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Introduction: According to ICD-11, personality disorders (PDs) are defined by the severity of self and interpersonal dysfunction in terms of personality functioning (PF) and an optional assessment of specific maladaptive personality trait expressions. Also, somatoform disorders are replaced by somatic symptom disorder (SSD). This study examines associations using the novel diagnostic criteria of SSD in an unselected primary care sample, PF, and maladaptive traits in patients with and without SSD. Methods: An anonymized cross-sectional study was conducted. A questionnaire including SSD-12 (Somatic Symptom Disorder B Criteria Scale-12) and PHQ-15 (Patient Health Questionnaire-15), LPFS-BF 2.0 (Level of Personality Functioning Scale – Brief Form) and PID-5BF+M (Modified Personality Inventory for DSM-5 – Brief Form Plus) was used. A bifactor (S-1) model was calculated with PF (reference for general factor) and personality traits (specific factors) to estimate associations between PF, specific maladaptive personality traits, and SSD. Differences in personality scales between SSD and non-SSD patients were calculated with the Mann-Whitney U test. Results: A total of 624 patients in six general practices participated (mean age 47 years; 60.4% female). SSD-12 and PHQ-15, respectively, showed significant associations with PF (γ = 0.51; γ = 0.48; p < 0.001), negative affectivity (γ = 0.50; γ = 0.38, p < 0.001) and psychoticism (γ = 0.29; γ = 0.28; p < 0.010). Besides, SSD-12 was significantly associated with disinhibition (γ = −0.38; p < 0.010) and anankastia (γ = −0.16; p < 0.010). Patients with SSD showed significantly impaired PF and maladaptive traits in all scales (p < 0.001). Conclusion: Impaired PF explains moderate to large amounts of the SSD symptoms and maladaptive personality traits negative affectivity, psychoticism, disinhibition, and anankastia show specific associations beyond PF. An in-depth understanding of these relations might be helpful to improve doctor-patient communication and treatment in SSD. [ABSTRACT FROM AUTHOR]

Childhood maltreatment (CM) has been demonstrated to be associated with changes in resting-state functional connectivity of the default-mode network (DMN) across various mental disorders. Growing evidence regarding severity of CM is available but transdiagnostic research considering the role of both severity and duration of CM for DMN connectivity at rest is still scarce. We recruited a sample of participants with varying levels of CM suffering from three disorders in which a history of CM is frequently found, namely, post-traumatic stress disorder, major depressive disorder, or somatic symptom disorder, as well as healthy volunteers to examine DMN connectivity in a transdiagnostic sample. We expected to find changes in inter-network connectivity of the DMN related to higher self-reported levels of CM severity and duration. Resting-state functional magnetic resonance imaging scans of 128 participants were analyzed focusing on regions of interest (ROI-to-ROI approach) and whole-brain Seed-to-Voxel analyses with retrospectively assessed CM as predictor in a regression model. Changes in connectivity between nodes of the DMN and the visual network were identified to be associated with CM duration but not severity. CM duration showed associations with increased connectivity of the precuneus and visual regions, as well as sensory-motor regions. The observed changes in connectivity could be interpreted as an impairment of information transfer between the transmodal DMN and unimodal visual and sensory-motor regions with impairment increasing with duration of exposure to CM. • Maltreatment duration not severity predicts transdiagnostic DMN connectivity. • Maltreatment duration predicts altered connectivity of precuneus and visual network. • Maltreatment duration predicts connectivity of precuneus and somato-motor network. [ABSTRACT FROM AUTHOR]

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The article focuses on a case of Painful Legs and Moving Toes Syndrome (PLMT) that initially resembled somatic symptom disorder. Topics include the clinical characteristics of PLMT, diagnostic challenges due to its rarity and varied symptomatology, and the differential diagnosis process involving neurophysiological studies to distinguish it from other conditions.

Psychological assessment plays a crucial role in the preoperative phase of septorhinoplasty (SRPL), exerting potential influence on both pre- and postoperative aspects of quality of life (QoL). In this prospective study, SRPL patients were systematically screened using two validated questionnaires for body dysmorphic disorder (BDD) and one each for anxiety, depression, and somatic symptom disorder (SSD). Nasal perception was evaluated utilizing two disease-specific, self-report instruments: The Rhinoplasty Outcomes Evaluation (ROE) and the Functional Rhinoplasty Outcome Inventory-17 (FROI-17). A total of 95 patients were enrolled. Positive screening rates were 40.4 and 28.3% for BDD, 37.3% for elevated anxiety, 16.4% for depression, and 22.4% for SSD. Mean scores on the ROE and FROI indicated lower QoL in all positive screening groups. Statistically significant differences were observed for anxiety (FROI total score: 47.1 ± 14.6 to 37.8 ± 16.2; p = 0.021) and BDD (ROE: 43.7 ± 15.7 to 32.5 ± 15.5; p = 0.003 and FROI total score: 47.4 ± 15.3 to 37.8 ± 17.1; p = 0.014). The Hospital Anxiety and Depression Scale exhibited a significant correlation with the preoperative FROI score (r = 0.34, p = 0.005). Patients with positive screenings for depression, anxiety, BDD, and SSD demonstrated compromised QoL during preoperative assessments compared with their negative counterparts, reflecting diminished nasal perception in both esthetic and functional dimensions. Surgeons must be cognizant of these psychological aspects during preoperative evaluations. [ABSTRACT FROM AUTHOR]

Abstract Background Functional somatic symptoms (FFS) and bodily distress disorders are highly prevalent across all medical settings. Services for these patients are dispersed across the health care system with minimal conceptual and operational integration, and patients do not currently access therapeutic offers in significant numbers due to a mismatch between their and professionals’ understanding of the nature of the symptoms. New service models are urgently needed to address patients’ needs and to align with advances in aetiological evidence and diagnostic classification systems to overcome the body–mind dichotomy. Method A panel of clinical experts from different clinical services involved in providing aspects of health care for patients with functional symptoms reviewed the current care provision. This review and the results from a focus group exploration of patients with lived experience of functional symptoms were explored by the multidisciplinary expert group, and the conclusions are summarised as recommendations for best practice. Results The mapping exercise and multidisciplinary expert consultation revealed five themes for service improvement and pathway development: time/access, communication, barrier-free care, choice and governance. Service users identified four meta-themes for best practice recommendations: focus on healthcare professional communication and listening skills as well as professional attributes and knowledge base to help patients being both believed and understood in order to accept their condition; systemic and care pathway issues such as stronger emphasis on primary care as the first point of contact for patients, resources to reduce the length of the patient journey from initial assessment to diagnosis and treatment. Conclusion We propose a novel, integrated care pathway for patients with ‘functional somatic disorder’, which delivers care according to and working with patients’ explanatory beliefs. The therapeutic model should operate based upon an understanding of the embodied nature of patient’s complaints and provide flexible access points to the care pathway.

