitations due to chest pain, and investigate to what degree any associations are mediated by the following chest pain–related coping styles: acceptance, seeking emotional support, seeking instrumental support, and avoidance. Self-reported measures from 94 participants with non-cardiac chest pain were collected. The results showed a relationship between emotional instability, illness worry, and perceived limitations due to chest pain. Moreover, this relationship was mediated by the coping styles avoidance and acceptance.

Age- and sex-specific associations between adverse life events and functional bodily symptoms in the general population

OBJECTIVE

To test age- and sex-specific associations between adverse life events and functional bodily symptoms (FBS) in the general population.

METHODS

In a population-based cohort, 964 participants (mean age 55 years SD 11, 48% male) completed two measurements waves of the present study. Lifetime exposure to 12 adverse life events was assessed through a modified version of the List of Threatening Experiences. Stress-sensitive personality was assessed with the 12-item neuroticism scale of the Eysenck Personality Questionnaire-Revised. Socio-economic status was retrieved from questionnaires. Participants completed the somatization section of the Composite International Diagnostic Interview to survey the presence of 42 FBS in the previous year.

RESULTS

Regression analyses, adjusted for age, revealed that lifetime scores of adverse life events were significantly associated with FBS in the previous year, an association that was nearly identical for females (beta=0.18, t=4.07, p<0.01) and males (beta=0.19, t=4.24, p<0.01). This association remained statistically significant when stress-sensitive personality and socio-economic status were added to the model. Associations between adverse life events during childhood and FBS were statistically significant in females (beta=0.13, t=2.90, p=0.04) but not in males (beta=0.06, t=1.24, p=0.22), whereas there was a stronger association with adverse life events during adulthood in males (beta=0.20, t=4.37, p<0.01) compared to females (beta=0.15, t=3.38, p=0.01). Life events in the previous year were not associated with FBS in the previous year.

CONCLUSION

Adverse life events during lifetime were associated with FBS in the previous year. This association was dependent on age and sex but largely independent of having a stress-sensitive personality or low socio-economic status. Future studies could adopt a life course perspective to study the role of adverse life events in FBS.

Functional limitations in functional somatic syndromes and well-defined medical diseases. Results from the general population cohort LifeLines

OBJECTIVE

Functional somatic syndromes (FSS), defined as physical syndromes without known underlying organic pathology, are sometimes regarded as less serious conditions than well-defined medical diseases (MD). The aims of this study were to evaluate functional limitations in FSS, and to compare the results to MD patients with the same core symptoms.

METHODS

This study was performed in 89,585 participants (age: 44.4±12.4 years, 58.5% female) of the general-population cohort LifeLines. Quality of Life (QoL) and work participation were examined as indicators of functional limitations. QoL was assessed with two summary scales of the RAND-36: the physical component summary (PCS) and the mental component summary (MCS). Work participation was assessed with a self-reported questionnaire. QoL and work participation were compared between FSS and MD patients, using Chi-squared tests and ANCOVA-analyses, adjusted for age, sex, educational level, and mental disorders.

RESULTS

Of the participants, 11.0% (n=9861) reported a FSS, and 2.7% (n=2395) reported a MD. Total QoL, PCS and MCS were significantly lower in all separate FSS and MD compared to controls (P≤.001). Clinically relevant differences in QoL were found between chronic fatigue syndrome and multiple sclerosis patients, and between fibromyalgia syndrome and rheumatoid arthritis patients. Compared to controls, FSS and MD patients reported a comparably reduced working percentage, increased sick absence, early retirement due to health-related reasons, and disability percentage (P≤.001).

CONCLUSION

Functional limitations in FSS patients are common, and as severe as those in patients with MD when looking at QoL and work participation, emphasizing that FSS are serious health conditions.

Noise and somatic symptoms: A role for personality traits?

OBJECTIVES

We investigated the role of a stress-sensitive personality on relations between noise, noise annoyance and somatic symptom reporting. First, we investigated the cross-sectional association of road traffic noise exposure and somatic symptoms, and its modification by hostility and vulnerability to stress. Second, we investigated the cross-sectional association of noise annoyance from eight sources (e.g. road traffic, aircraft, neighbours) and somatic symptoms, and it's confounding by hostility and vulnerability to stress.

METHODS

Data were obtained from LifeLines, a general population cohort from the Netherlands. Road traffic noise was estimated using the Common Noise Assessment Methods in Europe (CNOSSOS-EU) noise model. Noise annoyance, hostility, vulnerability to stress, and somatic symptoms were assessed with validated questionnaires.

