1. Affect Regulation in Patients with Somatoform and Psychosomatic Disorders
Masa Bozovic ¹ / Aleksandar Dimitrijevic ¹ / Sonja Milojevic ¹ ²
1 Department of Psychology, University of Belgrade / 2 Institute of Criminological and Sociological Research, Belgrade
RESEARCH RATIONALE
RESULTS
DISCUSSION
The application of attachment and mentalization concepts and methods in psychosomatic medicine is still at an early stage. Research has been conducted infrequently, with different instruments, on heterogeneous samples, so that inconsistent results were obtained.
Fearful (Ciechanowski et al., 2002), and both preoccupied and fearful (Kidd & Sheffield, 2005) styles were associated with increased symptom reporting. Also, it turns out that fearful attachment mediates the link between childhood trauma and somatization for women, while for men childhood trauma and insecure attachment contributions to predicting levels of somatization independently (Waldinger, Schulz, Barsky & Ahern, 2006).
Attachment insecurity contributes to three mechanisms that increase disease risk connected to psychosomatic disorders: altered stress physiology, increased use of external affect regulators, and altered use of health-protective behaviors (Maunder & Hunter, 2001).
As psychoanalytic theories of Bion and Marty have claimed long ago, our results confirm that persons with diagnoses of Somatoform and Psychosomatic disorders have problems with affect regulation. Compared to controls, the patients are more anxious, while less prone to thinking about own and others' emotions.
The significance of the discriminant function highlights the importance of attachment anxiety, mentalization, and empathy as distinct features of Somatoform and Psychosomatic disorders, where effects for empathy are large and for mentalization and attachment anxiety medium.
With Cronbach Alphas between .57 and .92, SM-ECR-R, S-EQ, and MAQ are reliable and valid instruments that enable correct prediction of group membership.
Discriminant function analysis
Structure matrix
Scales
Function
Empathy
.679
Mentalization
.526
Anxiety
-.485
Avoidance
-.263
Discriminant analysis yielded one significant function
r=.529, χ²(3)=31.345, p<.001
Correctness of group classification
75.5% of the total cases
83.7% in the clinical and 67.3% in the control group
CONCLUSION
1. Patients with Somatoform and Psychosomatic disorders do have problems with attachment anxiety, empathy and mentalization.
2. These three traits do differentiate these patients as a group.
3. Self-report measures of attachment related phenomena can be useful for research with some clinical samples.
Analysis of variances
Mean differences between groups
PROBLEM
The purpose of this study is to investigate:
1. whether patients with Somatoform and Psychosomatic disorders differ from non-patients on measures of attachment, empathy and mentalization, and
2. whether it is possible to make plausible conclusions based on self-report measures.
Effect sizes
Scales
Eta squared
Avoidance
.003
Anxiety
.082
Empathy
.166
Mentalization
.106
REFERENCE
Ciechanowski, P. S., Katon, W. J., Russo, J. E., & Dwight-Johnson, M. M. (2002). Association of attachment style to lifetime medically unexplained symptoms in patients with hepatitis C.  Psychosomatics,  43(3),
Kidd, T., & Sheffield, D. (2005). Attachment style and symptom reporting: Examining the mediating effects of anger and social support.  British Journal of Health Psychology,  10(4),
Maunder, R. G., & Hunter, J. J. (2001). Attachment and psychosomatic medicine: developmental contributions to stress and disease. Psychosomatic Medicine, 63(4),
Waldinger, R. J., Schulz, M. S., Barsky, A. J., & Ahern, D. K. (2006). Mapping the road from childhood trauma to adult somatization: the role of attachment. Psychosomatic Medicine, 68(1),
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METHOD
Participants and procedure:
Clinical sample: 50 adult patients diagnosed with “Psychosomatic” or Somatoform Disorders (F54, F45), tested individually in the psychiatric hospital „Dr Dragisa Misovic – Dedinje”, in Belgrade, Serbia.
Control sample: 50 nonpatients, matched by gender, age, and education.
Measures: Experiences in Close Relationships-Revised (SM-ECR-R) for assessment of attachment avoidance and anxiety, Empathy Quotient (S-EQ), and Mentalization Assessment Questionnaire (MAQ).