Somatoform disorders: personality and the social matrix of somatic distress.

Personality traits that may contribute to somatization are reviewed. Negative affectivity is associated with high levels of both somatic and emotional distress. Agreeableness and conscientiousness may influence interactions with health care providers that lead to the failure of medical reassurance to reduce distress. Absorption may make individuals more liable to focus attention on symptoms and more vulnerable to suggestions that induce illness anxiety. More proximate influences on the selective amplification of somatic symptoms include repressive style, somatic attributional style, and alexithymia; however, data in support of these factors are scant. Most research on somatoform disorders confounds mechanisms of symptom production with factors that influence help seeking. Longitudinal community studies are needed to explore the interactions of personality with illness experience and the stigmatization of medically unexplained symptoms.

[1]  L. Ross,et al.  The Person and the Situation: Perspectives of Social Psychology , 1991 .

[2]  J. M. Digman.  PERSONALITY STRUCTURE: EMERGENCE OF THE FIVE-FACTOR MODEL , 1990 .

[3]  W. Katon,et al.  Dissociation in women with chronic pelvic pain. , 1992, The American journal of psychiatry.

[4]  R. McCrae.  Traits and trait names: How well is Openness represented in natural languages? , 1990 .

[5]  Thomas F. Cash,et al.  Body Images: Development, Deviance, and Change , 1991 .

[6]  M. Hendryx,et al.  Dimensions of alexithymia and their relationships to anxiety and depression. , 1991, Journal of personality assessment.

[7]  C. Robert Cloninger,et al.  An adoption study of somatoform disorders. II. Identification of two discrete somatoform disorders. , 1984, Archives of general psychiatry.

[8]  S. Lilienfeld.  The association between antisocial personality and somatization disorders: A review and integration of theoretical models. , 1992 .

[9]  Paul T. Costa,et al.  Personality Disorders and the Five-Factor Model of Personality , 1994 .

[10]  I. Pilowsky.  PRIMARY AND SECONDARY HYPOCHONDRIASIS , 1970, Acta psychiatrica Scandinavica.

[11]  T. Widiger.  DSM-IV sourcebook , 1994 .

[12]  R. Bagby,et al.  Validation of the Alexithymia Construct: A Measurement-Based Approach * , 1990, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[13]  P. Costa,et al.  Four ways five factors are basic , 1992 .

[14]  P. Costa.  Influence of the normal personality dimension of neuroticism on chest pain symptoms and coronary artery disease. , 1987, The American journal of cardiology.

[15]  J. Kihlstrom,et al.  Absorption, openness to experience, and hypnotizability. , 1991, Journal of Personality and Social Psychology.

[16]  James W. Pennebaker,et al.  The psychology of physical symptoms , 1982 .

[17]  D. Spiegel.  Dissociation and trauma. , 1991 .

[18]  G. Klerman,et al.  The somatosensory amplification scale and its relationship to hypochondriasis. , 1990, Journal of psychiatric research.

[19]  B. Kinder,et al.  Alexithymia among empirically derived subgroups of chronic back pain patients. , 1990, Journal of personality assessment.

[20]  D. Cioffi.  BEYOND ATTENTIONAL STRATEGIES : A COGNITIVE-PERCEPTUAL MODEL OF SOMATIC INTERPRETATION , 1991 .

[21]  D. Watson,et al.  Structures of personality and their relevance to psychopathology. , 1994, Journal of abnormal psychology.

[22]  R. Larsen.  Neuroticism and selective encoding and recall of symptoms: evidence from a combined concurrent-retrospective study. , 1992, Journal of personality and social psychology.

[23]  A Steptoe,et al.  Individual differences in the perception of bodily sensations: the role of trait anxiety and coping style. , 1992, Behaviour research and therapy.

[24]  A. Kleinman.  Social Origins Of Distress And Disease , 1986 .

[25]  L. Kirmayer,et al.  Cognitive and social factors in somatization. , 1991 .

[26]  C. Bass,et al.  Somatization : physical symptoms and psychological illness , 1990 .

[27]  L. Kirmayer,et al.  Current Concepts of Somatization: Research and Clinical Perspectives , 1991 .

[28]  D. Grayson.  Can Categorical and Dimensional Views of Psychiatric Illness be Distinguished? , 1987, British Journal of Psychiatry.