Abstract Objective The somatic symptom disorder (SSD) is characterized by one or more distressing or disabling somatic symptoms accompanied by an excessive amount of time, energy and emotion related to the symptoms. These manifestations of SSD have been linked to alterations in perception and appraisal of bodily signals. We hypothesized that SSD patients would exhibit changes in interoceptive accuracy (IA), particularly when emotional processing is involved. Methods Twenty-three patients with SSD and 20 healthy controls were recruited. IA was assessed using the heartbeat perception task. The task was performed in the absence of stimuli as well as in the presence of emotional interference, i.e., photographs of faces with an emotional expression. IA were examined for correlation with measures related to their somatic symptoms, including resting-state heart rate variability (HRV). Results There was no significant difference in the absolute values of IA between patients with SSD and healthy controls, regardless of the condition. However, the degree of difference in IA without emotional interference and with neutral facial interference was greater in patients with SSD than in healthy controls (p = 0.039). The IA of patients with SSD also showed a significant correlation with low-frequency HRV (p = 0.004) and high-frequency HRV (p = 0.007). Conclusion SSD patients showed more significant changes in IA when neutral facial interference was given. These results suggest that bodily awareness is more affected by emotionally ambiguous stimuli in SSD patients than in healthy controls.

Background: Functional somatic symptoms (FFS) and bodily distress disorders are highly prevalent across all medical settings. Services for these patients are dispersed across the health care system with minimal conceptual and operational integration, and patients do not currently access therapeutic offers in significant numbers due to a mismatch between their and professionals’ understanding of the nature of the symptoms. New service models are urgently needed to address patients’ needs and to align with advances in aetiological evidence and diagnostic classification systems to overcome the body–mind dichotomy. Method: A panel of clinical experts from different clinical services involved in providing aspects of health care for patients with functional symptoms reviewed the current care provision. This review and the results from a focus group exploration of patients with lived experience of functional symptoms were explored by the multidisciplinary expert group, and the conclusions are summarised as recommendations for best practice. Results: The mapping exercise and multidisciplinary expert consultation revealed five themes for service improvement and pathway development: time/access, communication, barrier-free care, choice and governance. Service users identified four meta-themes for best practice recommendations: focus on healthcare professional communication and listening skills as well as professional attributes and knowledge base to help patients being both believed and understood in order to accept their condition; systemic and care pathway issues such as stronger emphasis on primary care as the first point of contact for patients, resources to reduce the length of the patient journey from initial assessment to diagnosis and treatment. Conclusion: We propose a novel, integrated care pathway for patients with ‘functional somatic disorder’, which delivers care according to and working with patients’ explanatory beliefs. The therapeutic model should operate based upon an understanding of the embodied nature of patient’s complaints and provide flexible access points to the care pathway. [ABSTRACT FROM AUTHOR]

Objective: The somatic symptom disorder (SSD) is characterized by one or more distressing or disabling somatic symptoms accompanied by an excessive amount of time, energy and emotion related to the symptoms. These manifestations of SSD have been linked to alterations in perception and appraisal of bodily signals. We hypothesized that SSD patients would exhibit changes in interoceptive accuracy (IA), particularly when emotional processing is involved. Methods: Twenty-three patients with SSD and 20 healthy controls were recruited. IA was assessed using the heartbeat perception task. The task was performed in the absence of stimuli as well as in the presence of emotional interference, i.e., photographs of faces with an emotional expression. IA were examined for correlation with measures related to their somatic symptoms, including resting-state heart rate variability (HRV). Results: There was no significant difference in the absolute values of IA between patients with SSD and healthy controls, regardless of the condition. However, the degree of difference in IA without emotional interference and with neutral facial interference was greater in patients with SSD than in healthy controls (p = 0.039). The IA of patients with SSD also showed a significant correlation with low-frequency HRV (p = 0.004) and high-frequency HRV (p = 0.007). Conclusion: SSD patients showed more significant changes in IA when neutral facial interference was given. These results suggest that bodily awareness is more affected by emotionally ambiguous stimuli in SSD patients than in healthy controls. [ABSTRACT FROM AUTHOR]

• Neurobiological link of default mode network connectivity in somatic symptom disorder. • Affective symptoms bridge links between neurobiological markers and somatic symptom. • Anxiety/anger mediate relation between default mode network and somatic symptom. • Depression/anger connect serotonin marker with somatic symptom. • Neuroimmune markers tie default mode network to affective symptom. Somatic symptom disorder (SSD) is characterized by physical symptoms and associated functional impairments that are often comorbid with depression and anxiety disorders. In this study, we explored relationships between affective symptoms and the functional connectivity of the default mode network (DMN) in SSD patients, as well as the impact of peripheral inflammation. We employed mediation analyses to investigate the potential pathways between these factors. We recruited a total of 119 individuals (74 unmedicated SSD patients and 45 healthy controls), who were subjected to comprehensive psychiatric and clinical evaluations, blood tests, and resting-state functional magnetic resonance imaging scanning. We assessed neuroimmune markers (interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), tryptophan, serotonin, and 5-hydroxyindoleacetic acid (5-HIAA)), clinical indicators of somatic symptoms, depression, anxiety, anger, alexithymia, and functional connectivity (FC) within the DMN regions. Data were analyzed using correlation and mediation analysis, with a focus on exploring potential relations between clinical symptoms, blood indices, and DMN FCs. Patients with SSD had higher clinical scores as well as IL-6 and TNF-α levels compared with those in the control group (P < 0.05). The SSD group exhibited lower FC strength between the left inferior parietal lobule and left prefrontal cortex (P false discovery rate (FDR) < 0.05). Exploratory correlation analysis revealed that somatic symptom scores were positively correlated with affective symptom scores, negatively correlated with the FC strength between the intra prefrontal cortex regions, and correlated with levels of IL-6, TNF- α, and tryptophan (uncorrected P < 0.01). Mediation analysis showed that levels of anxiety and trait anger significantly mediated the relations between DMN FC strength and somatic symptoms. In addition, the DMN FC mediated the level of trait anger with respect to somatic symptoms (all P FDR < 0.05). The levels of depression and trait anger exhibited significant mediating effects as suppressors of the relations between the level of 5-HIAA and somatic symptom score (all P FDR < 0.05). Further, the level of 5-HIAA had a mediating effect as a suppressor on the relation between DMN FC and state anger. Meanwhile, the levels of hs-CRP and IL-6 had full mediating effects as suppressors when explaining the relations of DMN FC strengths with the level of depression (all P FDR < 0.05). The patterns of valid mediation pathways were different in the control group. Affective symptoms may indirectly mediate the associations between DMN connectivity, somatic symptoms, and neuroimmune markers. Inflammatory markers may also mediate the impact of DMN connectivity on affective symptoms. These results emphasize the importance of affective dysregulation in understanding the mechanisms of SSD and have potential implications for the development of tailored therapeutic approaches for SSD patients with affective symptoms. Furthermore, in SSD research using DMN FC or neuroimmune markers, considering and incorporating such mediating effects of affective symptoms suggests the possibility of more accurate prediction and explanation. [ABSTRACT FROM AUTHOR]

