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Persistent physical symptoms (synonymous with persistent somatic symptoms) is an umbrella term for distressing somatic complaints that last several months or more, regardless of their cause. These symptoms are associated with substantial disability and represent a major burden for patients, health-care professionals, and society. Persistent physical symptoms can follow infections, injuries, medical diseases, stressful life events, or arise de novo. As symptoms persist, their link to clearly identifiable pathophysiology often weakens, making diagnosis and treatment challenging. Multiple biological and psychosocial risk factors and mechanisms contribute to the persistence of somatic symptoms, including persistent inflammation; epigenetic profiles; immune, metabolic and microbiome dysregulation; early adverse life experiences; depression; illness-related anxiety; dysfunctional symptom expectations; symptom focusing; symptom learning; and avoidance behaviours, with many factors being common across symptoms and diagnoses. Basic care consists of addressing underlying pathophysiology and using person-centred communication techniques with validation, appropriate reassurance, and biopsychosocial explanation. If basic care is insufficient, targeted psychological and pharmacological interventions can be beneficial. A better understanding of the multifactorial persistence of somatic symptoms should lead to more specific, personalised, and mechanism-based treatment, and a reduction in the stigma patients commonly face., Competing Interests: Declaration of interests BL reports research funding (no personal honoraria) from the German Research Foundation, the German Federal Ministry of Education and Research, the German Innovation Committee at the Joint Federal Committee, the European Commission's Horizon 2020 Framework Programme, the European Joint Programme for Rare Diseases, the Ministry of Science, Research and Equality of the Free and Hanseatic City of Hamburg, Germany, and the Foundation Psychosomatics of Spinal Diseases. He has received remunerations for scientific book articles from Elsevier, Thieme Publishing, Clett Kotta Publishing, and Hogrefe Publishing. He has received remunerations from the Norddeutscher Rundfunk for interviews in medical knowledge programmes on public television, and as a committee member from Aarhus University, Denmark. He received travel expenses from the European Association of Psychosomatic Medicine (EAPM) and accommodation and meals from the Societatea de Medicina Biopsyhosociala, Romania, for a presentation at the EAPM Academy at the Conferința Națională de Psihosomatică in October, 2023. He was a board member of the EAPM (unpaid) until 2022. AT reports research funding (no personal honoraria) from the German Research Foundation. She has received remunerations for a printed textbook from Ernst Reinhardt Publishing. JGMR reports research funding (no personal honoraria) from the European Commission's Horizon 2020 Framework Programme, the National Institutes of Mental Health, the Netherlands Research Council, and the Netherlands Organisation for Health Research and Development. She has received honoraria from Lannoo Publishers for a book she coedited and from educational institutions for teaching psychosomatic therapists. She is a member of the advisory board and the data safety and monitoring board of the SOMACROSS research unit (FOR 5211) and the scientific board of the Lifelines cohort study and biobank (both unpaid). She is vice president of the EAPM and the Dutch Network Persistent Somatic Symptoms (both unpaid). W-LH reports research funding (no personal honoraria) from National Health Research Institutes and Ministry of Science and Technology in Taiwan, and the National Taiwan University Hospital Yunlin Branch. He has received consultation fees from Janssen, Servier, and Boehringer Ingelheim. He has given lectures with personal honoraria for Janssen, Servier, Pfizer/Viatris, Sumitomo, Otsuka, and Boehringer Ingelheim. CB reports research funding (no personal honoraria) from the UK National Institute for Health Research and the European Commission's Horizon 2020 Framework Programme. He has received remuneration from Wiley for editing a book. AW reports research funding (no personal honoraria) from the Werner Otto Foundation. She has received remunerations for a lecture at the Lindauer Psychotherapietage and she has been treasurer of the EAPM (unpaid) since 2021. JLL has received royalties from American Psychiatric Publishing for two books and from UpToDate for several topic entries. He has received a one-time payment from the American Psychiatric Association (APA) for a course presented at the 2023 APA meeting. He has received expert witness fees in legal cases, none of which are related to the topic of this Review. PH reports research funding (no personal honoraria) from the German Research Foundation, the German Federal Ministry of Education and Research, and the German Innovation Committee at the Joint Federal Committee. He has received remunerations for a book chapter from Oxford University Press and for a book from Springer Nature. He has received remunerations as a scientific programme consultant of the Lindauer Psychotherapietage and has received payment of travel expenses and remunerations for presentations at several universities and other public hospitals in Germany (no commercial companies). He has received travel expenses and registration fees for the German Congress of Psychosomatic Medicine. He has received remunerations as a committee member from Aarhus University, Denmark. He has been a board member of the EAPM (unpaid) since 2023., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Childhood maltreatment has been linked to adult somatic symptoms, although this has rarely been examined in daily life. Furthermore, the localization of somatization associated with childhood maltreatment and its subtypes is unknown. This large-scale experience sampling study used body maps to examine the relationships between childhood maltreatment, its subtypes, and the intensity and location of negative somatic sensations in daily life. Participants (N = 2,234; 33% female and 67% male) were part of MyBPLab 2.0, a study conducted using a bespoke mobile phone application. Four categories of childhood maltreatment (emotional abuse, emotional neglect, physical abuse, and physical neglect) were measured using the Childhood Trauma Questionnaire. Using gender-matched human silhouettes, participants indicated the location and intensity of feelings of negative activation in the body. Childhood maltreatment generally and its four measured subtypes were all positively associated with heightened negative activation on both the front and back body maps. For females, total childhood maltreatment was associated with negative activation in the abdomen and lower back, while for males, the association was localized to the lower back. Similarly, each of the four subscales had localized associations with negative activation in the abdomen and lower back in females and lower back in males, except for emotional abuse, which was also associated with negative activation in the abdomen in males. These associations likely reflect increased somatization in individuals exposed to childhood maltreatment, suggesting a role for psychotherapeutic interventions in alleviating associated distress., Competing Interests: Competing interests statement:The authors declare no competing interest.

Background: Temporomandibular disorders and somatization have shown interrelation in many studies. The physical and psychological factors which contributed to the occurrence and relation of both conditions are yet to be determined., Objectives: The personality traits, coping styles and psychological distress of young adults with temporomandibular disorder (TMD) and somatic symptoms were characterized together with the determination of psychological risk factors for TMDs, somatization and combined conditions., Methods: Participants were recruited from university-attending young adults. TMD and somatic symptoms were appraised with the short-form Fonseca Anamnestic Index and Patient Health Questionnaire-15. Psychological variables were assessed with the Big Five Personality Inventory-10, Brief-COPE Inventory and Depression, Anxiety, and Stress Scales-21. Data were evaluated using chi-squared/non-parametric tests and logistic regression analyses (α = .05)., Results: Among the 507 participants (mean age 22.2 ± 1.5 years), 46.4% reported no TMD/somatic symptoms (NS) while 7.5%, 34.5% and 11.6% had TMDs only (TS), somatization only (SS) and combined TMDs-somatization (CS), respectively. Significant differences in conscientiousness (NS > SS), agreeableness (NS, TS > CS; NS > SS), dysfunctional coping, general distress, depression, anxiety and stress (CS ≥ SS > NS) were discerned. Multivariate analyses indicated that the odds of TS were increased by anxiety (OR = 1.10; 95% CI = 1.01-1.21), while the odds of SS/CS were affected by anxiety (OR = 1.15; 95% CI = 1.06-1.25/OR = 1.34; 95% CI = 0.19-1.52) and problem-focused coping (OR = 0.71; 95% CI = 0.56-0.89/OR = 0.55; 95% CI = 0.39-0.78)., Conclusion: Though individuals with TMDs and somatization have dissimilar psychological profiles, anxiety constantly increased their likelihood. Problem-focused coping strategies may help alleviate psychosocial and physical stressors associated with TMDs and somatization., (© 2023 John Wiley & Sons Ltd.)