RESULTS

Poisson regression models adjusted for demographic and socioeconomic variables indicated no association of noise exposure and somatic symptoms (incidence rate ratio (IRR) 1.001; 95% confidence interval (CI) 1.000-1.001; n=56,937). Interactions of noise exposure and hostility and vulnerability to stress were not statistically significant. Small positive associations were found for noise annoyance from each of the eight sources and somatic symptoms, when adjusted for demographic and socioeconomic variables (e.g. for road traffic noise annoyance IRR 1.014, 95% CI 1.011-1.018; n=6177). Additional adjustment for hostility and vulnerability to stress resulted in small decreases of the IRRs for noise annoyance from each of the eight sources, but the associations remained statistically significant.

CONCLUSIONS

Personality facets hostility and vulnerability to stress did not modify the relation between road traffic noise exposure and somatic symptom reporting, or confound relations between noise annoyance and symptoms.

Somatic and cognitive symptoms as indicators of potential endophenotypes in bipolar spectrum disorders: an exploratory and proof-of-concept study comparing bipolar II disorder with recurrent brief depression and healthy controls

BACKGROUND

We examined whether somatic symptoms reported by patients with bipolar spectrum disorder (BSD), in this study defined as bipolar II (BD-2) or recurrent brief depression with (RBD-H) or without (RBD-O) a history of hypomanic symptoms might point to the possible underlying disease markers (endophenotypes). We hypothesized that somatic symptoms that are possible indirect indicators of endophenotypes should be more prevalent among patients than among healthy controls; should not correlate with neuroticism; should not correlate with the severity of current mental status (e.g., anxiety, depression); and should not correlate with the use of psychotropic drugs including antiepileptics or be explained by co-morbid medical diseases.

METHODS

Sixty-one patients (BD-2: n=21; RBD-H: n=19; RBD-O: n=21) were compared with 21 healthy controls. Assessments included a 123-item somatic symptom checklist; assessments for neuroticism, anxiety and depression. Candidate somatic symptoms were selected using a 4-step inclusion/exclusion procedure.

RESULTS

Seven symptoms survived in all three groups: general (fatigue, feeling exhausted); sensory (leaden sensation in legs, pain in the body, impaired sense of smell); cognitive (loss of memory) and autonomic (excessive perspiration). In addition 15 symptoms survived in one or two groups (examples: impaired hearing, hypersensitivity to sound, inability to find words).

LIMITATIONS

Possible selection bias and small sample size precludes firm conclusions with regards to specific symptoms.

CONCLUSION

Our approach identified symptoms for which an association with BSDs has been suggested previously, as well as symptoms not commonly associated with BSDs. The findings support the feasibility and validity of using assessment of somatic symptoms as an approach to identify potential endophenotypes in BSDs.

Role of negative affects in pathophysiology and clinical expression of irritable bowel syndrome

Irritable bowel syndrome (IBS) is regarded as a multifactorial disease in which alterations in the brain-gut axis signaling play a major role. The biopsychosocial model applied to the understanding of IBS pathophysiology assumes that psychosocial factors, interacting with peripheral/central neuroendocrine and immune changes, may induce symptoms of IBS, modulate symptom severity, influence illness experience and quality of life, and affect outcome. The present review focuses on the role of negative affects, including depression, anxiety, and anger, on pathogenesis and clinical expression of IBS. The potential role of the autonomic nervous system, stress-hormone system, and immune system in the pathophysiology of both negative affects and IBS are taken into account. Psychiatric comorbidity and subclinical variations in levels of depression, anxiety, and anger are further discussed in relation to the main pathophysiological and symptomatic correlates of IBS, such as sensorimotor functions, gut microbiota, inflammation/immunity, and symptom reporting.

Regional gray matter volume and anxiety-related traits interact to predict somatic complaints in a non-clinical sample

Somatic complaints can be important features of an individual's expression of anxiety. Anxiety-related traits are also risk factors for somatic symptoms. However, it is not known which neuroanatomical mechanisms may be responsible for this relationship. In this study, our first step was to use voxel-based morphometry (VBM) approaches to investigate the neuroanatomical basis underlying somatic complaints in a large sample of healthy subjects. We found a significant positive correlation between somatic complaints and parahippocampal gyrus (PHG) volume adjacent to the entorhinal cortex. Further analysis revealed that the interaction between PHG volume/entorhinal cortex and neuroticism-anxiety (N-Anx) predicted somatic complaints. Specifically, somatic complaints were associated with higher N-Anx for individuals with increased PHG volume. These findings suggest that increased PHG volume and higher trait anxiety can predict vulnerability to somatic complaints in the general population.