A key diagnostic criterion of Somatic Symptom and related Disorders (SSD) comprises significant distress and excessive time-and-energy consuming thoughts, feelings, and behavior pertaining to somatic symptoms. This diagnostic criterion is lacking in central sensitivity syndromes (CSS), such as fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome. This strong emphasis on disturbed psychological processing of somatic symptoms, suggests that psychological flexibility is low in SDD. Psychological flexibility is defined as the ability to approach difficult or challenging internal states (thoughts, emotions, and bodily sensations) in a non-judgmental, mindful way, and being committed to pursue one's values. To clarify the potential significance of psychological flexibility in SSD, we examined its levels in 154 people referred to specialized treatment for SDD, as compared to reference groups from the general population encompassing 597 people with CSS and 1422 people without SSD or CSS (controls). Mean levels of psychological flexibility (adjusted for demographic covariates) were lowest for SSD and highest for controls (F = 154.5, p < 0.001, pη2 = 0.13). Percentages of people with low psychological flexibility (<0.8 SD below the mean of controls) were: SSD 74%, CSS 42%, controls 21%. In SSD, higher psychological flexibility was associated with better mental health (β = 0.56, p < 0.001), but interaction analysis rejected that psychological flexibility preserved health when having more severe somatic symptoms (β ≤ 0.08, p ≥ 0.10). The results indicate that lower psychological flexibility is a prevalent problem in SSD that is associated with lower mental health. This suggests that it is worthwhile to take account of psychological flexibility in SSD in screening, monitoring, and therapy. • Psychological flexibility in people with somatic symptom disorder (SDD) is low. • Three out of four patients with SSD have low or very low psychological flexibility. • Lower psychological flexibility is associated with lower mental health. • Assess psychological flexibility in SSD in screening, monitoring, and therapy. [ABSTRACT FROM AUTHOR]

This article discusses a case of a 71-year-old female patient who visited an outpatient toxicology clinic with concerns of being poisoned by her neighbor. The patient reported various symptoms and experiences, and the article provides information on evaluating non-specific toxicologic exposures and signs of intentional malicious poisoning. The article also explores the differential diagnosis for the patient's symptoms, including the possibility of delusions and psychosis. It discusses substances and environmental factors that can potentially cause psychosis, as well as pharmaceutical agents associated with psychosis. The document emphasizes the importance of a multidisciplinary approach and provides recommendations for treatment and care. [Extracted from the article]

Research Summary: The aim of this research is to identify the nature of the relationship between cyberchondria(Search for health information online) and both somatic symptom disorder and irrational beliefs about health, as well as to identify the differences between the gender in cyberchondria, and to predict cyberchondria through the variables of somatic symptom disorder and irrational beliefs about health. The sample of the study consisted of (300) male and female students at the university, and used the following: the cyberchondria scale (prepared by the researcher), the Somatic symptom disorder scale (prepared by the researcher) and the scale of irrational beliefs about health (prepared by the researcher).The results showed that there is a positive correlation between cyberchondria and both Somatic symptom disorder and irrational beliefs about health among university students, and the results showed that there are statistically significant differences between the gender in cyberchondria in favor of females. Cyberchondria can also be predicted by variables of somatic symptom disorder and irrational beliefs about health. Finally, there are fundamental differences between high cyberchondria and low cyberchondria in personality dynamics. [ABSTRACT FROM AUTHOR]

Alterations in sensory processing, a key component of autism spectrum disorder (ASD), have recently attracted increasing attention as they result in peculiar responses to sensory stimuli, possibly representing a risk factor for the development of somatic symptom disorder (SSD). Contextually, other features also associated with ASD, such as alexithymia, camouflaging and altered verbal, and non-verbal communication, have been suggested to represent risk factors for the occurrence and worsening of somatic symptomatology. The aim of this work was to review the available literature about the association between SSD and the autism spectrum. The results highlighted not only a higher prevalence of autistic features in patients suffering from SSD and a higher prevalence of reported somatic symptomatology in subjects with ASD but also how ASD subjects with co-occurrent somatic symptoms exhibit more severe autism-linked symptomatology. From the paper reviewed also emerged many shared features between the two conditions, such as alexithymia, altered sensitivity to sensory stimuli, cognitive inflexibility, intolerance of uncertainty, and an increased risk of experiencing stressful life events, which may provide an explanation for the correlation reported. Even though studies on the topic are still scant, the evidence reported suggests the importance of further assessing the correlation between the two disorders. [ABSTRACT FROM AUTHOR]

