Thesis (Ph. D.)--Auburn University, 2008. / Abstract. Includes bibliographical references (p. 88-98).

The following study examines two samples of children; children diagnosed as having a chronic illness, and children experiencing psychological distress. Children from both samples are at risk for similar things: poor social skills, challenges in establishing peer relationships, and the later development of psychiatric disorders in adulthood. Adding to these negative outcomes is the development of somatic complaints within each sample. Little research has examined children experiencing psychological distress prior to diagnosis, nor has a comprehensive study been conducted on children with epilepsy examining each of the adaptive skill areas. Further study of the adaptive skill areas for each group provides a foundation for understanding the strengths and weaknesses that each sample has. The following study is a quantitative, multisource, retrospective research project using parent/guardian completed rating scales relating to child behaviors; medical history information was also obtained from the chronic illness group. The relationship between somatic complaints and adaptive skills for children experiencing psychological distress (n = 128) was explored utilizing nonparametric statistical analysis. Additional nonparametric analyses were used for children with chronic illness (n = 94) to understand the relationship between adaptive skills and somatic complaints with the added medical factors of duration of illness and age of onset. The results of the children experiencing psychological distress suggest that age and sex play a role in adaptive skills, with both groups sharing common deficits in functional communication and adaptive skills. Internalizing and externalizing disorders were both positively correlated with somatic complaints, while adaptability and leadership were negatively correlated. The results of the epilepsy group indicate differing adaptive skill profiles for the complex partial (CP) and secondary generalized (SGTC) tonic clonic group. SGCT group had deficits in the areas of activities of daily living and leadership, while the CP group had no reported adaptive skill concerns but elevations in somatization. For both groups, onset and duration of illness were correlated with adaptability, functional communication and activities of daily living. Exploratory analysis utilizing teacher reports yielded negative correlations between somatization and functional communication, and deficits in the area of adaptability for the CP seizure group.

The purpose of the present study was to compare the factor structure of distress, comprised of depression, anxiety, and somatization, across Turkey and the U.S., and to investigate the metric invariance of the instruments used to measure distress: The Beck Depression Inventory-II, The State Trait Anxiety Inventory Trait subscale, and TheSymptom Check List 90-R Somatization subscale. Data from 778 Turkish and U.S. participants were used for the analyses. It was found that depression, somatization, and anxiety are three distinct but related constructs for both Turkish and U.S. participants. It was also found that BDI-II, STAI-Trait, and SCL-90-R-Somatization do not have metric invariance across the two cultures, and these instruments do not measure the same distress construct across Turkey and U.S. Stated differently, distress as measured by these three instruments has different meanings for Turkish and U.S. participants. According to the results of a freelist analysis, somatic, cognitive, behavioral, and affective reactions to distress were equally salient for Turkish students. In contrast, affective and somatic reactions to distress had more salience for the U.S. participants.Some of the results obtained from the current study contradicted previous findings, while some were consistent. The results were consistent with the way depression, anxiety, and somatization are conceptualized in the DSM-IV (American Psychiatric Association, 1994) as separate constructs, but contradicted Krueger et al.'s findings (2003) and Broom's unitary model of personhood (2000, 2003). Results from the freelist analysis contradicted the previous findings indicating that Turkish individuals are more likely to somatize compared to individuals from the U.S. (Gureje et al., 1997). The methodological differences between the current study and the previous studies (Gureje et al., 1997), such as differences in the instrumentation and the educational levels of the participants, may have caused the observed differences in the findings. The results from the current study should be interpreted in light of its limitations, such as use of convenience sampling, instrumentation, and the effect of potential response biases. Future studies are needed to further investigate the cross-cultural metric invariance and item bias of BDI-II, STAI-Trait, and SCL-90-R-Somatization individually. / Department of Counseling Psychology and Guidance Services

published_or_final_version / Psychology / Master / Master of Philosophy

Thesis (M. Phil.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 89-103). Also available in print.

Thesis (Ph. D.)--Rutgers University, 2008. / "Graduate Program in Psychology." Includes bibliographical references (p. 70-74).

Thesis (M.A.)--George Mason University, 2009. / Vita: p. 60. Thesis director: Koraly Perez-Edgar. Submitted in partial fulfillment of the requirements for the degree of Master of Arts in Psychology. Title from PDF t.p. (viewed Oct. 12, 2009). Includes bibliographical references (p. 54-59). Also issued in print.

Previous studies have reported that deficits in attention are often a common complaint in individuals suffering from pain and attentional impairment in patients with pain has been demonstrated on a variety of neuropsychological measures. Much of the research to-date, however, has not taken into account extraneous factors that may contribute to observed cognitive deficits. Using the California Verbal Learning Test - II, attention and memory performance was examined in two clinical populations (pain and mild traumatic brain injury) while controlling for effort using the Word Memory Test. Controlling for effort led to different explanations of poor performance on attention variables. While mild deficits were expected, and could be accounted for by psychological factors (i.e. somatization), extremely poor performance was more likely related to poor effort. The findings of this study strongly support the necessity of measuring effort during neuropsychological and pain psychological evaluations.