Objective: Evidence shows that many patients with COVID-19 present persistent symptoms after the acute infection. Some patients may be at a high risk of developing Somatic Symptom Disorder (SSD), in which persistent symptoms are accompanied by excessive and disproportionate health-related thoughts, feelings and behaviors regarding these symptoms. This study assessed the frequency of persistent physical symptoms and SSD and their associated factors in patients with confirmed COVID-19., Methods: We conducted a longitudinal retrospective study after the first two French lockdowns at the Lille University Hospital (France), including all patients with confirmed COVID-19. Persistent physical symptoms and excessive preoccupations for these symptoms were measured 8 to 10 months after the onset of COVID-19. The combination of the Patient Health Questionnaire-15 and the Somatic Symptom Disorder-B Criteria Scale was used to identify the individuals likely to present with SSD. Two linear regression models were performed to identify sociodemographic and medical risk factors of SSD., Results: Among the 377 patients with a laboratory-confirmed diagnosis, 220 (58.4%) completed the questionnaires. Sixty-five percent of the 220 included patients required hospitalization, 53.6% presented at least one persistent physical symptom and 10.4% were considered to present SSD. Female sex, older age, infection during the second wave and having probable PTSD were significantly associated with the severity of SSD and SSD was associated with a significantly higher healthcare use., Conclusions: The identification of SSD should encourage clinicians to move beyond the artificial somatic/psychiatric dualism and contribute to a better alliance based on multi-disciplinary care., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Population-based data regarding the relationship between childhood maltreatment (CM), somatization and health-related quality of life (HRQoL) in adults are limited., Objective: To investigate the association of CM history (emotional and physical abuse and neglect, sexual abuse) with somatization and with physical and mental HRQoL in adults., Participants and Setting: Data from 2305 participants from the population-based Study of Health in Pomerania were analyzed (aged 20 to 80 years)., Methods: We applied the Childhood Trauma Questionnaire. Somatoform disorders were diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) in a clinical interview. Using a self-administered questionnaire, we assessed the number of somatic symptoms and physical and mental HRQoL., Results: Sexual abuse was related to the diagnosis of a somatoform disorder (odds ratio [OR] 1.87; 95% confidence interval [CI] 1.29, 2.69). Emotional abuse and physical neglect were associated with the number of somatic symptoms (B = 0.93; 95% CI 0.42, 1.45 and B = 0.50; 95% CI 0.17, 1.83, respectively). Sexual abuse and physical neglect were related to lower physical HRQoL (B = -1.87; 95% CI -3.17, -0.57 and B = -1.26; 95% CI -2.02, -0.49, respectively), and emotional abuse was associated with lower mental HRQoL (B = -2.83; 95% CI -4.03, -1.62)., Conclusions: A history of CM, in particular sexual abuse, emotional abuse and physical neglect, is a risk factor for somatization and impaired HRQoL in adults. Individuals with somatic symptoms are an important target group for CM screening. Addressing HRQoL might be significant in psychotherapy for individuals with CM experience., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Determining the somatosensory and psychosocial profile of patients with painful temporomandibular joint (TMJ) clicking can help to understand the pain mechanisms in cases of TMJ clicking., Objective: To characterise the somatosensory and psychosocial profile of patients with painful TMJ clicking when compared to patients with painless TMJ clicking and healthy control group., Methods: Somatosensory and psychosocial functions were assessed in 90 individuals: patients with painful TMJ clicking (n = 30); patients with painless TMJ clicking (n = 30); and healthy controls (n = 30). Somatosensory profile included: mechanical pain threshold (MPT); wind-up ratio (WUR); pressure pain threshold (PPT); and conditioned pain modulation (CPM). Psychosocial profile included some questionnaires: Pittsburgh Sleep Quality Index (PSQI); Pain Vigilance-Awareness Questionnaire (PVAQ); Pain Catastrophizing Scale (PCS); Tampa Scale for Kinesiophobia (TSK); Perceived Stress (PSS); and State-Trait Anxiety Inventory (STAI). All variables were compared among all groups., Results: Higher values of MPT and WUR; lower PPT; less efficient CPM; and higher scores of PSQI, PVAQ, PCS, and TSK were found in patients with painful TMJ clicking when compared to the other two groups (P < .001). Patients with painless TMJ clicking showed lower PPT and higher scores of PVAQ and TKS than the healthy control group. PSS and STAI data had no differences., Conclusion: Patients with painful TMJ clicking had abnormalities in the somatosensory profile, with a significant somatosensory gain of function (more sensitive) to mechanical pain tests and less efficient CPM. Poor sleep quality along with higher levels of hypervigilance, pain catastrophising, and kinesiophobia were features of psychosocial profile of these patients., (© 2020 John Wiley & Sons Ltd.)

Background: Gait impairment is common after concussion. "Dizziness" is associated with prolonged recovery after concussion. Most often each of these symptoms is considered to be of vestibular origin. However, whether or not there are psychological etiologies of gait instability that complicate concussion recovery has been less fully explored., Methods: A chart review was performed of all patients seen between 2017 and 2019 in a weekly pediatric traumatic brain injury clinic., Results: Of eighty-four patients with traumatic brain injury, five were found to have developed a classic psychogenic gait. All were adolescents at the time of diagnosis. Recognition of this complication led to modification/initiation of physical therapy and/or mental health intervention and eventual resolution for all patients., Conclusion: Although uncommon, psychogenic gait disorders may complicate concussion recovery in adolescents likely at a higher rate than their occurrence in the general population. This association has not been previously reported. Accurate diagnosis of psychogenic gait likely improves outcomes in this subset of patients with concussion., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Cranial functional movement disorders (CFMDs) affect the face, eyes, jaw, tongue, and palate., Objectives: We aimed to examine our large series of functional movement disorders (FMDs) patients where the cranial muscles were involved to determine their phenomenology and other clinical features., Methods: This is a chart review of 26 patients who presented with CFMDs., Results: There were 16 (61.53%) females and 10 (38.46%) male patients. The mean ± [standard deviation (SD)] age at the presentation was 33.96 ± 16.94 (Range: 11-83) years. The duration of symptoms ranged from one day to 6 years (Mean ±SD: 402.03 ±534.97 days). According to the Fahn-Williams criteria, CFMDs were documented in 24 patients and clinically established in two patients. The facial [38.46% (10/26)] involvement was the most common in our CFMDs patients. Oromandibular [19.23% (5/26)], ocular [15.38% (4/26)], lingual [15.38% (4/26)], speech [15.38% (4/26)] and palatal [(3.85; 1/26)] involvement was also seen. 10 (38.46%) patients also had associated FMD in the extracranial regions. Precipitating factors were present in 84.61% (22/26) of the patients and associated illnesses were present in 42.30% (11/26) of the patients. At 3 months follow-up, 9 (34.61%) patients had improved, 13 (50%) had partial improvement and 4 (15.38%) had no improvement., Conclusions: There was a slight female preponderance in our patients. CFMDs are more likely to involve facial muscles. Associated medical conditions like neuropsychiatric disturbances and headaches are frequently present in CFMDs patients. Early clinical diagnosis will avoid unnecessary investigations and allow the patient to seek the right treatment., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2020 The Author(s).)

Anophthalmic patients not only cause obvious functional deficits and facial deformities, but lead to poor psychological outcomes, although prosthesis wearing can offer improvements in psychological well-being to some extent. The study aimed to comprehensively evaluate the psychological symptoms and analyze related factors in anophthalmic patients wearing ocular prosthesis.Total of 150 anophthalmic patients and 120 control subjects were included in this cross-sectional study. Baseline characteristics survey and the symptom checklist-90 scale were completed by all participants to assess the psychological symptoms and analyze their related factors by multivariate analysis.The anophthalmic patients exhibited the increased levels of somatization, depression, anxiety, and hostility compared with control subjects. The most prominent symptom was hostility with the median score of 1.20. Female patients presented with higher somatization, depression, anxiety, and hostility. Marital status single was positively associated with depression, anxiety, and hostility symptoms. Lower education and cause of enucleation were related to higher levels of hostility.Anophthalmic patients wearing ocular prosthesis presented with more prominent hostility and somatization besides its higher depression and anxiety symptoms. The findings suggest that for female single anophthalmic patients with low education, especially caused by trauma, timely psychological assessment and intervention should be provided to avoid undesirable consequences.