Personality traits, defense mechanisms and hostility features associated with somatic symptom severity in both health and disease

OBJECTIVE

Somatic symptoms are widespread in clinical practice. The association of somatic symptom severity with impaired health status holds both when symptoms are medically unexplained and when they are medically explained. The role of personality dimensions in the formation of somatic symptoms in patients with established, chronic diseases when compared to healthy participants had not been investigated prior to this study.

METHODS

In samples of 411 healthy subjects and 810 participants with any of 9 established, chronic medical conditions, we measured psychological distress (SCL-90-R), personality traits (Zuckerman-Kuhlman Personality Questionnaire), defensive profiles (Defense Style Questionnaire), individual defenses (Life Style Index) and hostility features (Hostility and Direction of Hostility Questionnaire). Hierarchical multivariate models were used to assess the independent associations between personality dimensions and somatic symptom severity in both samples. The SCL-90-R somatization scale served as the outcome variable.

RESULTS

In both samples, older age, less education, higher neuroticism, adoption of the displacement defense and depressive symptoms were independently and positively associated with somatic symptom severity. Higher somatic symptom severity was also associated with more "introverted" features (i.e., the self-sacrificing defensive style and self-criticism) among participants with established, chronic medical conditions.

CONCLUSIONS

These data suggest that similar personality traits and defense mechanisms are associated with somatic symptom severity in health and disease, indicating that somatic symptoms are not simply consequences of having a medical condition. The specific associations of the self-sacrificing defensive profile and self-criticism with somatic symptom severity in the patient sample may have important clinical implications.

Affective temperaments and ego defense mechanisms associated with somatic symptom severity in a large sample

BACKGROUND

Several complex mechanisms including biological, psychological and social factors may contribute to the development of bodily symptoms. Affective temperaments may represent heritable subclinical manifestations of mood disorders, and the concept of ego defense mechanisms has also provided a model for the comprehension of psychopathology. The relationship between affective temperaments, defensive functioning and somatic symptom severity remains unknown.

METHODS

We obtained data from a subsample of the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). Participants completed the Affective and Emotional Temperament Composite Scale (AFECTS), the Defense Style Questionnaire (DSQ-40) and the Symptom Checklist-90-Revised (SCL-90-R). SCL-90-R Somatization scale was used as outcome variable.

RESULTS

Among 9937 participants (4472 male; 45%), individuals with dysphoric, cyclothymic and depressive temperaments and those who adopted displacement, somatisation and passive aggression as their predominant defense mechanisms presented high somatic symptom severity. Participants with dysphoric temperament and those with higher displacement scores were more likely to endorse numerous bodily symptoms after controlling for age, gender, education and depressive symptoms. Moderator analysis showed that the relationship of dysphoric temperament with somatic symptom severity was much more powerful in people who adopted displacement as their predominant defense.

LIMITATIONS

The data was collected from a convenience web-based sample. The study was cross-sectional. There was no information on the presence of established physical illness.

CONCLUSIONS

Affective temperaments and defense mechanisms are associated with somatic symptom severity independently of depressive symptoms. These two personality theories provide distinct but interacting views for comprehension of somatic symptom formation.

Emerging themes in the revision of the classification of somatoform disorders

The somatoform disorders, as currently defined in DSM-IV and ICD-10, have been criticized for their complexity and poor clinical utility. In this paper we consider these criticisms as well as the conceptual question of whether there is sufficient evidence for classifying them as mental and behavioural disorders. The review suggests that, as currently defined, somatoform disorders do not fulfil a recently articulated set of criteria for mental and behavioural disorders. In particular, the disorders are not defined according to positive psychological and behavioural disorders and evidence is sparse to support their classification as different and distinct diagnoses. Any revision of the disorders should not be based on 'medically unexplained' symptoms. Rather, the relevant diagnoses should include a combination of bothersome somatic symptoms with several other psychological features including beliefs about somatic symptoms and evidence of marked concerns about health and illness. Finally, the review presents a set of proposals for the revision of these disorders, by the Somatic Disorders and Dissociative Disorders Working Group of the WHO International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders, which attempt to take account of the criticisms and current understanding of somatic experiences.

