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Macina C, Bendel R, Walter M, Wrege JS. Somatization and Somatic Symptom Disorder and its overlap with dimensionally measured personality pathology: A systematic review. J Psychosom Res 2021; 151:110646. [PMID: 34715494 DOI: 10.1016/j.jpsychores.2021.110646] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 01/05/2023]
Abstract
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).
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Affiliation(s)
- Caroline Macina
- University Psychiatric Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland.
| | - Rebecca Bendel
- University Psychiatric Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Marc Walter
- University Psychiatric Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland.
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Maggio J, Alluri PR, Paredes-Echeverri S, Larson AG, Sojka P, Price BH, Aybek S, Perez DL. Briquet syndrome revisited: implications for functional neurological disorder. Brain Commun 2020; 2:fcaa156. [PMID: 33426523 PMCID: PMC7784044 DOI: 10.1093/braincomms/fcaa156] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 12/13/2022] Open
Abstract
With the creation of the Somatic Symptom and Related Disorders category of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition in 2013, the functional neurological (symptom) disorder diagnostic criteria underwent transformative changes. These included an emphasis on ‘rule-in’ physical examination signs/semiological features guiding diagnosis and the removal of a required proximal psychological stressor to be linked to symptoms. In addition, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition somatization disorder, somatoform pain disorder and undifferentiated somatoform disorder conditions were eliminated and collapsed into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition somatic symptom disorder diagnosis. With somatic symptom disorder, emphasis was placed on a cognitive-behavioural (psychological) formulation as the basis for diagnosis in individuals reporting distressing bodily symptoms such as pain and/or fatigue; the need for bodily symptoms to be ‘medically unexplained’ was removed, and the overall utility of this diagnostic criteria remains debated. A consequence of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition restructuring is that the diagnosis of somatization disorder that encompassed individuals with functional neurological (sensorimotor) symptoms and prominent other bodily symptoms, including pain, was eliminated. This change negatively impacts clinical and research efforts because many patients with functional neurological disorder experience pain, supporting that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition would benefit from an integrated diagnosis at this intersection. We seek to revisit this with modifications, particularly since pain (and a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition somatization disorder comorbidity, more specifically) is associated with poor clinical prognosis in functional neurological disorder. As a first step, we systematically reviewed the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition somatization disorder literature to detail epidemiologic, healthcare utilization, demographic, diagnostic, medical and psychiatric comorbidity, psychosocial, neurobiological and treatment data. Thereafter, we propose a preliminary revision to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition allowing for the specifier functional neurological disorder ‘with prominent pain’. To meet this criterion, core functional neurological symptoms (e.g. limb weakness, gait difficulties, seizures, non-dermatomal sensory loss and/or blindness) would have ‘rule-in’ signs and pain (>6 months) impairing social and/or occupational functioning would also be present. Two optional secondary specifiers assist in characterizing individuals with cognitive-behavioural (psychological) features recognized to amplify or perpetuate pain and documenting if there is a pain-related comorbidity. The specifier of ‘with prominent pain’ is etiologically neutral, while secondary specifiers provide additional clarification. We advocate for a similar approach to contextualize fatigue and mixed somatic symptoms in functional neurological disorder. While this preliminary proposal requires prospective data and additional discussion, these revisions offer the potential benefit to readily identify important functional neurological disorder subgroups—resulting in diagnostic, treatment and pathophysiology implications.