[29]  R. Stelmack.  Biological bases of extraversion: psychophysiological evidence. , 1990, Journal of personality.

[30]  Harold I. Kaplan,et al.  Comprehensive textbook of psychiatry/III , 1980 .

[31]  S. Snyder,et al.  Characterizing somatization, hypochondriasis, and hysteria in the borderline personality disorder , 1986, Acta psychiatrica Scandinavica.

[32]  Z. J. Lipowski.  Somatization: the concept and its clinical application. , 1988, The American journal of psychiatry.

[33]  V. Starcevic.  Role of reassurance and psychopathology in hypochondriasis. , 1990, Psychiatry.

[34]  T. Thompson.  American Psychiatric Press Review of Psychiatry, vol. 12 , 1994 .

[35]  W K Vaughn,et al.  Elevated MMPI scores for hypochondriasis, depression, and hysteria in patients with rheumatoid arthritis reflect disease rather than psychological status. , 1986, Arthritis and rheumatism.

[36]  R. Kellner.  Psychosomatic Syndromes and Somatic Symptoms , 1992 .

[37]  D. Blumer,et al.  Chronic Pain as a Variant of Depressive Disease The Pain‐Prone Disorder , 1982, The Journal of nervous and mental disease.

[38]  R. Kellner.  Somatization and Hypochondriasis , 1985 .

[39]  L. Kirmayer,et al.  Three Forms of Somatization in Primary Care: Prevalence, Co‐occurrence, and Sociodemographic Characteristics , 1991, The Journal of nervous and mental disease.

[40]  A. Mathews,et al.  Interpretation of bodily symptoms in hypochondriasis. , 1992, Behaviour research and therapy.

[41]  J. Pennebaker,et al.  The psychology of somatic symptoms. , 1991 .

[42]  C. Ross,et al.  Psychiatric diagnosis as reified measurement. , 1989, Journal of health and social behavior.

[43]  R. Bagby,et al.  The alexithymia construct: relationship with sociodemographic variables and intelligence. , 1989, Comprehensive psychiatry.

[44]  L. Kirmayer,et al.  Attributions of common somatic symptoms , 1991, Psychological Medicine.

[45]  M. Zuckerman,et al.  The psychophysiology of sensation seeking. , 1990, Journal of personality.

[46]  S. Benjamin,et al.  Abnormal illness behaviour: childhood experiences and long-term consequences , 1992 .

[47]  H. Radtke,et al.  The relationship between absorption, openness to experience, anhedonia, and susceptibility. , 1991, The International journal of clinical and experimental hypnosis.

[48]  R. Pihl,et al.  Inherited predisposition to alcoholism: characteristics of sons of male alcoholics. , 1990, Journal of abnormal psychology.

[49]  G. Brown,et al.  A causal analysis of chronic pain and depression. , 1990, Journal of abnormal psychology.

[50]  N L Segal,et al.  Personality similarity in twins reared apart and together. , 1988, Journal of personality and social psychology.

[51]  J. Garber,et al.  Somatization symptoms in pediatric abdominal pain patients: Relation to chronicity of abdominal pain and parent somatization , 1991, Journal of abnormal child psychology.

[52]  L. Kirmayer,et al.  Cognitive and social correlates of the Toronto Alexithymia Scale. , 1993, Psychosomatics.

[53]  Ernest R. Hilgard,et al.  Hypnosis in the Relief of Pain , 1975 .

[54]  C. Hayward,et al.  Somatization and Personality Disorder Traits in Nonclinical Volunteers , 1990 .

[55]  D. Buss,et al.  Personality psychology : recent trends and emerging directions , 1989 .

[56]  M. Sharpe,et al.  Pathophysiological mechanisms in somatization , 1992 .

[57]  L. Kirmayer,et al.  Culture, Affect and Somatization , 1984 .

[58]  F. W. Brown,et al.  The comorbidity of DSM-III-R personality disorders in somatization disorder. , 1992, General hospital psychiatry.

[59]  P. Costa,et al.  Neuroticism, somatic complaints, and disease: is the bark worse than the bite? , 1987, Journal of personality.

[60]  Ian E. Wickramasekera,et al.  Clinical Behavioral Medicine: Some Concepts and Procedures , 1988 .

[61]  S. Wilkinson.  The Child's World of Illness: The Development of Health and Illness Behaviour , 1988 .