Objective: This study explored the association between self-compassion, alexithymia, and psychosomatic symptom distress in a clinical sample of somatic symptom disorder (SSD) patients participating in a mindfulness-based cognitive therapy (MBCT) program. Methods: One hundred sixteen SSD patients who had participated in an MBCT program and completed ≥4 intervention sessions were included in a retrospective study (76.7% women, mean age = 40.0, SD = 9.5). Psychometric measures of psychosomatic symptom distress [Brief Symptom Inventory-18 Global Severity Index (BSI-GSI)], self-compassion [Self-Compassion Scale (SCS)], and alexithymia [Toronto Alexithymia Scale (TAS)] were collected upon admission to the MBCT program and at 6-month follow-up following treatment inclusion. Results: Serial mediation analysis (MBCT→ΔSCS→ΔTAS→ΔBSI-GSI) suggested that changes in both self-compassion and alexithymia had significant indirect effects on improvement in psychosomatic distress [ΔSCS β = -1.810, 95% bootstrap CI (-2.488, -1.160); ΔTAS β = -1.615, bootstrap 95% CI (-2.413, -0.896); ΔSCS→ΔTAS β = -0.621, bootstrap CI (-1.032, -0.315)]. Furthermore, a post-hoc analysis with a reverse sequence (MBCT→ΔTAS→ΔSCS→ΔBSI-GSI) revealed that reduction in alexithymia improved psychosomatic distress and that an increase in self-compassion was a subsequent outcome of alleviation of alexithymia [ΔTAS β = -2.235, bootstrap 95% CI (-3.305, -1.270); ΔSCS β = 0.013, 95% bootstrap CI (-0.600, 0.682); ΔTAS→ΔSCS β = -1.823, bootstrap CI (-2.770, -1.047)]. Conclusion: Both alleviation of alexithymia and improvement in self-compassion play a mediating role in the reduction of psychosomatic distress in SSD patients following an MBCT program. Improvement in self-compassion might be a subsequent outcome of MBCT-related alleviation of alexithymia. [ABSTRACT FROM AUTHOR]

Introduction: Based on two diagnostic accuracy studies in high-prevalence settings, two distinctly different combinations of cut-off values have been recommended to identify persons at risk for somatic symptom disorder (SSD) with the combination of the Patient-Health Questionnaire-15 (PHQ-15) and the Somatic Symptom Disorder--B Criteria Scale (SSD-12). We investigated whether the reported sensitivity and specificity of both recommended cut-off combinations are transferable to primary care. Methods: In a cross-sectional study, 420 unselected adult primary care patients completed PHQ-15 and SSD-12. Patients scoring ≥9 and ≥ 23 (recommended cut-off combination #1) or ≥ 8 and ≥ 13 (recommended cut-off combination #2) were considered test-positive for SSD, respectively. To assess the validity of the reported sensitivity and specificity in different low- to high-prevalence settings, we compared correspondingly expected proportions of test positives to the proportion observed in our sample. Results: Based on combination #1, 38 participants (9%) were found to be test positive, far fewer than expected, based on the reported values for sensitivity and specificity (expected minimum frequency 30% with a true prevalence ≥1%). This can only be explained by a lower sensitivity and higher specificity in primary care. For combination #2, 98 participants (23%) were test positive, a finding consistent with a true prevalence of SSD of 15% or lower. Discussion: Our analyzes strongly suggest that the sensitivity and specificity estimates reported for combination #1 are not applicable to unselected primary care patients and that the cut-off for the SSD (≥23) is too strict. Cut-off combination #2 seems more applicable but still needs to be tested in studies that compare screening findings by questionnaires with validated diagnostic interviews as reference standards in primary care populations. [ABSTRACT FROM AUTHOR]

Background: Somatic symptom disorder is a culturally dependent form of disorder, and culturally appropriate tools are necessary for its assessment, diagnosis, and treatment. Although various studies emphasize the influence of culture on the factors and fields effective in the formation of somatic symptoms disorder, However, few studies have developed a suitable test to evaluate the factors and fields of Somatic symptom disorder in iranian culture. Aims: The present study was conducted with the aim of development and validating the questionnaire of the Antecedents of somatic symptom disorder (causal and contextual) in the Iranian society. Methods: In terms of purpose, the present research is fundamental-applicative, in terms of gathering information, it is survey-questionnaire, and in terms of methodology, it is considered among testmaking studies, which was carried out in the form of a correlational research project. The statistical population of the research included all people over 18 years of age in Tehran in 2023. The statistical sample size was 915 adults who were selected by available sampling method. To collect data, a researcher-made questionnaire on the antecedents of somatic symptom disorder, which was derived from a qualitative research, was used. Data analysis was done using exploratory and confirmatory factor analysis of the first and second type to check the construct validity and principal component analysis method using SPSS-24 and AMOS-24 software. Results: The findings of this research showed that the questionnaire of the antecedents of somatic symptom disorder in iranian society has favorable psychometric characteristics. The results of factor analysis showed that this questionnaire has 4 subscales of dictatorial parenting, dysfunctional couple relations, emotional and cognitive characteristics of childhood. Using Cronbach's alpha, the values of the internal consistency coefficient were found to be 0.922 for dictatorial parenting, 0.929 for dysfunctional couple relationships, 0.842 for the child's feelings, and 0.846 for the child's thoughts. Conclusion: According to the obtained results, it is suggested that specialists in medical centers use the questionnaire of the antecedents of somatic symptom disorder to evaluate, diagnose and prepare a treatment plan for somatic symptom disorder in iranian society. [ABSTRACT FROM AUTHOR]

Background: Specific learning disability is one of the neurodevelopmental disorders with problems in one of the basic skills such as reading, writing, and arithmetic. Identifying at an early age can lead to a proper referral and reduce the occurrence of psychosomatic symptoms. Materials and Methods: This study aimed to estimate the prevalence of specific learning disability (SLD) in children aged 6-14 years who presented to the pediatric outpatient department (OPD) and to find out the association between SLD and somatic symptom disorder. A retrospective hospital-based study was done in the child guidance and rehabilitation center, department of paediatrics of a teaching hospital in Puducherry. Data from all children aged 6-14 years who came to the pediatric OPD during February 2017-2022 were included and all children with incomplete medical records, incomplete recording of assessment in the register of child guidance and rehabilitation center obvious hearing and visual impairment, those with an intellectual quotient <70, and all sick children were excluded from the study. The medical records of all patients who were evaluated by a child psychologist were audited through hospital information management software-specific learning disabilities were assessed using the NIMHANS Learning Disability score. The intelligence quotient was assessed using Malin's Intelligence Scale for Indian Children. Results: A total of 5457 children aged 6-14 years were included and 364 children (364/5457; 6.6%) had different grades of SLD. The children who were presenting with somatic symptom disorder had (OR - 9.64, 95% confidence interval - 7.51-12.37, P < 0.0001) a significant chance of having SLD. Conclusion: The prevalence of specific learning disabilities is 6.6%. There is a six-fold association between SLD and psychosomatic disorder. [ABSTRACT FROM AUTHOR]