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Affiliation(s)
- Julie Maggio
- Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Priyanka R Alluri
- Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara Paredes-Echeverri
- Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anna G Larson
- Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Petr Sojka
- Department of Psychiatry, University Hospital Brno, Czech Republic
| | - Bruce H Price
- Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Selma Aybek
- Department of Neurology, Inselspital University Hospital Bern and Clinical Neurosciences Bern, Bern University, Switzerland
| | - David L Perez
- Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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de Vroege L, Koppenol I, Kop WJ, Riem MME, van der Feltz-Cornelis CM. Neurocognitive functioning in patients with conversion disorder/functional neurological disorder. J Neuropsychol 2020; 15:69-87. [PMID: 32223071 PMCID: PMC8048909 DOI: 10.1111/jnp.12206] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/03/2020] [Indexed: 01/25/2023]
Abstract
Neurocognitive symptoms are common in individuals with somatic symptom and related disorders (SSRD), but little is known about the specific impairments in neurocognitive domains in patients with conversion disorder (CD)/functional neurological disorder (FND). This study examines neurocognitive functioning in patients with CD/FND compared to patients with other SSRD. The sample consisted of 318 patients. Twenty‐nine patients were diagnosed with CD/FND, mean age 42.4, standard deviation (SD) = 13.8 years, 79.3% women, and 289 patients had other SSRD (mean age 42.1, SD = 13.3, 60.2% women). Patients completed a neuropsychological test battery that addressed a broad range of neurocognitive domains, including information processing speed, attention and executive functioning. Patients with CD/FND had clinically significant neurocognitive deficits in all neurocognitive domains based on normative data comparison. Patients with CD/FND also performed significantly worse than patients with other SSRD on information processing speed (Digit Symbol Substitution Test (V = .115, p = .035), Stroop Color–Word Test (SCWT) card 1 (V = .190, p = .006), and SCWT card 2 (V = .244, p < .001). No CD/FND vs. other SSRD differences were observed in other neurocognitive domains. These findings indicate the patients with CD/FND perform worse on information processing speed tests compared to patients with other SSRD.
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Affiliation(s)
- Lars de Vroege
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, the Netherlands.,Tilburg School of Social and Behavioral Sciences, Tranzo Department, Tilburg University, the Netherlands
| | - Iris Koppenol
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, the Netherlands
| | - Willem Johan Kop
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, the Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, the Netherlands
| | - Madelon M E Riem
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, the Netherlands
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Hyperventilation-Induced Non-epileptic Seizures in an Adolescent Boy with Pediatric Medical Traumatic Stress. Harv Rev Psychiatry 2018; 25:180-190. [PMID: 28471819 DOI: 10.1097/hrp.0000000000000131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Schmaling KB, Fales JL. The association between borderline personality disorder and somatoform disorders: A systematic review and meta-analysis. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Karen B. Schmaling
- Department of Psychology; Washington State University; Vancouver Washington
| | - Jessica L. Fales
- Department of Psychology; Washington State University; Vancouver Washington
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Carlier IVE, Andree Wiltens DH, van Rood YR, van Veen T, Dekker J, van Hemert AM. Treatment course and its predictors in patients with somatoform disorders: A routine outcome monitoring study in secondary psychiatric care. Clin Psychol Psychother 2018; 25:550-564. [PMID: 29573030 DOI: 10.1002/cpp.2191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 02/14/2018] [Accepted: 02/14/2018] [Indexed: 12/27/2022]
Abstract
AIM Somatoform disorders are common and often chronic. It would be helpful to distinguish those patients who are likely to have a positive treatment course from those who are likely to follow a negative course. Such studies of different somatoform disorders are scarce, especially in secondary psychiatric care. This study examined the 6-month treatment course of psychological, physical symptoms, and functioning, and its predictors in a naturalistic sample of secondary psychiatric care outpatients with somatoform disorders. METHOD The present study used routine outcome monitoring data of patients with somatoform disorders regarding their 6-month treatment course of psychological and physical symptoms as well as functioning. The following patient groups were included: total group of somatoform disorders (N = 435), and undifferentiated somatoform disorder (N = 242), pain disorder (N = 102), body dysmorphic disorder (N = 51), and hypochondriasis (N = 40). Measures were Mini-International Neuropsychiatric Interview plus, Brief Symptom Inventory, Montgomery-Ǻsberg Depression Rating Scale, Brief Anxiety Scale, Short Form Health Survey 36, and Physical Symptom Checklist (PSC). RESULTS The study population generally showed high co-morbidity, especially with anxiety and mood disorders. The PSC total score, body dysmorphic disorder, and hypochondriasis were significant predictors for the treatment course of symptoms (Brief Symptom Inventory), whereas the PSC total score was the only significant predictor for the course of functioning (Short Form Health Survey 36). CONCLUSION Secondary psychiatric care outpatients with somatoform disorders showed high co-morbidity with anxiety and mood disorders, and an unfavourable 6-month course of both symptoms and functioning. Clinical implications are discussed, such as additional treatment of co-morbidity in somatoform disorders.