Objectives: To test the hypothesis that the prevalence of joint hypermobility is greater in children with irritable bowel syndrome and functional abdominal pain than in healthy control children and is related to gastrointestinal symptoms and psychosocial distress (anxiety, depression, and somatization)., Study Design: Children (irritable bowel syndrome, n = 109; functional abdominal pain, n = 31; healthy control, n = 69), 7-12 years of age completed prospective 2-week pain and stooling diaries and child- and parent-reported measures of anxiety, depression, and somatization. Joint hypermobility was determined using Beighton criteria (score of ≥4 or 6). We also examined possible relationships between Beighton score, race, body mass index, gastrointestinal symptoms, and psychosocial distress., Results: Beighton scores were similar between groups, as was the proportion with joint hypermobility. Scores were higher in girls (3.1 ± 2.4) than boys (2.3 ± 1.8; P = .004) and decreased with age (P < .001; r = -0.25). Race and body mass index did not impact joint hypermobility prevalence. Beighton scores were not related to abdominal pain or stooling characteristics. Participants with a score of ≥4 and ≥6 had greater somatization and depression by child report (P = .017 and P = .048, respectively). No association was seen for anxiety. There was no significant association between joint hypermobility and psychosocial distress measures per parent report., Conclusions: Contrary to the adult literature, the prevalence of joint hypermobility does not differ among children with irritable bowel syndrome, functional abdominal pain, or healthy control children. The presence or severity of joint hypermobility does not correlate with abdominal pain or stooling characteristics. Somatization and depression by child report appear to have a relationship with joint hypermobility., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: The psychological contribution to functional neurological and somatic symptom disorders is a major topic in current medical debate., Objective: For an understanding of the processes leading to functional somatic symptoms, it is paramount to explore their relationship with stress and life events and to elucidate the contribution of cultural factors., Methods: A total of 937 case records of civilian and military patients with functional somatic disorders treated in London during World War 1 were analysed. Group differences in symptom profiles and contemporaneous diagnoses were tested with χ2 tests., Results: Paralyses and speech disturbances were significantly more common in soldiers (43.3 and 17.2% of cases) than in civilian male (28.1 and 6.5%) and female patients (32.4 and 7.5%), whereas female patients had the highest rates of pain (48.6%) and somatic symptoms (67%). Triggers were identified in around two-thirds of cases and included accidents, physical illness, and work stress, in addition to the combat experience of the soldier patients. The nature of the trigger influenced symptom expression, with acute (combat and noncombat) events being particularly prone to trigger loss of motor function. Symptom profiles showed a great deal of multi-morbidity and overlap, although some symptom clusters were more (motor and speech disturbance) or less common (pain and loss of energy) in soldiers than civilians. Triggering life events in civilians were similar to those reported by patients with somatic symptom disorders today, with an important role of physical factors. Patterns of multi-morbidity and symptom clusters also resembled those of modern cohorts., Conclusions: Analysis of historical records, illness trajectories, and treatments can enhance the understanding of the presentation, mechanisms, and course of functional neurological and related disorders and their consistency over time., (© 2020 The Author(s) Published by S. Karger AG, Basel.)

Objectives: 'Katakori', discomfort or dull pain around the neck and shoulder, is common in Japan. Somatizing tendency is important in the quality of daily living. This study aimed to examine the association between disability due to Katakori and high somatizing tendency. Methods: This internet study included 34,754 Japanese adults who reported Katakori in the past four weeks. Katakori was classified into four grades: 1) no Katakori, 2) Katakori without difficulty in activities for daily living (ADL), 3) Katakori with ADL difficulty but without absence from social activities, and 4) Katakori with absence from social activities. Somatizing tendency was assessed using the Somatic Symptom Scale-8 (SSS-8). The association between a very high (SSS-8 ≥ 16) somatizing tendency and Katakori grade was examined using logistic regression adjusting for age, sex, body mass index, marital status, smoking, regular exercise, low back pain, depression, and the number of chronic conditions. Results: Katakori grade was significantly associated with a very high somatizing tendency (Odds ratio (OR)= 5.36 [4.36-6.60] in grade 4 vs. 2, and OR= 2.57 [2.30-2.89] in grade 3 vs. 2). Conclusion: When treating severe Katakori with disability, somatizing tendency should be assessed to facilitate better management.

Insecure attachment is a predisposing risk factor for the development of functional neurological disorder (FND). There is limited research investigating connections between attachment styles, other predisposing vulnerabilities, and symptom severity in patients with motor FND. By using a within-group design with prospective data collection, the authors performed univariate tests followed by multivariate linear regressions to investigate neuropsychiatric factors associated with four attachment styles (secure, fearful, preoccupied, and dismissing) among 56 patients with motor FND (mean age=40.2 years [SD=13.0]; women, N=41; men, N=15). In univariate analyses, fearful attachment style was associated with self-reported adverse life event burden, alexithymia, dissociation, depression, anxiety, impaired stress coping skills, functional neurologic symptom severity, and marital status. In a multivariate stepwise linear regression analysis, childhood abuse, alexithymia, depression, and not being married independently predicted fearful attachment. In a post hoc analysis, childhood sexual and emotional abuse were each independently associated with fearful attachment tendencies. There were no independent predictors of secure, preoccupied, or dismissing attachment styles in this study population. Future studies with larger cohorts are needed to investigate nuanced relationships among predisposing vulnerabilities for the development of FND, as well as potential links between risk factors, functional neurologic symptom severity, and clinical outcomes.