Polypharmacy and somatic symptom disorder (SSD) are common conditions clinicians see every day in practice. Polypharmacy is easy to identify and causation seems to be straightforward. However, SSD may not be so obvious and may be an underlying cause of the polypharmacy that may be more difficult to identify. Identifying SSD as a potential psychiatric cause for polypharmacy and understanding that adding more medications will not adequately resolve the patient’s symptoms is important to prevent polypharmacy from being exacerbated.

Background: Somatic symptom disorder is a culturally dependent form of disorder, and culturally appropriate tools are necessary for its assessment, diagnosis, and treatment. Although various studies emphasize the influence of culture on the factors and fields effective in the formation of somatic symptoms disorder, However, few studies have developed a suitable test to evaluate the factors and fields of Somatic symptom disorder in iranian culture. Aims: The present study was conducted with the aim of development and validating the questionnaire of the Antecedents of somatic symptom disorder (causal and contextual) in the Iranian society. Methods: In terms of purpose, the present research is fundamental-applicative, in terms of gathering information, it is survey-questionnaire, and in terms of methodology, it is considered among test-making studies, which was carried out in the form of a correlational research project. The statistical population of the research included all people over 18 years of age in Tehran in 2023. The statistical sample size was 915 adults who were selected by available sampling method. To collect data, a researcher-made questionnaire on the antecedents of somatic symptom disorder, which was derived from a qualitative research, was used. Data analysis was done using exploratory and confirmatory factor analysis of the first and second type to check the construct validity and principal component analysis method using SPSS-24 and AMOS-24 software. Results: The findings of this research showed that the questionnaire of the antecedents of somatic symptom disorder in iranian society has favorable psychometric characteristics. The results of factor analysis showed that this questionnaire has 4 subscales of dictatorial parenting, dysfunctional couple relations, emotional and cognitive characteristics of childhood. Using Cronbach's alpha, the values of the internal consistency coefficient were found to be 0.922 for dictatorial parenting, 0.929 for dysfunctional couple relationships, 0.842 for the child's feelings, and 0.846 for the child's thoughts. Conclusion: According to the obtained results, it is suggested that specialists in medical centers use the questionnaire of the antecedents of somatic symptom disorder to evaluate, diagnose and prepare a treatment plan for somatic symptom disorder in iranian society.

Abstract Background If somatization is an independent personality trait, it is not clear whether it is specific to the temperament or maladaptive spectrum of personality. We aimed at the head-to-head comparison of temperament and maladaptive systems and spectra of personality to predict both somatization and somatic symptom and related disorders (SSRD). Methods The samples included 257 cases with SSRD (70.8% female) and 1007 non-SSRD (64.3% female) from Western Iran. The Personality Inventory for DSM-5 (PID-5), Personality Diagnostic Questionnaire-4 (PDQ-4), Temperament and Character Inventory (TCI), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A), Affective and Emotional Composite Temperament Scale (AFECTS), and Positive Affect and Negative Affect Model (PANAS) was used to data collection. A somatization factor plus temperament and maladaptive spectra of personality were extracted using exploratory factor analysis. Several hierarchical linear and logistic regressions were used to test the predictive systems and spectra. Results All personality systems jointly predict both somatization and SSRD with a slightly higher contribution for temperament systems. When the temperament and maladaptive spectra were compared, both spectra above each other significantly predicted both somatization (R 2 = .407 versus .263) and SSRD (R 2 = .280 versus .211). The temperament spectrum explained more variance beyond the maladaptive spectrum when predicting both the somatization factor (change in R 2 = .156 versus .012) and SSRD (change in R 2 = .079 versus .010). Conclusion All temperament and maladaptive frameworks of personality are complementary to predicting both somatization and SSRD. However, the somatization is more related to the temperament than the maladaptive spectrum of personality.

Abstract Background Somatic symptom disorder (SSD) presents challenges to the healthcare system, including frequent medical visits, lack of symptom relief experienced by individuals with this condition, high associated medical costs, and patient dissatisfaction. This study examined the utility of a novel, low-barrier, brief cognitive behavioural therapy (CBT) group intervention for individuals with SSD. Methods Participants were referred by their mental health providers or self-referral. Each participant underwent a telephone screen and in-person psychological and neuropsychological screen. Two cycles of the CBT-based group (n = 30), each consisting of six weekly two-hour sessions, were facilitated at a large outpatient mental healthcare facility in Ontario, Canada. The final sample consisted of 13 individuals of whom 11 completed the treatment. Clinical outcome measures were administered pre-, mid- and post-group, including the Generalized Anxiety Disorder–7, Perceived Stress Scale–4, Pain Self-Efficacy Questionnaire, Pain Disability Index, Revised Illness Perception Questionnaire, and sections of the Patient Health Questionnaire. Six healthcare utilization metrics were collected from electronic medical records at six months pre- and post-group. Paired samples t-tests were used to examine pre- to post-group differences in participants’ somatic symptoms, psychological functioning, health, and degree of healthcare utilization. Results When comparing pre- and post- group, we observed reductions in the mean scores for somatic symptom severity, depressive symptomatology, anxiety, perceived stress, and perceived disability related to pain. The change in depressive symptomatology yielded a small effect size (d = 0.30). Further, we observed downward trends across participants’ pre- to post-group healthcare utilization, with small effect sizes observed for hospital admission (d = 0.36), days admitted to hospital (d = 0.47), and inpatient consults (d = 0.42). Differences between pre- and post-group measures of somatic symptom severity, psychological functioning, health, or healthcare utilization did not reach significance. Conclusions Current findings provide support for the potential effectiveness of an abbreviated CBT group for individuals with SSD in reducing psychiatric symptomatology. Further research is recommended, including randomized control trials, cost-benefit analyses, and comparisons between abbreviated versus longer-duration treatment programs for SSD. Trial registration Not applicable.