Personality profiles and health: longitudinal evidence among Finnish adults

This study investigates the associations of longitudinal Big Five personality profiles with long-term health in 304 adults (53% males). Personality traits (Neuroticism, Extraversion, Openness, Conscientiousness, Agreeableness) were assessed at ages 33, 42, and 50. Subjective (self-rated health, symptoms, psychological distress) and objective (body mass index, waist-to-hip ratio, blood pressure, cholesterol, triglycerides) indicators of health were measured at ages 42 and 50. Five longitudinally stable personality profiles were extracted over 17 years by latent profile analysis. The levels of traits were the same in each profile at each age. Resilient individuals (N = 65; Neuroticism low, other traits high) had the best subjective health and Overcontrolled individuals (N = 40; Neuroticism high, other traits low) the poorest health over eight years. Reserved individuals (N = 25; high Conscientiousness, other traits low), Undercontrolled (N = 41; high Openness and Extraversion, low Conscientiousness), and Ordinary (N = 133; all traits scored medium) individuals were in the middle of these extremes in subjective health. No differences between the profiles were found in the objective indicators of health. Thus, overcontrol and resilience were most discriminative in terms of good health. Moreover, personality profiles revealed associations with health to be more nuanced than simply being composed of single traits. High Extraversion needed to be combined with high Conscientiousness (Resilients) in order to be associated with the best health; high Extraversion with low Conscientiousness (Undercontrolled) was associated with average health; and low Extraversion with high Neuroticism (Overcontrolled) was associated with the poorest health.

The role of cognitive, emotional and personality factors in the experience of fatigue in a university and community sample

The aim of this study was to investigate the contribution of cognitive, emotional and personality factors to the experience of fatigue severity in healthy adult individuals. Specifically, the study examined whether fatigue catastrophising and emotional distress mediated the relationships between neuroticism, general irrational and rational thoughts to fatigue severity. One hundred and eighty nine university students and community volunteers completed self-report questionnaires assessing fatigue catastrophising and symptom severity, neuroticism, general rational and irrational thoughts and emotional distress. A series of correlational and path analyses were conducted to test the study hypotheses. Neuroticism and more general negative, irrational cognitions were associated with elevated fatigue catastrophising and fatigue severity, whereas more adaptive, rational cognitions were related to lower fatigue catastrophising and fatigue severity. Both elevated fatigue catastrophising and emotional distress uniquely and simultaneously mediated the relationships between irrational and rational cognitions and neuroticism to fatigue severity. These findings demonstrate that cognitions play a role in fatigue severity. The results have implications in the assessment and treatment of fatigue disturbances in the general community.

The epidemiology of multiple somatic symptoms

BACKGROUND

The risk factors for a high total somatic symptom count are unclear; and it is not known whether total somatic symptoms count is a predictor of impaired health status.

METHOD

A prospective population-based cohort study in North West England. Randomly sampled residents (1443 participants; 58% response) completed questionnaires to determine number of somatic symptoms (SSI), health status and a wide range of risk factors; 741 completed questionnaires 1 year later. We used logistic regression to identify risk factors for high SSI at follow-up and for persistently high SSI. We used ANCOVAR and multiple regression to assess whether baseline SSI predicted health status at follow-up.

RESULTS

Twenty-one percent of participants scored over 25 on the Somatic Symptom Inventory (SSI) at baseline and 14% at both baseline and follow-up. Risk factors for a persistent high SSI were: fewer than 12 years of education, separated, widowed or divorced status, reported psychological abuse during childhood, co-existing medical illnesses, anxiety and depression. In multivariate analysis baseline SSI predicted health status (SF12 physical component score and health-related quality of life (EuroQol)) 12 months later. Persistent high SSI was a clinically meaningful predictor of these outcomes.

CONCLUSIONS

Our data support a biopsychosocial approach to somatic symptoms rather than the dualistic approach of identifying "medically unexplained" symptoms. The risk factors for total somatic symptom count were those associated with psychiatric disorders including physical illness. A persistent high somatic symptom count provides a readily measured dimension of importance in epidemiology as a predictor of health status.

The Emotional Intelligence, Health, and Well-Being Nexus: What Have We Learned and What Have We Missed?

This paper reviews the claimed pivotal role of emotional intelligence (EI) in well-being and health. Specifically, we examine the utility of EI in predicting health and well-being and point to future research issues that the field might profitably explore. EI is predictive of various indicators of well-being, as well as both physical and psychological health, but existing research has methodological limitations including over-reliance on self-report measures, and neglect of overlap between EI and personality measures. Interventions focusing on emotional perception, understanding and expression, and emotion regulation, seem potentially important for improving health and well-being, but research on EI has not yet made a major contribution to therapeutic practice. Future research, using a finer-grained approach to measurement of both predictors and criteria might most usefully focus on intra- and inter-personal processes that may mediate effects of EI on health. A video abstract of this article can be viewed at http://www.youtube.com/watch?v=2_8JZX1Uc4k.