Somatic symptom disorder (SSD) is a diagnosis that was introduced with publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013. It eliminated the diagnoses of somatisation disorder, undifferentiated somatoform disorder, hypochondriasis and pain disorder; most of the patients who previously received these diagnoses are now diagnosed in DSM-5 with SSD. The main feature of this disorder is a patient's concern with physical symptoms for which no biological cause is found. It requires psychiatric assessment to exclude comorbid psychiatric disease. Failure to recognise this disorder may lead the unwary physician or surgeon to embark on investigations or diagnostic procedures which may result in iatrogenic complications. It also poses a significant financial burden on the healthcare service. Patients with non-specific abdominal pain have a poor symptomatic prognosis with continuing use of medical services. Proven treatments include cognitive behavioural therapy, mindfulness therapy and pharmacological treatment using selective serotonin reuptake inhibitors or tricyclic antidepressants. The authors describe the case of a 31-year-old woman with an emotionally unstable personality disorder and comorbid disease presenting to the emergency department with a 3-week history of left-sided abdominal and leg pain. Despite a plethora of investigations, no organic cause for her pain was found. She was reviewed by the multidisciplinary team including surgeons, physicians, neurologists and psychiatrists. A diagnosis of somatoform symptom disorder was subsequently rendered. As patients with SSD will present to general practice and the emergency department rather than psychiatric settings, this case provides a cautionary reminder of furthering the need for appropriate recognition of this condition., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Functional somatic syndromes are frequent in general and specialized medicine practices. Several treatments can be useful. However, the treatment program is often hampered by patients' reluctance to acknowledge the diagnosis because of erroneous lay representations. Recent advances in cognitive science offer a new understanding of the pathophysiology of functional somatic disorders, making this diagnosis more acceptable for patients and caregivers. Simply explained with practical examples, the Bayesian model in particular provides some insights into the underlying cognitive mechanisms of functional somatic syndromes and their treatments. Advantages of this approach are twofold: it is consistent with current scientific knowledge and it can facilitate the physician-patient relationship., (Copyright © 2019 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Aim: The goal of this retrospective cohort study was to analyze the relationship between induced abortion and the incidence of depression, anxiety disorder, adjustment disorder, and somatoform disorder in Germany., Methods: Women who had undergone induced abortions for the first time in 281 gynecological practices in Germany between January 2007 and December 2016 were included (index date). Women with live births were matched (1:1) to those with induced abortion by age, index year, and physician. The main outcome of the study was the incidence of depression, anxiety disorder, adjustment disorder, and somatoform disorder as a function of induced abortion. Survival analyses and Cox regression models were used to investigate the association between induced abortion and psychiatric disorders., Results: This study included 17581 women who had had an induced abortion and 17581 women who had had a live birth. Within 10 years of the index date, 6.7% of the participants with induced abortions and 5.4% of those with live births were diagnosed with depression (log-rank p-value = 0.003). The respective figures were 3.4% and 2.7% for anxiety disorder (log-rank p-value = 0.255), 6.2% and 5.6% for adjustment disorder (log-rank p-value = 0.116), and 19.3% and 13.3% for somatoform disorder (log-rank p-value<0.001). Induced abortion was significantly associated with depression (hazard ratio [HR] = 1.34), adjustment disorder (HR = 1.45) and somatoform disorder (HR = 1.56), but not with anxiety disorder (HR = 1.17)., Conclusions: There was a positive association between induced abortion and several psychiatric disorders in Germany. Further analyses are recommended to assess how induced abortion can have such a negative impact on mental health., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Study Objective: We evaluate a sobering center as an alternate destination for acute intoxication. Our aims are to count patient visits that originated from emergency medical services (EMS) or the emergency department (ED) that then result in a secondary transfer from the sobering center to the ED, and to describe and categorize the clinical reasons for transfer to the ED., Methods: The San Francisco Sobering Center, a continuously nurse-staffed facility operating since 2003, provides short-term (6- to 8-hour) care for adults with acute alcohol intoxication. Paramedics use a county EMS protocol to triage low-risk intoxicated patients to the sobering center. A case review was performed on all visitors during 3 years who were secondarily transferred from the sobering center. Reason for transfer was categorized by clinical indication., Results: From July 2013 to June 2016, 11,596 visits (from 3,268 unduplicated adults) were documented. Of these, 4,045 (35%) were referred by EMS and 1,348 (12%) were referred from the ED. Other referring parties included the mobile van service, police, homeless service provider, self-referral, and others. Of the total visitors, 506 (4.4%; 95% confidence interval 4.0% to 4.8%) were secondarily transferred to an ED; 151 were referred by EMS and 62 by the ED. Clinical indications for ED transfer included pulse greater than 100 beats/min (26%), alcohol withdrawal (19%), pain (excluding chest pain) (19%), altered mental status (13%), and emesis (13%). Most clients had more than one clinical indication for transfer (median 2; range 1 to 5)., Conclusion: The San Francisco Sobering Center is an appropriate, safe EMS destination for patients with acute alcohol intoxication., (Copyright © 2019 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Background: In order to prevent health and social problems later in life, it is important to identify childhood conditions related to the development of somatic symptoms. This prospective study expands on previous research by investigating whether negative childhood conditions are related to somatization later in life, taking other risk factors into account. This study aims to investigate whether somatic symptoms of the participants' parents, poor family functioning, or negative life events during childhood result in somatic symptoms in early or late adolescence., Methods: The study population includes participants from the West Jutland Cohort Study who responded to the survey on their somatic symptoms at age 15 (n = 2963) and/or age 18 (n = 2341). The study also includes additional questionnaire information about the participants' poor family functioning, number of negative life events, and parental reports of somatic symptoms as well as register information about parental socioeconomic background. Generalized linear models for the binomial family were used and the results were presented as relative risks (RR) and risk differences (RD) with 95% confidence intervals (95%-CI)., Results: Experiencing poor family functioning at age 15 showed associations with somatic symptoms at age 15 (RR 1.75, 95%-CI, 1.43-2.14 and RD 18, 95%-CI, 11-25%) and 18 (RR 1.32, 95%-CI, 1.00-1.75 and RD 7, 95%-CI, 0.2-14%). The relative risks between poor family functioning and somatic symptoms were 2.5 for the boys at age 15 and 1.71 for the girls at age 18. Having experienced two or more negative life events up to the age of 15 was associated with reporting somatic symptoms at age 15 (RR 1.73, 95%-CI, 1.31-2.28 and RD 24, 95%-CI, 11-37%). No relative risks above 1.35 were found between parents reporting somatic symptoms and participants reporting somatic symptoms at ages 15 or 18., Conclusions: An increased awareness of the association between a poor social climate in the family and somatic symptoms may help professionals in health and educational systems prevent the development of such symptoms among adolescents.

Background: The positive association between adverse life events and somatoform disorders is a consistent observation. But no systematic studies have evaluated the relationship between health-related life events (HLEs) in patients with somatic symptom disorder (SSD)/somatoform disorders., Aim: To examine the nature and relationship of HLE in patients with SSD and to assess the correlates of HLE., Methods: A total of 50 adult patients with SSD and 50 matched healthy controls from a Neuropsychiatric hospital were recruited. Sociodemographic interview, scale for assessment of somatic symptoms (SASS), Patient Health Questionnaire-15 (PHQ-15) and a semi-structured interview schedule to gather information on HLE were used., Results: Patients in the SSD group had a significantly higher number of total HLE in general (4.72 ± 2.63, 3.36 ± 1.92; p = .004), major HLE (1.48 ± 1.45, 0.68 ± 0.94; p = .006), during their lifetime in comparison to controls. Infections, trauma, non-communicable diseases and reproductive system-related diseases were the more common types of HLE in SSD group., Conclusion: Our findings may implicate a role of major HLE of patients and HLE of their family members in the pathophysiology of SSD.

Studies of caregiving provided to HIV/AIDS orphans by sub-Saharan African grandparents have found that it has physical, financial, and emotional consequences. Our study extended this research by identifying and characterizing the symptoms experienced by Ugandan grandparent- caregivers, particularly as related to the caregiving role, loss and grief. Grounded theory methodology was used to conduct and analyze audio-recorded, semi-structured interviews with 32 grandparents. Findings revealed a cluster of biopsychosocial distress symptoms, especially anguish (driven by traumatic anxiety and disbelief), depression, and somatic symptoms that were linked primarily to psychological distress. The impact of cultural practices and beliefs on these symptoms was also identified. Results have implications for public health, research, and policy changes needed to alleviate symptoms of biopsychosocial distress among Uganda grandparent-caregivers.

Depression is a normally occurring, severe, repeated disorder associated to diminished role functioning and quality of life, medical morbidity, and mortality. But presentation of depression differs culture to culture. We aimed to see the proportion of depressed patients presented spontaneously with the somatic complaints at department of Psychiatry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. This descriptive, cross sectional study was conducted within the time period of June 2016 to December 2017 among the outdoor patients of the university. Purposive consecutive sampling was used to collect data from 105 depressed patients. The diagnosis was confirmed by the psychiatrist based on the DSM-5 criteria of depression. Data were collected through face to face interview with semi structured preformed pretested questionnaire. All data were entered into SPSS 16.0 software and were analyzed. The mean±SD age was 32.09±12.13 years, ranging from 18 to 70 years. Among the 105 respondents 36% of the depressive patients had complaints of somatic symptoms spontaneously. Headache (34.21%), weakness (2%), body ache (5%), hearing problem, heaviness of the body, restlessness, chest pain, palpitation, dizziness, vertigo, breathlessness, abdominal discomfort and burning sensation were the mentionable symptoms. Fear (11), anger (2), undue suspiciousness (2) & sexual dysfunction were the mentionable psychological symptoms. Due to multiple factors depressed patients can spontaneously present with somatic complaints, but after questioning on depression they can be diagnosed as depression. So, unexplained somatic symptoms should be attended and addressed properly in any stage of care.

Background: There is a lack of studies investigating the effectiveness of inpatient trauma-focused psychotherapy of complex post-traumatic stress disorder. The first aim of this retrospective investigation was to analyze the course of PTSD. Second, possible predictors of treatment response were investigated., Methods: 150 inpatients of Clinic St. Irmingard with complex PTSD following childhood physical and childhood sexual abuse were assessed regarding childhood abuse, PTSD symptomatology, mindfulness, dissociation and general psychopathology. Differences in pre and post scores were analyzed using regression analyses. A classification tree was used to identify predictors of response., Results: The significant reduction of PTSD symptoms corresponded to a large effect (d=1.8) and a reponse rate of 52% according to the reliable change index (p<0.05). Effect sizes for other symptoms were medium to large (0.5

The current study examined the role of personality traits on psychosomatic distress (PD) and tested the hypothesis that the association between perfectionism and PD would be moderated by self-compassion. One hundred and seventy-three community volunteers, of whom 24.9% were men, mean age 31.52 ± 13.29, reported online on the DS14, a measure of Type D personality, on the TCI-140, a measure of temperament and character, on the Frost multidimensional perfectionism scale, on the short form of the self-compassion scale and on the SOMS-7 for psychosomatic symptoms. We defined psychosomatic distress as the product of the symptom count and severity rating score of the SOMS-7. The hierarchical linear regression model that included all the personality variables as well as the interaction term between self-compassion and perfectionism accounted for 25% of the variance in PD. The interaction between perfectionism and self-compassion entered into the model in the last block was highly protective. High self-compassion moderated the effect of perfectionism on PD. Our finding correspond with the notion that personality can enhance PD but can also mitigate it. Protective personality traits, such as self-compassion, might be good targets for psychological intervention.