BackgroundThe etiology and pathogenesis of somatic symptom disorder are complicated， for which no effective treatment currently exists， posing a critical impact on their quality of life.ObjectiveTo analyze the current situation and development trend in domestic and foreign research on somatic symptom disorder from 2011 to 2021， and to better understand the research frontiers and hot spots in this field.MethodsOn 31 August 2022， literature on somatic symptom disorder published from January 1， 2011 to January 1， 2023 were searched in China National knowledge Infrastructure （CNKI）， Wanfang Data Knowledge Service Platform， Web of Science and PubMed， and a total of 15 035 articles were included， then the visualization analysis of the number of publications and keywords was conducted based on Microsoft Excel and CiteSpace software.ResultsIn the field of somatic symptoms disorder research from 2011 to 2021， the number of annual publications demonstrated an overall upward trend in foreign studies， and displayed a slow downward trend in domestic studies. The keyword co-occurrence network analysis revealed that the top five high-frequency keywords were "mental health" "depressive disorder" "depression" "anxiety" and "somatic symptom" in domestic studies， and were "symptom" "prevalence" "depression" "disorder" and "quality of life" in foreign studies. The burst analysis suggested that the burst terms in past five years were "somatic symptom" "syndrome" and "quality of life" in domestic studies， and were "major depressive disorder" and "outcome" in foreign studies. The clustering analysis yielded 8 clusters in domestic studies and 4 clusters in foreign studies， reflecting in the related disease， prevention and treatment protocols and epidemiological characteristics of somatic symptom disorder.ConclusionIn recent years， the publications and academic concerns regarding the research on somatic symptom disorder show an upward trend in foreign studies and are relatively inadequate in domestic studies， and both the domestic and foreign studies have been focused on the influencing factors of somatic symptom disorder. ［Funded by the Medical Health Science and Technology Project of Zhejiang Provincial （number， 2020PY064）； Medical Health Science and Technology Project of Hangzhou （number， 0020190783）］

Background: If somatization is an independent personality trait, it is not clear whether it is specific to the temperament or maladaptive spectrum of personality. We aimed at the head-to-head comparison of temperament and maladaptive systems and spectra of personality to predict both somatization and somatic symptom and related disorders (SSRD). Methods: The samples included 257 cases with SSRD (70.8% female) and 1007 non-SSRD (64.3% female) from Western Iran. The Personality Inventory for DSM-5 (PID-5), Personality Diagnostic Questionnaire-4 (PDQ-4), Temperament and Character Inventory (TCI), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A), Affective and Emotional Composite Temperament Scale (AFECTS), and Positive Affect and Negative Affect Model (PANAS) was used to data collection. A somatization factor plus temperament and maladaptive spectra of personality were extracted using exploratory factor analysis. Several hierarchical linear and logistic regressions were used to test the predictive systems and spectra. Results: All personality systems jointly predict both somatization and SSRD with a slightly higher contribution for temperament systems. When the temperament and maladaptive spectra were compared, both spectra above each other significantly predicted both somatization (R2 =.407 versus.263) and SSRD (R2 =.280 versus.211). The temperament spectrum explained more variance beyond the maladaptive spectrum when predicting both the somatization factor (change in R2 =.156 versus.012) and SSRD (change in R2 =.079 versus.010). Conclusion: All temperament and maladaptive frameworks of personality are complementary to predicting both somatization and SSRD. However, the somatization is more related to the temperament than the maladaptive spectrum of personality. [ABSTRACT FROM AUTHOR]

Introduction: Elite athletes are exposed to a variety of sport-specific stressors that may put them at particular risk for mental health symptoms and disorders. The aim of the present study was to assess data on mental health of elite athletes and investigate associations and interconnections among different variables using network analysis. Methods: A cross-sectional study was conducted from December 2021 to December 2022. The sample consisted of 275 German elite athletes (167 females) aged ≥18  years. Next to sociodemographic, medical and sport-related data, psychometric data such as psychological distress, symptoms of generalized anxiety, depression, and somatic symptom disorder have been gathered through questionnaires and analyzed by means of network analysis. Results: Over 95.0% of the athletes showed elevated distress and 28.6% reported symptoms of depression. Results of the network analysis show, among other findings, that symptoms of somatic symptom disorder were associated with severe injuries and substance use. Moreover, elite athletes who reported a better financial situation reported fewer symptoms of depression, generalized anxiety, and somatic symptom disorder. They also reported a lower incidence of mild to moderate injuries and severe injuries, fewer years spent in elite sports, less substance use, and fewer training sessions per week. Conversely, these athletes reported a higher level of distress. Furthermore, sex, financial situation and number of training units per week emerged as significant predictors for mental health symptoms. Discussion: Elite athletes showed increased numbers regarding mental health symptoms. Providing appropriate mental health interventions for elite athletes and further analysis of factors that influence the mental health of elite athletes and their interplay seem to be of central importance for the general well-being of elite athletes. [ABSTRACT FROM AUTHOR]