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Affiliation(s)
- I V E Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Y R van Rood
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - T van Veen
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - J Dekker
- Department of Psychiatry and Department of Rehabilitation Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - A M van Hemert
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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Holster J, Hawks EM, Ostermeyer B. Somatic Symptom and Related Disorders. Psychiatr Ann 2017. [DOI: 10.3928/00485713-20170308-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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van Dijk SDM, Hanssen D, Naarding P, Lucassen P, Comijs H, Oude Voshaar R. Big Five personality traits and medically unexplained symptoms in later life. Eur Psychiatry 2016; 38:23-30. [PMID: 27611331 DOI: 10.1016/j.eurpsy.2016.05.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/24/2016] [Accepted: 05/02/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Personality dysfunction has been postulated as the most clinically salient problem of persons suffering from medically unexplained symptoms (MUS) but empirical studies are scarce. This study aims to compare the personality profile of older patients suffering from MUS with two comparison groups and a control group. METHODS Ninety-six older patients with MUS were compared with 153 frequent attenders in primary care suffering from medically explained symptoms (MES), 255 patients with a past-month depressive disorder (DSM-IV-TR), and a control group of 125 older persons. The Big Five personality domains (NEO-Five-Factor Inventory) were compared between groups by multiple ANCOVAs adjusted for age, sex, education, partner status and cognitive functioning. Linear regression analyses were applied to examine the association between health anxiety (Whitley Index) and somatization (Brief Symptom Inventory). RESULTS The four groups differed with respect to neuroticism (P<0.001), extraversion (P<0.001), and agreeableness (P=0.045). Post hoc analyses, showed that MUS patients compared to controls scored higher on neuroticism and agreeableness, and compared to depressed patients lower on neuroticism and higher on extraversion as well agreeableness. Interestingly, MUS and MES patients had a similar personality profile. Health anxiety and somatization were associated with a higher level of neuroticism and a lower level of extraversion and conscientiousness, irrespective whether the physical symptom was explained or not. CONCLUSIONS Older patients with MUS have a specific personality profile, comparable to MES patients. Health anxiety and somatization may be better indicators of psychopathology than whether a physical symptom is medically explained or not.
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Affiliation(s)
- S D M van Dijk
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion regulation (ICPE), PO box 30.001, 9700 RB Groningen, The Netherlands.
| | - D Hanssen
- Radboud University Nijmegen Medical Center, Department of Psychiatry & Research Institute for Health Sciences, Nijmegen, The Netherlands
| | - P Naarding
- Radboud University Nijmegen Medical Center, Department of Psychiatry & Research Institute for Health Sciences, Nijmegen, The Netherlands; Department of Old Age Psychiatry, GGNet, Apeldoorn, The Netherlands
| | - P Lucassen
- Radboud University Nijmegen Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - H Comijs
- GGZinGeest & Department Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - R Oude Voshaar
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion regulation (ICPE), PO box 30.001, 9700 RB Groningen, The Netherlands
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Inamura K, Tsuno N, Shinagawa S, Nagata T, Tagai K, Nakayama K. Correlation between cognition and symptomatic severity in patients with late-life somatoform disorders. Aging Ment Health 2015; 19:169-74. [PMID: 24874978 DOI: 10.1080/13607863.2014.920297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Various aging associated factors, such as functional decline, psychosocial problems, and cognitive dysfunction, are risk factors for somatoform disorders (SDs) in the elderly. The aim of the present study was to evaluate how cognition is correlated with the severity of late-life SDs from a neuropsychological viewpoint. METHODS Fifty-three patients over 60 years of age who had been diagnosed as having SDs were examined in this study. The severity of the somatic symptoms was assessed using the Hamilton Anxiety Rating Scales (HAMA). Cognitive functions were assessed using the Mini-Mental State Examination (MMSE), the Frontal Assessment Battery (FAB), and the Japanese version of the Neurobehavioral Cognitive Examination (J-COGNISTAT). RESULTS The J-COGNISTAT subtest score for attention was below the cutoff point (8 points) but was not correlated with the severity of the somatic symptoms in the patients with late-life SDs. The severity of anxiety as assessed using the HAMA was significantly correlated with the calculation scores (P < 0.005) among the J-COGNISTAT subtests, the FAB total (P < 0.05), and the FAB subtest scores (similarities and motor series) (P < 0.01). Other factors, including the benzodiazepine dosage, antidepressant dosage, the duration of illness, and the onset age, were not significantly correlated with the symptomatic severities. CONCLUSION Patients with late-life SDs showed attention deficits, but no correlation was seen between the attention deficits and symptomatic severities. Attention deficits might be associated with the appearance of symptoms. Executive dysfunction and working memory might be associated with the severity of symptoms.