Problem: To investigate the associations between attachment quality, metacognition problems, and somatization., Methods: One thousand and seven adolescents between the ages of 14-17 were included in the study. They completed the DSM-V Level 2 Somatic Symptoms Scale, the Inventory of Parent and Peer Attachment (short version), the Metacognitions Questionnaire for Children (MCQ-C), and the Strengths and Difficulties Questionnaire. The Spearmen's rank-order correlation test and structural equation modeling were used to analyze the associations between the scales., Findings: Correlation coefficients and structural equation modeling indicated that attachment quality is significantly associated with somatic symptom severity, and MCQ-C scores play a partial mediator role in the relationship between attachment quality and somatization., Conclusion: Improving metacognitive skills in adolescents with low attachment quality may increase therapeutic success when addressing somatization., (© 2019 Wiley Periodicals, Inc.)

We report the case of multiple adverse reactions following HPV vaccination in Colombian adolescents in Carmen de Bolivar. In August 2012, the country introduced a school-based HPV immunization programme which successfully reached over 90% of the target population in the first year. In 2014, between May 29th and June 2nd,15 adolescent girls in one school presented adverse reactions after vaccination and were admitted to the local hospital. Soon, videos of girls fainting, twitching, and arriving unconscious at emergency rooms started to appear in national news media as well as on social media platforms such as YouTube. The viral spread of these videos and disturbing images were followed by the viral spread of symptoms, with over 600 cases reported across Colombia. Thorough epidemiological investigation by Colombian health authorities found no organic association between the teenagers' symptoms and the HPV vaccine, concluding this was a case of mass psychogenic reaction to vaccination. Scientific evidence did not appease the anxious public whose confidence in HPV immunization dropped dramatically. By 2016, HPV vaccine uptake among eligible girls declined to 14% for the first dose and 5% for the complete course, down from 98% and 88%, respectively, in 2012. We document this case and discuss the role of news and social media, particularly YouTube, as a driver of contagious psychogenic reactions. We also discuss the role of health authorities and government, and the importance of acting rapidly and appropriately to contain the spread of such symptoms and maintain public confidence in vaccines.

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.

In the title of this text, by somatic disorders we mean those physical illnesses clearly related to a non-psychiatric medical field, frequently termed psychosomatic illnesses and somatoform disorders. For forty years, a trend of thought has focused with pertinence on the psychological peculiarities in patients with severe somatic diseases. Moreover, causality was often supposed in the regularly mentioned association between personality features and somatoform disorders. However, the revival of the study of the earlier field of relationships between mind and body by Briquet, Charcot, Janet and Freud in his first period has led to the reassessment of the meaning of these observations. This reexamination is marked out by several assertions. Two of them work as preliminaries to argumentation: 1. existential wounds may produce long-lasting personality alterations; 2. existential wounds may produce somatoform disorders. These phenomena have been rediscovered over the last few years among assaulted subjects as well as war veterans in whom a frequent occurrence of somatizations has been, in addition, closely linked to the incidence of behavior or personality disorders. Two theses then emerge: 1. somatic diseases may produce long-lasting personality alterations; 2. until now no premorbid personality univocally predisposing to somatic diseases could be found. Indeed, during the 1980s a growing body of negative results coming from retrospective and prospective studies as well as anatomical comparisons have accumulated upon the potential role of certain personality factors in the incidence of somatic illnesses. This dialectic leads to the connection of two corollary assertions: 1. "pensée opératoire" and "alexithymia" in patients with somatic diseases may represent only an effect of the announcement or chronicity of the organic disease; 2. the old "dissociative hysteria" with somatic manifestations finds its substratum in existential wounds and not in pre-trauma personality. Indeed, on the one hand, recent publications do not allow the assertion to be confirmed that alexithymia and "pensée opératoire" predispose to somatizations. On the other hand, personality disorders in subjects with "dissociative hysteria" as well as their somatoform symptoms appear mainly as an effect of an existential wound and express in fact the Janetian concept of "a drop in Psychological Tension". Then, in spite of their differences, conversion and psychosomatic symptoms share the property of being a primitive response to existential wounds in which the subject cannot produce any appropriate psychic or behavioral response to his distress. Light is shed on these phenomena when put alongside the field of "fixed ideas" thought of by Pierre Janet as the recourse to archaic automatisms. Indeed, the experience which contradicts the vision of existence provokes an "unspeakable terror". It is mentally unrepresented or represented in too slight a way. In such cases, no previous personality prevails, but the resulting personality often appears modified, including when the breakdown of vision of the existence results from the diagnosis of an illness or its protracted course., (Copyright © 2018 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Background: Irritable bowel syndrome (IBS) is common and is characterised by recurrent abdominal pain, which is a major contributor to healthcare seeking. The neurobiological basis of this pain is incompletely understood. Conditioned pain modulation is a neuromodulatory mechanism through which the brain inhibits the nociceptive afferent barrage through the descending pathways. Reduced conditioned pain modulation has been implicated in the pathophysiology of IBS, although to date only in studies with relatively small sample sizes., Aim: To clarify the relationship between conditioned pain modulation and IBS by undertaking a systemic review and meta-analysis METHODS: A systematic review of MEDLINE and Web of Science databases was searched (up to 10 May 2018). We included studies examining conditioned pain modulation in adults with IBS and healthy subjects. Data were pooled for meta-analysis to calculate the odds ratio and effect size of abnormal conditioned pain modulation in IBS, with 95% confidence intervals (CI)., Results: The search strategy identified 645 studies, of which 13 were relevant and 12 met the inclusion criteria. Conditioned pain modulation in IBS patients vs healthy subjects was significantly reduced, odds ratio 4.84 (95% CI: 2.19-10.71, P < 0.0001), Hedges' g effect size of 0.85 (95% CI: 0.42-1.28, P < 0.001). There was significant heterogeneity in effect sizes (Q-test χ 2 = 52, P < 0.001, I 2 = 78.8%) in the absence of publication bias., Conclusion: Conditioned pain modulation is significantly diminished in patients with IBS vs healthy controls. These data suggest that abnormal descending pathways may play an important pathophysiological role in IBS, which could represent an investigation and a therapeutic target in IBS., (© 2018 John Wiley & Sons Ltd.)

Objective: Dental students have been identified as a group with high risks of developing both temporomandibular disorders (TMD) and psychosocial conditions. Our primary aim was to evaluate the cross-sectional prevalence of TMD diagnoses, as defined in the Diagnostic Criteria (DC)/TMD, among dental students. The secondary aim was to evaluate the prevalence and association of behavioural and psychosocial factors in relation to DC/TMD diagnoses., Materials and Methods: The study was conducted among undergraduate dental students during the second semester of their third year at the Department of Odontology, Medical Faculty, Umeå University, Sweden. Three consecutive cohorts were recruited during August in 2013, 2014, 2015. In total, 54 students were included and examined according the DC/TMD procedure., Results and Conclusions: The prevalence of any DC/TMD diagnosis was 30%. The most prevalent TMD diagnosis was myalgia. Individuals with a TMD-pain diagnosis (i.e. myalgia or arthralgia) reported significantly higher pain intensity levels according to the Graded Chronic Pain Scale (GCPS) as compared to individuals without TMD-pain (Fisher's exact test p < .001, two-sided). In addition, individuals with any TMD scored significantly higher jaw functional limitations according to the Jaw Functional Limitation Scale 20 (JFLS-20, p < .001) and oral parafunctions according to the Oral Behavior Checklist (OBC, p = .005) as compared to individuals without TMD. The psychosocial factors evaluated did not differ between individual with or without a TMD diagnosis. The majority of the dental students reported symptoms that are already identified as risk factors for developing TMD and pain conditions. However, longitudinal data are needed to evaluate how this evolves over time.