Literature investigating the impact of COVID-19 on healthcare professionals barely addresses predictors of somatic symptom burden during the COVID-19 pandemic. As biopsychosocial models propose that not only the disease but also sociodemographic and psychosocial factors contribute to the development and maintenance of symptoms, this study investigates the predictive value of these factors for bothersome somatic symptoms in SARS-CoV-2 negative healthcare professionals. German healthcare professionals were assessed with self-rating questionnaires and underwent SARS-CoV-2 IgG antibody tests at baseline and 8 weeks later between April and August 2020. Differences in psychosocial variables between the time points were analyzed and regression analyses were performed to predict somatic symptoms at follow-up. 1185 seronegative healthcare professionals completed both assessments. Previous somatic symptom burden, higher levels of anxiety, being a nurse, younger age, higher psychological symptom burden, lower efficiency, and higher fatigability at baseline predicted somatic symptom burden at follow-up. Comparisons between baseline and follow-up showed a significant improvement in psychological impairment and deterioration of physical exhaustion. Our study applies a biopsychosocial perspective to bothersome somatic symptoms during the COVID-19 pandemic and contributes to the identification of potential risk factors as a starting point for future interventions that could support the handling of symptoms. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to examining the effective factors in the formation of somatic symptoms disorder in people with complex post-traumatic stress disorder. Method: The approach studied in this research was qualitative and based on grounded theory. A number of 15 people with somatic symptom disorder and complex post trumatic Stress Disorder in the age of 18-60 years old in Tehran city, who were willing to interview and cooperate, were selected by the purposeful sampling method until reaching theoretical saturation. These people were investigated using a semistructured and in-depth interview. Data analysis was done according to the method of Strauss and Corbin (2014) and using MAXQDA software. Method: Based on the findings of the research, open codes around 89 concepts, axial codes including 8 concepts and selective codes in 4 concepts including causal factors (destructive family interactions), contexual factors (child's emotional-cognitive characteristics), Intervening factors (passive parenting-idealistic parenting) and strategies (child's behavioral-cognitive strategies) were idendified. Conclusion: Children's cognitive, emotional and behavioral strategies in response to childhood truma (destructive family interactions and destructive parenting) are effective in the formation and continuation of somatic symptoms disorder. Therefore, for the prevention of somatic symptom disorder in children, it is possible to improve the destructive family interactions, and in the treatment of adults with somatic symptom disorder, it can be used from effective strategies of regulating one's emotions, thoughts and change in one's interactions. [ABSTRACT FROM AUTHOR]

Background: Research has shown that patients with somatoform disorders (SFD) have difficulty using medical reassurance (i.e. normal results from diagnostic testing) to revise concerns about being seriously ill. In this brief report, we investigated whether deficits in adequately interpreting the likelihood of a medical disease may contribute to this difficulty, and whether patients' concerns are altered by different likelihood framings. Methods: Patients with SFD (N = 60), patients with major depression (N = 32), and healthy volunteers (N = 37) were presented with varying likelihoods for the presence of a serious medical disease and were asked how concerned they are about it. The likelihood itself was varied, as was the format in which it was presented (i.e. negative framing focusing on the presence of a disease v. positive framing emphasizing its absence; use of natural frequencies v. percentages). Results: Patients with SFD reported significantly more concern than depressed patients and healthy people in response to low likelihoods (i.e. 1: 100 000 to 1:10), while the groups were similarly concerned for likelihoods ⩾1:5. Across samples, the same mathematical likelihood caused significantly different levels of concern depending on how it was framed, with the lowest degree of concern for a positive framing approach and higher concern for natural frequencies (e.g. 1:100) than for percentages (e.g. 1%). Conclusions: The results suggest a specific deficit of patients with SFD in interpreting low likelihoods for the presence of a medical disease. Positive framing approaches and the use of percentages rather than natural frequencies can lower the degree of concern. [ABSTRACT FROM AUTHOR]

Objective: Patients with severe health anxiety have complex interpersonal relationships with medical providers and others in their social context, often resulting in conflictual interactions with providers and perception of poor medical care. An adequate understanding of the causes and consequences of these interactions is lacking, particularly 1 informed by the experience of the patient. This study used qualitative methods to explore the development and maintenance of health anxiety from the perspective of patients with lived experience of coping with health anxiety and their interactions with the healthcare system. Method: We conducted qualitative interviews with 11 primary care patients purposely sampled to describe their experience living with health anxiety, provider interactions, and social and family interactions surrounding health and health anxiety. We extracted themes related to living with health anxiety and interactions with providers and other significant relationships. Results: Thematic content analysis revealed 5 themes including 3 causal themes, 1 response theme, and 1 theme reflecting factors that mitigate health anxiety. Causal themes included subthemes reflecting predisposing factors of the self, key stimulus events from patient learning history, and maladaptive social interaction factors. The response theme was comprised of 2 subthemes: logical conclusions and health anxiety symptoms. The mitigating factors theme included subthemes of a trusting care relationship and recognition of disconfirming evidence. Conclusion: The themes and constituent subthemes identified in this study largely map onto cognitive-behavioral theory of health anxiety, demonstrating alignment between patient experience and theory. The resulting model also identifies potential points of intervention in the developmental and maintenance process. We provide recommendations to maximize those points of intervention. [ABSTRACT FROM AUTHOR]

Background: Somatic symptom disorder (SSD) presents challenges to the healthcare system, including frequent medical visits, lack of symptom relief experienced by individuals with this condition, high associated medical costs, and patient dissatisfaction. This study examined the utility of a novel, low-barrier, brief cognitive behavioural therapy (CBT) group intervention for individuals with SSD. Methods: Participants were referred by their mental health providers or self-referral. Each participant underwent a telephone screen and in-person psychological and neuropsychological screen. Two cycles of the CBT-based group (n = 30), each consisting of six weekly two-hour sessions, were facilitated at a large outpatient mental healthcare facility in Ontario, Canada. The final sample consisted of 13 individuals of whom 11 completed the treatment. Clinical outcome measures were administered pre-, mid- and post-group, including the Generalized Anxiety Disorder–7, Perceived Stress Scale–4, Pain Self-Efficacy Questionnaire, Pain Disability Index, Revised Illness Perception Questionnaire, and sections of the Patient Health Questionnaire. Six healthcare utilization metrics were collected from electronic medical records at six months pre- and post-group. Paired samples t-tests were used to examine pre- to post-group differences in participants' somatic symptoms, psychological functioning, health, and degree of healthcare utilization. Results: When comparing pre- and post- group, we observed reductions in the mean scores for somatic symptom severity, depressive symptomatology, anxiety, perceived stress, and perceived disability related to pain. The change in depressive symptomatology yielded a small effect size (d = 0.30). Further, we observed downward trends across participants' pre- to post-group healthcare utilization, with small effect sizes observed for hospital admission (d = 0.36), days admitted to hospital (d = 0.47), and inpatient consults (d = 0.42). Differences between pre- and post-group measures of somatic symptom severity, psychological functioning, health, or healthcare utilization did not reach significance. Conclusions: Current findings provide support for the potential effectiveness of an abbreviated CBT group for individuals with SSD in reducing psychiatric symptomatology. Further research is recommended, including randomized control trials, cost-benefit analyses, and comparisons between abbreviated versus longer-duration treatment programs for SSD. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