Self-reported adverse drug events and the role of illness perception and medication beliefs in ambulatory heart failure patients: A cross-sectional survey

BACKGROUND

Identifying patients with heart failure (HF) who are at risk of experiencing symptomatic adverse drug events (ADEs) is important for improving patient care and quality of life. Several demographic and clinical variables have been identified as potential risk factors for ADEs but limited knowledge is available on the impact of HF patients' beliefs and perceptions on their experience of ADEs.

OBJECTIVE

The purpose of the study was to identify the relationship between HF patients' illness perception and medication beliefs and self-reported ADEs.

DESIGN

A cross-sectional survey was performed between November 2008 and March 2009.

SETTINGS

One university medical centre, two regional hospitals and 20 general practitioners in the Netherlands participated in the study.

PARTICIPANTS

495 patients with HF were included.

METHODS

Patients completed the validated Revised Illness Perception Questionnaire (IPQ-R) and the Beliefs about Medication Questionnaire (BMQ) which collected data on their illness perception and medication beliefs. In addition, data on ADEs as experienced in the previous four weeks were collected through an open-ended question and a symptom checklist. Multivariate logistic regression was performed to identify factors associated with these ADEs.

RESULTS

In total, 332 (67%) patients had experienced ADEs in the previous four weeks, of whom 28% reported dry mouth, 27% dizziness and 19% itchiness as the most prevalent. In the adjusted multivariate analysis, disease-related symptoms (illness identity) (OR for 1-5 symptoms 3.57; 95% CI 2.22-5.75, OR for >5 symptoms 7.37; 95% CI 3.44-15.8), and general beliefs about medication overuse (OR 1.07; 95% CI 1.01-1.13) were independently associated with experiencing ADEs, whereas none of the demographic or clinical factors were significant.

CONCLUSIONS

HF patients who perceive a high number of disease symptoms and have negative medication beliefs are at higher risk of experiencing self-reported ADEs. We suggest that future studies and interventions to improve ADE management should focus on negative medication beliefs and assisting patients in differentiating disease symptoms from ADEs.

Utility of the NEO-FFI in multi-dimensional assessment of orofacial pain conditions

The purpose of this study was to examine the utility of using the NEO-FFI personality assessment as part of multi-dimensional psychological assessment in orofacial pain patients during the initial diagnostic visit. All patients completed an orofacial pain questionnaire and a battery of psychological questionnaires that cover a wide range of symptoms and behaviors important to developing a comprehensive treatment plan. For purposes of the present study, the NEO-FFI was included. Personality characteristics were within normal ranges compared to NEO-FFI norms. Regression analyses demonstrated higher self-reported pain severity was associated with lower openness. Higher psychological distress was associated with higher neuroticism, lower extraversion, and lower openness. In patients reporting a traumatic life experience, neuroticism and extraversion mediated the relationship between trauma-symptoms and psychological distress. The addition of a global personality measure in standard assessment batteries may help the clinician develop coping strategies and techniques based on individual characteristics of the pain patient. Greater understanding of the individual's personality characteristics will likely influence the nature of the pain management program and predict treatment outcomes.

The personality trait of neuroticism is strongly associated with long-term morbidity in testicular cancer survivors

BACKGROUND

Neuroticism is a personality trait expressing nervousness and insecurity. Associations between neuroticism and morbidity in long-term cancer survivors have hardly been explored. The aim of this study was to explore associations between neuroticism and somatic and mental morbidity and lifestyle issues in long-term survivors of testicular cancer (TCSs).

MATERIAL AND METHODS

All Norwegian TCSs treated between 1980 and 1994 (n = 1 814) were invited to this cross-sectional study. Among them 1 428 (79% response rate) delivered valid data. Neuroticism was self-rated on an abridged version of the Eysenck Personality Inventory. Information was collected by mailed questionnaires. The associations of neuroticism and self-reported variables were tested with multivariate logistic regression analyses.

RESULTS

Neuroticism was significantly associated with presence of somatic complaints, reduced physical function, neurotoxic side-effects (tinnitus, hearing impairment, peripheral neuropathy, and Raynaud's Phenomenon), self-esteem, concerns about not being able to father children, sexual problems, hazardous alcohol use, daily use of medication, use of sedatives and hypnotics, recent visits to a general practitioner, and seeing a psychologist/ psychiatrist after ended cancer treatment. Poor self-rated health, higher number of negative life events, economical problems and problems getting loans granted showed significant associations with neuroticism.

DISCUSSION

Neuroticism in TCSs at long-term follow-up is significantly associated with somatic and mental morbidities, and several aspects of unhealthy lifestyle. High levels of neuroticism should be considered in TCSs expressing multiple complaints and concerns at follow-up consultations. Assessment of neuroticism may be clinically important in order to offer appropriate interventions to prevent and manage morbidity in TCSs.