Hematidrosis is an eccrine sweat disorder characterized by one or more episodes of spontaneous, bloody sweating from non-traumatized skin. The author carried out a systematic review of all cases of hematidrosis reported in PubMed over the past 20 years. A total of 25 cases were reviewed; 21 were women (84%), the median age was 13 years (range 9-72), and the majority (62%) were from Asia, mainly India. Hematidrosis was located on the face-including the forehead (40%), eyes (40%), and ears (36%)-in 96% of the cases and on the umbilicus in 24% and the palms in 20%. Prodromal symptoms were reported by almost 30% of the patients. Possible triggering factors were identified in 56% of the cases; most of these (86%) were stress factors within families (conflicts or abuse) or at school. In two cases, platelet dysfunction and epilepsy were suspected as culprits. Nine patients had a psychiatric diagnosis associated with hematidrosis. The outcome was favorable in most of the cases with medical treatment (e.g., beta-blocker, anxiolytics) and psychological support. The number of cases has increased in recent years. Hematidrosis appears to be a somatization disorder that mainly affects children from developing countries. Its physiopathology remains largely unknown. It deserves better recognition because it is usually a temporary condition when managed properly.

Objective: Approximately 30% of individuals who initially present with stroke are found to be stroke mimics (SM), with functional/psychological SM (FSM) accounting for up to 6.4% of all stroke presentations. Middle Eastern countries may have higher rates of somatization of emotional distress. The aim of this study was to evaluate the incidence and characteristics of FSM at a large general hospital in the Middle East., Methods: All patients presenting with an initial diagnosis of stroke from June 2015 to September 2016 were eligible for this study. Clinical and sociodemographic data were obtained from the hospital's stroke database. All SM and strokes were diagnosed by Joint Commission International-certified stroke program neurologists. SM was defined as any discharge diagnosis (other than acute stroke) for symptoms that prompted initial admission for suspected stroke. FSM were compared with medical stroke mimics (MSM) and strokes (ischemic, hemorrhagic, and transient ischemic attacks)., Results: A total of 1961 patients were identified; 161 FSM (8.2%), 390 MSM (19.9%), and 1410 strokes (71.9%) (985 ischemic strokes, 196 transient ischemic attacks, 229 intracerebral hemorrhages). Admission with FSM was related to patients' nationality, with the highest frequency in Arabic (15.6%) and African (16.8%) patients. FSM patients were younger, more often female, and had fewer cardiovascular risk factors except for smoking compared with the strokes. FSM patients presented with more left-sided weakness and had more magnetic resonance imagings than the stroke and MSM groups. A total of 9.9% of FSM patients received thrombolysis versus only 0.5% of the MSM and 16.4% of ischemic strokes., Conclusions: FSM frequencies varied by nationality, with Arab and African nationals being twice as prevalent. Stress, vulnerable status as expats, sociopolitical instability, and exposure to trauma are proposed as potential factors contributing to FSM.

Objectives: Only a minority of patients referred to specialists with sinonasal symptoms have clear evidence of chronic rhinosinusitis (CRS). This study aims to estimate the prevalence of and associations between (i) general illness factors (fatigue, autonomic dysfunction) and (ii) psychological factors (anxiety, depression, somatisation, personality traits) in patients presenting with sinonasal symptoms., Design: The following validated questionnaires were administered to patients: the Sino-Nasal Outcome Test-22 (SNOT-22) identifying symptom burden, Composite Autonomic Symptom Score-31 (COMPASS-31) measuring autonomic function, Chalder Fatigue Questionnaire, Patient Health Questionnaire-15 (PHQ-15) addressing somatisation symptoms, Hospital Anxiety and Depression Scale (HADS), and the International Personality Item Pool-50 (IPIP-50). Comparisons were made with normative and general population data, and relationships were analysed using nonparametric correlation., Setting: Secondary care ENT outpatients., Participants: Adults referred with chronic sinonasal symptoms., Main Outcome Measures: SNOT-22, COMPASS-31, Chalder, PHQ-15, HADS, and IPIP-50 questionnaire scores., Results: Sixty-one patients were included. There was a high prevalence of all general and psychological factors assessed compared with controls. Total SNOT-22 scores showed significant correlation with Chalder fatigue scores, total autonomic dysfunction score, anxiety, depression, somatisation tendencies and the emotionally unstable personality trait. Emotional instability and psychological dysfunction correlated significantly with sleep and psychological subscales of SNOT-22 but not the rhinological or ear/facial subscales., Conclusion: Patients with sinonasal symptoms demonstrate high prevalence and complex associations of general illness factors, psychological distress and certain personality traits. The SNOT-22 is a valuable tool, but its utility is limited by correlations with these confounding factors (eg psychological factors) that may exaggerate the total score. The use of the SNOT-22 component subscales is likely to provide more clinically meaningful and discriminant information., (© 2017 John Wiley & Sons Ltd.)

Importance: From late 2016 through August 2017, US government personnel serving on diplomatic assignment in Havana, Cuba, reported neurological symptoms associated with exposure to auditory and sensory phenomena., Objective: To describe the neurological manifestations that followed exposure to an unknown energy source associated with auditory and sensory phenomena., Design, Setting, and Participants: Preliminary results from a retrospective case series of US government personnel in Havana, Cuba. Following reported exposure to auditory and sensory phenomena in their homes or hotel rooms, the individuals reported a similar constellation of neurological symptoms resembling brain injury. These individuals were referred to an academic brain injury center for multidisciplinary evaluation and treatment., Exposures: Report of experiencing audible and sensory phenomena emanating from a distinct direction (directional phenomena) associated with an undetermined source, while serving on US government assignments in Havana, Cuba, since 2016., Main Outcomes and Measures: Descriptions of the exposures and symptoms were obtained from medical record review of multidisciplinary clinical interviews and examinations. Additional objective assessments included clinical tests of vestibular (dynamic and static balance, vestibulo-ocular reflex testing, caloric testing), oculomotor (measurement of convergence, saccadic, and smooth pursuit eye movements), cognitive (comprehensive neuropsychological battery), and audiometric (pure tone and speech audiometry) functioning. Neuroimaging was also obtained., Results: Of 24 individuals with suspected exposure identified by the US Department of State, 21 completed multidisciplinary evaluation an average of 203 days after exposure. Persistent symptoms (>3 months after exposure) were reported by these individuals including cognitive (n = 17, 81%), balance (n = 15, 71%), visual (n = 18, 86%), and auditory (n = 15, 68%) dysfunction, sleep impairment (n = 18, 86%), and headaches (n = 16, 76%). Objective findings included cognitive (n = 16, 76%), vestibular (n = 17, 81%), and oculomotor (n = 15, 71%) abnormalities. Moderate to severe sensorineural hearing loss was identified in 3 individuals. Pharmacologic intervention was required for persistent sleep dysfunction (n = 15, 71%) and headache (n = 12, 57%). Fourteen individuals (67%) were held from work at the time of multidisciplinary evaluation. Of those, 7 began graduated return to work with restrictions in place, home exercise programs, and higher-level work-focused cognitive rehabilitation., Conclusions and Relevance: In this preliminary report of a retrospective case series, persistent cognitive, vestibular, and oculomotor dysfunction, as well as sleep impairment and headaches, were observed among US government personnel in Havana, Cuba, associated with reports of directional audible and/or sensory phenomena of unclear origin. These individuals appeared to have sustained injury to widespread brain networks without an associated history of head trauma.

Background: Evidence points toward shared characteristics between female survivors of sexual abuse and women with dyspareunia. This study explored, for the first time, similarities and differences between women who were exposed to sexual abuse to those with dyspareunia, in order to examine whether insecure attachment styles and high somatization level are associated with trauma among women with dyspareunia., Methods: Attachment styles were explored using the Experience in Close Relationships Scale to reflect participants' levels of anxiety and avoidance. Somatization was assessed using the Brief Symptom Inventory focusing on the frequency of painful and non-painful bodily complaints. Trauma was categorized into three levels: sexual trauma, nonsexual trauma, and no trauma., Results: Sexually abused (SA) women (n = 21) compared to women with dyspareunia (dys) (n = 44) exhibited insecure attachment styles, as expressed by high levels of avoidance (SA 4.10 ± 0.99 vs. dys 3.08 ± 1.04, t (61)  = 2.66, p = .01) and anxiety (SA 4.29 ± 1.22 vs. dys 3.49 ± 1.04, t (61)  = 3.61, p = .001), and higher somatization (21.00 ± 8.25 vs. 13.07 ± 7.57, t (59)  = 3.63, p = .001). Attachment and somatization level did not differ significantly between women with dyspareunia without trauma to those with nonsexual trauma., Conclusions: Our findings emphasized the unique role of sexual trauma as a contributing factor to the augmentation of perceived bodily symptoms and to insecure attachment style. This illuminates the importance of disclosing previous sexual abuse history among women with dyspareunia.