[62]  R. Bagby,et al.  Alexithymia and somatic complaints in psychiatric out-patients. , 1992, Journal of psychosomatic research.

[63]  Ronald Melzack,et al.  Handbook of pain assessment , 1992 .

[64]  P. Tyrer,et al.  A plea for the diagnosis of hypochondriacal personality disorder. , 1990, Journal of psychosomatic research.

[65]  J. Singer.  Repression and dissociation : implications for personality theory, psychopathology and health , 1990 .

[66]  R. Weiner.  Complexities of Stress. (Book Reviews: Perturbing the Organism. The Biology of Stressful Experience.) , 1992 .

[67]  L. Kirmayer,et al.  Somatization and the recognition of depression and anxiety in primary care. , 1993, The American journal of psychiatry.

[68]  V. Starcevic.  Relationship between hypochondriasis and obsessive-compulsive personality disorder: close relatives separated by nosological schemes? , 1990, American journal of psychotherapy.

[69]  G. Klerman,et al.  Overview: hypochondriasis, bodily complaints, and somatic styles. , 1983, The American journal of psychiatry.

[70]  R. McCrae,et al.  The five-factor model and its assessment in clinical settings. , 1991, Journal of personality assessment.

[71]  M. Hendryx,et al.  An application of item response theory to alexithymia assessment among abstinent alcoholics. , 1992, Journal of personality assessment.

[72]  L. Kirmayer,et al.  Mind and Body as Metaphors: Hidden Values in Biomedicine , 1988 .

[73]  K. Phillips,et al.  Body dysmorphic disorder: 30 cases of imagined ugliness. , 1993, The American journal of psychiatry.

[74]  P. R. Slavney.  Perspectives on Hysteria , 1990 .

[75]  J. Pennebaker,et al.  Levels of Thinking , 1990 .

[76]  A. Stoudemire.  Current Concepts of Somatization , 1992 .

[77]  T. M. Kashner,et al.  Antisocial personality disorder in primary care patients with somatization disorder. , 1991, Comprehensive psychiatry.

[78]  L. Kirmayer,et al.  The Body's Insistence on Meaning: Metaphor as Presentation and Representation in Illness Experience , 1992 .

[79]  S. Briggs,et al.  The Optimal Level of Measurement for Personality Constructs , 1989 .

[80]  F. Frankel.  Hypnotizability and dissociation. , 1991, The American journal of psychiatry.

[81]  G. Bonanno,et al.  Repressive personality style: Theoretical and methodological implications for health and pathology , 1990 .

[82]  W. Katon,et al.  Somatization: a spectrum of severity. , 1991, The American journal of psychiatry.

[83]  A. Buss,et al.  Consciousness of Body: Private and Public , 1981 .

[84]  Daniel M. Wegner,et al.  The hyperaccessibility of suppressed thoughts. , 1992 .

[85]  D. Goldberg,et al.  Determinants of somatization in primary care , 1991, Psychological Medicine.

[86]  J. Wilson‐Barnett,et al.  An Investigation of Hysteria using the Illness Behaviour Questionnaire , 1985, British Journal of Psychiatry.

[87]  D. Watson,et al.  Health complaints, stress, and distress: exploring the central role of negative affectivity. , 1989, Psychological review.

[88]  G. Canino,et al.  Functional somatic symptoms: a cross-ethnic comparison. , 1992, The American journal of orthopsychiatry.

[89]  L. Kirmayer,et al.  SOMATIZATION AND THE SOCIAL CONSTRUCTION OF ILLNESS EXPERIENCE , 1986 .

[90]  E. Gordon,et al.  Augmentation of auditory evoked potentials in somatization disorder. , 1990, Journal of psychiatric research.

[91]  R. L. Chastain,et al.  Self-Concealment: Conceptualization, Measurement, and Health Implications , 1990 .

[92]  R. Gardner,et al.  Somatization Tendencies and Ability to Detect Internal Body Cues , 1990, Perceptual and motor skills.

[93]  G. Klerman,et al.  Psychiatric comorbidity in DSM-III-R hypochondriasis. , 1992, Archives of general psychiatry.

[94]  S. Guze,et al.  A prospective follow-up and family study of somatization in men and women. , 1986, The American journal of psychiatry.