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Affiliation(s)
- Keisuke Inamura
- a Department of Psychiatry, Kashiwa Hospital , Jikei University School of Medicine , Chiba , Japan
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Al-Adawi S, Al-Zakwani I, Obeid YA, Zaidan Z. Neurocognitive functioning in women presenting with undifferentiated somatoform disorders in Oman. Psychiatry Clin Neurosci 2010; 64:555-64. [PMID: 20727107 DOI: 10.1111/j.1440-1819.2010.02117.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM There is a dearth of research from non-Western populations focusing on neurocognitive functioning in patients presenting with undifferentiated somatoform disorders. The aim of the present quest is to examine the presence of cognitive impairment and other health-related parameters among attendees at psychiatric settings in Oman, an Arab/Islamic country, with a diagnosis of undifferentiated somatoform disorder. METHOD In order to compare the performance of patients diagnosed with undifferentiated somatoform disorder (n = 20) and normal healthy subjects (n = 18) on indices of attention and concentration, tests of executive functioning, mood, somatization and vegetative functioning were carried out. RESULTS The performance of patients with undifferentiated somatoform disorder differed from that of normal healthy subjects on the presently operationalized indices of working memory and executive functioning, anxiety, quality of sleep and psychosomatically expressed psychological distress. CONCLUSION To our knowledge, this is the first study highlighting neurocognitive functioning in patients with undifferentiated somatoform disorders from a non-Western population. This type of study has the potential of shedding light on the covariates of such a debilitating and intransigent condition as undifferentiated somatoform disorder.
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Affiliation(s)
- Samir Al-Adawi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman.
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Thomas JJ, Vartanian LR, Brownell KD. The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: meta-analysis and implications for DSM. Psychol Bull 2009; 135:407-33. [PMID: 19379023 DOI: 10.1037/a0015326] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Eating disorder not otherwise specified (EDNOS) is the most prevalent eating disorder (ED) diagnosis. In this meta-analysis, the authors aimed to inform Diagnostic and Statistical Manual of Mental Disorders revisions by comparing the psychopathology of EDNOS with that of the officially recognized EDs: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). A comprehensive literature search identified 125 eligible studies (published and unpublished) appearing in the literature from 1987 to 2007. Random effects analyses indicated that whereas EDNOS did not differ significantly from AN and BED on eating pathology or general psychopathology, BN exhibited greater eating and general psychopathology than EDNOS. Moderator analyses indicated that EDNOS groups who met all diagnostic criteria for AN except for amenorrhea did not differ significantly from full syndrome cases. Similarly, EDNOS groups who met all criteria for BN or BED except for binge frequency did not differ significantly from full syndrome cases. Results suggest that EDNOS represents a set of disorders associated with substantial psychological and physiological morbidity. Although certain EDNOS subtypes could be incorporated into existing Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) categories, others-such as purging disorder and non-fat-phobic AN-may be best conceptualized as distinct syndromes. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
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