The custom of Couvade and Couvade syndrome is a phenomenon observed since ancient times. Whether it constitutes a disease entity or it should be considered a ritual or custom remains a matter of debate. Historical transcripts shed light into the distinct origins and inclinations of couvade behaviors, some of them having religious inclinations. Currently, there are several views on this phenomenon including medical, psychoanalytic, and psychological. Some explain this syndrome as part of men's preparation and participation in pregnancy and post-partum period. Others see it as men rivalling with women for procreative ability or ability to carry an unborn child in the womb. There are a set of criteria that can be used in diagnosing Couvade syndrome, which may be helpful in standardizing clinical detection and management of patients. It is important to embed this syndrome in contemporary society to understand the complexity of male involvement in pregnancy and fatherhood, which at the end may not be a disease. In this review, the authors will guide the reader through history, possible etiologies, and clinical aspects of Couvade syndrome., (© 2018 S. Karger AG, Basel.)

Objectives: To examine long-term outcomes of self-reported physical and mental health among Post-9/11 Veterans stratified by traumatic brain injury (TBI) severity, we hypothesized that more severe TBI would be associated with significantly poorer outcomes., Methods: A prospective longitudinal survey of physical and mental health status was conducted with a national cohort of Post-9/11 Veterans. We then used generalized linear models (GLM) to assess the unique contribution of TBI severity on long-term outcomes after controlling for socio-demographic characteristics, comorbidity phenotypes, and deployment experiences., Results: TBI of any severity was associated with significantly poorer outcomes relative to the No TBI group. However, the manifestation of these outcomes identified in our study differed meaningfully by TBI severity level., Conclusions: Veterans with any TBI exposure experience poorer long-term outcomes than those with no TBI even when covariates are considered. In particular, measures of somatization, PTSD symptom distress, and depression indicate pervasive and long-term health concerns among individuals with TBI. Additional research is required to fully explicate what appear to be complex relationships among TBI severity, physical and mental well-being, combat exposures, and socioeconomic resources in this population.

Gender-specific Differences in the Degree of Burden on Children and Adolescents Taken into Custody Children and adolescents who were taken into care are a high-risk group for mental disorders such as externalizing problems or conduct disorders. 95 children and adolescents who were taken into care were tested with the Screening Child Trauma Questionnaire (CTQ) and the Massachusetts Youth Screening Instrument 2 (MAYSI-2). In a large proportion of those children and adolescents emotional and physical neglect and abuse was identified. There were sex differences in suicidal thoughts, somatoform disorders, and emotional abuse. The knowledge of mental disorders as well as the gender-specific characteristics is important for specialists of inhospital institutions, in order to optimize their quality of care.

Psychogenic nonepileptic seizures (PNES) are the most common type of functional neurological symptom disorders and are frequently diagnosed in tertiary care epilepsy monitoring units. These are associated with significant decline in social functioning and quality of life. The majority of patients with PNES are women, outnumbering men by a ratio of 3:1. Female sex preponderance occurs after puberty and usually before the age of 55 years. Many of the psychiatric risk factors in PNES (depression, anxiety, history of traumatic experiences, other somatic symptom disorders) are more common in women and may partially account for the difference in sex prevalence. Neurobiological and neurohumoral mechanisms may also play a role, but our understanding is limited at this point. In this review, we present information on epidemiology and risk factors, neurobiological and psychological mechanisms, clinical approach to diagnosis, evidence-based treatment, and long-term outcomes. We highlight findings related to differences between women and men in PNES. Most of these data are not decisive and require further corroboration. While the disorder may be more frequently suspected in women, all patients with suspected PNES deserve an objective and thorough investigation of their symptoms. Early and accurate identification of this disorder should be a priority, especially as evidence-based treatments, which may lead to improved outcomes, are increasingly available., Competing Interests: Conflict of Interest: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

The paper reviews and summarizes the history and the development of somatosensory amplification, a construct that plays a substantial role in symptom reports. Although the association with negative affect has been supported by empirical findings, another key elements of the original concept (i.e. body hypervigilance and the tendency of focusing on mild body sensations) have never been appropriately addressed. Recent findings indicate that somatosensory amplification is connected with phenomena that do not necessarily include symptoms (e.g. modern health worries, or expectations of symptoms and medication side effects), and also with the perception of external threats. In conclusion, somatosensory amplification appears to refer to the intensification of perceived external and internal threats to the integrity of the body ("somatic threat amplification") rather than amplification of perceived or actual bodily events only. Practical implications of this new approach are also discussed., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Veterans with purely physical disorders, such as ankle-foot neuromusculoskeletal disorders, are often neglected in psychological assessments because mental health evaluations are usually focused on those with a psychological disturbance or with a high percentage of injury. The purpose of this study was to evaluate the psychological condition of veterans with ankle-foot neuromusculoskeletal disorders., Methods: A cross-sectional study was performed between 2014 and 2016 on veterans with war-related ankle-foot injuries living in two provinces of Iran. An information form for demographic data and injury-related factors was used. Additionally, the previously validated Persian version of the Symptom Checklist-90-Revision (SCL-90-R) questionnaire was used for data collection., Results: The respondents were 215 male veterans with a mean age of 51.7 ± 7.5 years. The most common mental health problems were observed for the somatization (24.7%), obsessions-compulsions (14.4%), and anxiety (12.6%). Based on the Global Severity Index (GSI), 48.6% of individuals had a possible psychiatric/psychological illness. According to the multivariate regression analysis, GSI scores were significantly higher among veterans who were older than 27 years at the time of injury (P = 0.005), had an associated injury (P = 0.002), and had a history of hospitalization within the past 12 months for reasons other than their injury (P = 0.035)., Conclusions: Approximately half of the combat veterans with ankle-foot neuromusculoskeletal disorders likely had psychological problems. The evaluation of the patterns and predicting factors of psychological conditions may inform strategic planning efforts and decision-making, which, in turn, may provide a better quality of life for veterans. Further studies that utilize longitudinal designs are needed to evaluate and compare the psychological status of different groups of veterans and other groups in the general population.

Vaccines against human papilloma virus (HPV) have been demonstrated to be very effective to prevent infection-related neoplasms. However, several reports describing heterogeneous post-vaccination phenomena have been published in last few years. The spectrum of these disorders includes both immune-mediated neurological diseases and neuropsychiatric functional disorders. Some researchers speculated about a genetic predisposition, but others hypothesized a role of adjuvants, including some metals and, particularly, aluminum. Here, we tested sixteen young girls developing somatoform and neurocognitive syndromes after the HPV immunization, through MELISA® test, detecting cell-mediated hypersensitivity to several metals. We found no association between these neurocognitive disorders and the results provided by this test; importantly, no patients showed hypersensitivity to aluminum, which is the inorganic adjuvant included in HPV vaccines. Thus, if aluminum played a role in the pathophysiology of musculoskeletal and neurocognitive disturbances occurring in some young girls after HPV immunization, that should recognize other mechanisms than the activation of aluminum-specific lymphocytes., (Copyright © 2017. Published by Elsevier Ltd.)

The aim of this study was to compare anorexia nervosa (AN) patients and functional motor symptoms (FMS) patients by assessing their variability in demographic and clinical characteristics, risk factors, precipitators, and family history. The authors assessed levels of depression and anxiety, alexithymia, dissociation, body awareness, self-objectification, and interoception in the two groups, using 20 healthy controls (HCs) as a control group for psychometric assessment and for interoception. Unexpectedly, no differences in the three groups were observed for the measures related to awareness of physical state, including body awareness, self-objectification, and interoceptive ability via the heartbeat task. However, the AN and FMS groups were not different from each other but were different from the HC group with regard to anxiety, depression, alexithymia, and dissociation. In light of the similarities found, these data support the hypothesis of a common etiology involving emotional dysfunction in both disorders. These findings suggest that AN and FMS may be disorders belonging to the same spectrum (where emotional dysregulation is a key feature) and that there exist potential opportunities for collaborative, integrated investigations of etiology, diagnosis, and management of these disorders.