To investigate the distribution of somatic symptom disorder (SSD) and bodily distress syndrome (BDS) and analyze the differences in psychosocial characteristics of patients with the two diagnoses. A total of 694 general hospital outpatients completed the diagnostic interviews for SSD and BDS, and a set of questionnaires evaluating their psychosocial characteristics. A secondary analysis of these data is done. SSD and BDS had a moderate overlap (kappa value = 0.43). Patients who fulfilled both SSD and BDS diagnosis showed significantly higher levels of symptom-related psychological distress (SSD-12), somatic symptom severity (PHQ-15), depression (PHQ-9), and general anxiety (GAD-7), as well as lower mental and physical quality of life (SF-12) compared to patients with neither diagnosis and patients with only one diagnosis. Patients with either diagnosis were associated with significantly higher psychosocial impairments as compared to those with neither diagnosis. Patients who only met SSD had higher SSD-12 scores, whereas those with only BDS had higher PHQ-15 scores (p <0.001). SSD and BDS appear to represent somewhat different psychopathologies, with SSD more associated with psychological distress and BDS associated with greater experience of somatic symptoms. Patients fulfilling both diagnosis show higher symptom severity in various psychosocial aspects. [ABSTRACT FROM AUTHOR]

Background: Previous research has shown that the more people believe their emotions are controllable and useful (BECU), the less they generally report psychological distress. Psychological distress, in turn, impacts health outcomes, and is among the most frequently reported complaints in psychotherapeutic and psychosomatic practice. Objective: We aimed to examine how BECU predicts psychological distress related to somatic symptoms in a prospective sample from the general population and to replicate this association in two cross‐sectional samples of psychosomatic patients. Methods: We applied a panel design with an interval of 2 weeks between T1 and T2 in general‐population panel‐participants (N = 310), assessing BECU and psychological distress related to somatic symptoms via validated self‐report measures. Moreover, we cross‐sectionally replicated the relationship between BECU and psychological distress in a clinical sample of psychosomatic outpatients diagnosed with somatoform disorders (n = 101) or without somatoform disorders (n = 628). Results: BECU predicted over and above the lagged criterion panel‐participants' psychological distress related to somatic symptoms, β = −.18, p <.001. BECU was also cross‐sectionally related to psychological distress in our clinical replication‐sample of psychosomatic outpatients diagnosed with somatoform disorders, rS(87) = −.33, p =.002 and in those without, rS(557) = ‐.21, p <.001. Conclusions: BECU as a malleable way of thinking about emotions predicted psychological distress related to somatic symptoms in general‐population panel‐participants and correlated with the same in two clinical replication samples. BECU thus becomes a promising treatment target in psychotherapeutic approaches. [ABSTRACT FROM AUTHOR]

Cognitive behavior therapy (CBT) is effective for pathological health anxiety, but little is known about unwanted outcomes. We investigated unwanted outcomes in the form of adverse events, overall symptom deterioration, and dropouts in CBT for pathological health anxiety based on a systematic review of 19 randomized controlled trials (PubMed, PsycInfo, and OATD; last updated 2 June 2023; pooled N = 2188), and then a secondary original study of two randomized controlled trials (pooled N = 336). In the systematic review, 10% of participants in CBT reported at least one adverse event and 17% dropped out. Heterogeneity was substantial. In the original investigation, 17% reported at least one adverse event, 0–10% met criteria for overall symptom deterioration, and 10–19% dropped out. In guided Internet-delivered CBT, dropouts were more common with lower education and lower credibility/expectancy ratings. Higher adherence was associated with a larger reduction in health anxiety. Unwanted effects are routinely seen in CBT for pathological health anxiety, but, under typical circumstances, appear to be acceptable in light of the treatment's efficacy. There is a need for more consistent methods to improve our understanding adverse events, dropouts, and overall symptom deterioration, and how these outcomes can be prevented. People who worry excessively about having or developing a serious disease are commonly offered cognitive behavior therapy (CBT). Little is known about unwanted outcomes in CBT for this patient group. This study had two parts. First, we conducted a systematic search of the existing literature where we found that about 10% of patients in CBT experience an event that they perceive as unwanted or negative. About 17% of patients drop out of treatment prematurely. Results differed substantially between studies. Second, we analyzed the outcome of two original studies and found that about 17% of patients in CBT experience an event that they perceive as unwanted or negative. Patients who experienced such an event reported, on average, a smaller reduction in health anxiety if CBT was delivered face-to-face, but not if it was delivered via the Internet. About 0–10% rated their health anxiety as having become worse after CBT, and 10–19% dropped out prematurely. In CBT delivered via the Internet, patients were more likely to drop out if their level of education was lower, and if they rated the treatment as less credible and expectancy-evoking during week 2. We conclude that unwanted effects are relatively common but typically mild and acceptable. [ABSTRACT FROM AUTHOR]

IntroductionBased on two diagnostic accuracy studies in high-prevalence settings, two distinctly different combinations of cut-off values have been recommended to identify persons at risk for somatic symptom disorder (SSD) with the combination of the Patient-Health Questionnaire-15 (PHQ-15) and the Somatic Symptom Disorder—B Criteria Scale (SSD-12). We investigated whether the reported sensitivity and specificity of both recommended cut-off combinations are transferable to primary care.MethodsIn a cross-sectional study, 420 unselected adult primary care patients completed PHQ-15 and SSD-12. Patients scoring ≥9 and ≥ 23 (recommended cut-off combination #1) or ≥ 8 and ≥ 13 (recommended cut-off combination #2) were considered test-positive for SSD, respectively. To assess the validity of the reported sensitivity and specificity in different low- to high-prevalence settings, we compared correspondingly expected proportions of test positives to the proportion observed in our sample.ResultsBased on combination #1, 38 participants (9%) were found to be test positive, far fewer than expected, based on the reported values for sensitivity and specificity (expected minimum frequency 30% with a true prevalence ≥1%). This can only be explained by a lower sensitivity and higher specificity in primary care. For combination #2, 98 participants (23%) were test positive, a finding consistent with a true prevalence of SSD of 15% or lower.DiscussionOur analyzes strongly suggest that the sensitivity and specificity estimates reported for combination #1 are not applicable to unselected primary care patients and that the cut-off for the SSD (≥23) is too strict. Cut-off combination #2 seems more applicable but still needs to be tested in studies that compare screening findings by questionnaires with validated diagnostic interviews as reference standards in primary care populations.