Background and Objective: Recent reports of outbreaks of lipoatrophia semicircularis (LS) in various countries have generated discussion regarding the potential role of the environmental characteristics of office workplaces in new buildings. The objective of this study was to investigate a suspected outbreak of LS among children in a public school in Barcelona, which generated tremendous alarm., Methods: We performed an epidemiological assessment including descriptive and prevalence analyses, and an environmental investigation followed by a psychiatric assessment according to Small's criteria. We compared the prevalence of LS and its 95% confidence interval between children and staff attending the day-care centre under study and other centres., Results: Among 86 children attending a day-care centre we detected 11 confirmed and 2 possible cases of LS (15.1%) while among 41 children attending other day-care centres we identified 8 cases and 4 possible cases (29.3%) (P=.10). Among 12 day-care staff, we detected 8 cases of LS (66.7%) while among 19 women working different jobs we identified 14 with the same condition as the staff (73.7%) (P=.98). All lesions were finally classified as indentations with different locations. The environmental evaluation didn't identify any exposure factors with a significant role in the onset of the outbreak. The outbreak shared 13 of Small's 16 criteria regarding epidemic somatoform disorder ("mass hysteria")., Conclusion: The presence of indentations can be considered a normal variant in the lower extremities of children. The characteristic development of the process leads us to the conclusion that this outbreak was an epidemic somatoform disorder., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)

Background: Lung cancer is a serious threat to human health and its morbidity and mortality in recent years has always been ranked first in the country. Lung cancer patients are often associated with anxiety, depression and other emotional problems, and anxiety, depression and other emotional problems will further lead to a series of somatic symptoms. At present, we lack the clinical understanding of somatization symptoms in patients with lung cancer and related clinical studies are not too much. This research is to study the features of clinical manifestation of lung cancer patients with somatization symptoms and correlative analysis between anxiety, depression and somatization symptoms in medical oncology department of general hospital., Methods: Lung cancer patients who met somatization symptoms diagnostic standard were assessed with the self-constructed somatic symptoms investigation questionnaire, the Chinese version of the Patient Health Questionnaire-15 (PHQ-15) and anxiety and depression were recorded by the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD). The detection rate of the anxiety, depression and the number of patients with different severity somatization symptoms were calculated, the relationship between the PHQ-15 scores and anxiety and/or depression and the distribution of the different frequency somatization symptoms were analyzed., Results: There were 43 patients with anxiety and/or depression in the 50 lung cancer patients with somatization symptoms. Prevalence rates of anxiety, depression and anxiety combined with depression were 10%, 10% and 66% respectively. The more severity the somatization symptoms are, the higher detection rates of anxiety combined with depression are. Significant positive correlations were observed between PHQ-15 scores, PHQ-15 positive symptom numbers and HAMA scores (r=0.752, P<0.001; r=0.710, P<0.001), HAMD scores (r=0.648, P<0.001; r=0.618, P<0.001). The most common somatization symptoms were fatigue (96%), weakness (88%), sleep disturbance (84%), dizziness (82%), and pain in extremities (80%). There was no significant statistical difference in somatization symptoms between lung cancer patients with different gender (P>0.05)., Conclusions: Symptoms of anxiety or depression were very common in lung cancer patients with somatization symptoms and there was a close relationship between anxiety, depression, and somatization symptoms. The most common symptoms of these patients were nonspecific generalized symptoms.
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Background: Children born of war are a common phenomenon of conflict. In the aftermath of World War II, more than 200,000 German occupation children (GOC) were fathered by occupation soldiers and born to local women. GOC often grew up under difficult conditions and showed high prevalence rates of mental disorders even decades later., Methods: Experiences of childhood maltreatment and their association with Posttraumatic Stress Disorder (PTSD), depression, and somatization in GOC (N = 146) are investigated and compared with a representative birth-cohort-matched sample (BCMS) from the German general population (N = 920)., Results: Outcomes show significantly higher prevalence rates of emotional abuse/neglect, physical, and sexual abuse in GOC compared to BCMS. All five subtypes of childhood maltreatment increase the risk of PTSD and somatoform syndrome; depressive syndromes are associated with emotional abuse/neglect and physical abuse. GOC were at high risk of childhood maltreatment., Conclusions: Findings underline the complex, long-term impact of developmental conditions and childhood maltreatment on mental disorders even decades later.

Medically unexplained symptoms (MUS) are extremely common in general practice as in all medical specialties, but their designation is not unambiguous and the approaches to take care of the patients differ from conventional therapeutic approaches. The difficulty is not to confirm the diagnosis, which is rapidly obvious with some experience, but to establish a genuinely human therapeutic relationship, without any technical help, which pushes the doctor to the edge of his empathy and communication skills. The discomfort or even distress regularly encountered by physicians in front of a patient with MUS shows that the foundations of the doctor-patient relationship under uncertainty are poorly mastered. Patients with MUS are regularly abused by the doctors, who unwittingly participate in the maintenance of their symptoms and even freeze them, leading to disastrous psychosocial and economic consequences. Yet the doctor-patient relationship is the key to their recovery or, at least, their improvement. The means of a successful patient-centered relationship are not always intuitive but can be learned. It is therefore essential to include SMI in medical school curricula and post-graduate medical education. Finally, if the management of early MUS mainly concerns the family medicine, that of severe MUS, including some fibromyalgia and chronic fatigue syndromes, falls within the scope of the internist doctor, who should be able to deliver a comprehensive care in partnership with the general practitioner and possibly a psychiatrist., (Copyright © 2016 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Functional Dyspepsia-Post-prandial Distress Syndrome (FD-PDS) was associated with mood-related increases in resting activity and lowered activation threshold in the somatosensory cortex (SSC), insula and perigenual anterior cingulate cortex(pgACC) in functional imaging studies. The underlying cortical neurochemical changes are unknown. We performed proton Magnetic Resonance Spectroscopy (1H-MRS) on 17 consecutive tertiary clinic-recruited psychotropic-naïve Rome III FD-PDS female and 17 age-sex matched healthy controls. Voxels were placed on bilateral pgACC, left insula and SSC. Water-suppressed spectra were acquired using PRESS with short echo time (TE) (T = 24 ms) to separately quantify glutamate (Glu) and glutamine (Gln). Main outcome measure was regional Glu/Cr + PCr. Severity of depression, anxiety, somatization, and dyspepsia were also assessed. We found significantly increased SSC Glu/Cr + PCr in FD-PDS subjects compared to controls. SSC Glu/Cr + PCr correlated significantly with postprandial distress chronicity, dyspeptic symptoms severity and anxiety. The SSC Glu/Cr + PCr - dyspepsia correlations became insignificant after controlling for anxiety but were independent of depression. Gln/Glu ratio, which indicates glial Glu cycling failure, was unchanged. No between-group differences were noted in other regional metabolite concentrations. Our findings suggested enhanced SSC glutamate transmission in FD-PDS that was linked to post-prandial distress chronicity and severity and anxiety.

Environmental medical syndromes comprise sick building syndrome (SBS), multiple chemical sensitivity (MCS)/idiopathic environmental intolerances (IEI), electromagnetic hypersensitivity, chronic fatigue syndrome (CFS), burnout, fibromyalgia, and the candida syndrome. There is also some overlap described in the literature. There is still no established knowledge of etiology, pathology, pathophysiology, diagnostics, therapy, prevention and prognosis. These syndromes are thought to result from a complex interaction of physical, chemical and/or (micro)biological environmental stresses, individual dispositions, psychological influencing factors, perceptual and processing processes, variants of somatization disorders, culturally or socially caused distress, or simply iatrogenic causation. Examination and treatment methods must be developed or existing ones scientifically validated. However, all uncertainties in the assessment of these syndromes do not absolve the physician from taking patients seriously and helping them as best as possible.