Placebo’s (positive expectancies producing positive outcomes) and nocebo’s (negative expectancies producing negative outcomes) are real and measurable effects. Real as these effects may be, predicting individuals that may be susceptible to placebo/nocebo effects has been inconsistent. The present study examined whether measures designed to assess somatization (MSPQ), catastrophizing (PCS) and childhood trauma (CTQ) would predict placebo and nocebo membership. In addition, measures designed to assess anxiety (ASI) anxiety about pain (PASS) and depression (BDI) were evaluated to determine whether anxiety or depression mediates responsiveness. The Hargreaves Thermal Withdrawal test and the submaximal effort tourniquet technique were employed as pain vehicles for the measurement of group differences. No significant effects of planned analyses were observed. However, unplanned analyses of childhood trauma subscales indicated that physical and emotional abuse predicted placebo response. Additionally, emotional neglect trended toward predicting nocebo responsiveness. These results indicate that further studies, correcting for weaknesses, is warranted.

O termo \"Psicossomática\" utilizado para designar a inter-relação entre sintomas físicos e fatores emocionais nas diversas patologias variou durante anos provocando confusões. Os diversos tratamentos médicos podem elevar gastos nos serviços de saúde. O presente estudo busca caracterizar a demanda de pacientes do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) no período de 1996 a 2004 cujo diagnóstico é Doença Psicossomática. A coleta de dados foi realizada em prontuários médicos, no Serviço de Arquivo Médico (SAME), com a categoria diagnóstica F 45 que, de acordo com o CID-10, significa Transtorno de Somatização; essa categoria foi utilizada como palavra chave no banco de dados. Na busca pelos prontuários foram encontrados 397, porém apenas 136 registravam o diagnóstico F 45, amostra do presente estudo. A coleta foi dificultada devido às letras ilegíveis e à falta de dados nos prontuários relacionados aos itens do instrumento de coleta. A população constitui-se pela maioria nascida no Estado de São Paulo com 43% da amostra, desses 14% nasceram em Ribeirão Preto-SP e 29% nasceram em outras cidades do Estado; são moradores do Estado de São Paulo 48%, desses 26% moram em Ribeirão Preto e 22% moram em outras cidades do Estado; 74,2% dos indivíduos são do sexo feminino; 87% têm cor de pele branca; 57% têm 1º grau incompleto; 70% professam a religião católica. Quanto ao estado civil, tem-se que 57% dos indivíduos são casados/amasiados; 52,96% possuem filhos; 32% dos indivíduos vivem com uma pessoa na mesma casa; 43,4% exercem a ocupação do lar e 14% dos indivíduos possuem como fator estressor problemas de saúde. Os indivíduos atendidos na Unidade de Emergência, em sua maior parte, comparecem numa freqüência de até cinco vezes (35%); os atendidos nos ambulatórios do HC, em sua maioria, comparecem numa freqüência de 20 vezes (49%). Os internados possuem a freqüência de zero a cinco vezes com 57% dos indivíduos. O local com o maior número de atendidos é a Unidade de Emergência com 43% dos indivíduos da amostra. Os dados encontrados caracterizam a população de indivíduos portadores de Transtorno de Somatização como: mulheres, casadas ou amasiadas, de baixa renda, sem filhos, do lar, com faixa etária entre 43 e 53 anos, de cor branca, com 1º grau de escolaridade incompleta, católicas, que moram com uma pessoa na mesma casa, nascidas em outras cidades do Estado de São Paulo, residentes em Ribeirão Preto e que freqüentam a Unidade de Emergência sem seguir um tratamento médico. Dessa forma, esses pacientes com Transtorno Psicossomático, isto é, pacientes com Transtorno de Somatização, contribuem para elevar os custos e a demanda dos Serviços de Saúde. Se esses indivíduos fossem atendidos de acordo com suas necessidades individuais, as filas de espera poderiam diminuir e suas condições de saúde poderiam ser melhores. / The term \"Psychosomatics\", used to designate the interrelation between physical symptoms and emotional factors in different diseases has varied over time, provoking confusion in medical treatments, and has increased health service expenses. This study aims to characterize the demand of patients who attended the Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School (HCFMRP-USP) between 1996 and 2004, and were diagnosed as Psychosomatic Disease. Data were collected in medical files at the Medical Filing Service (SAME), which contained the diagnosis category F 45. According to the ICD-10, this means Somatization Disorder. This category was used as a key word in the file search. We found 397 files, only 136 of which contained registries of the F45 diagnosis and constituted the study sample. Data collection was impaired by unreadable handwriting and lack of data about items for data to be surveyed. The population consists of a majority born in the State of São Paulo (42%), 29% born in other cities in the same state and 14% in Ribeirão Preto; most participants (26%) live in Ribeirão Preto, while 22% live in other cities in the same state; 74.2% of individuals are women; 87% of the sample are white; 57% have not finished primary education and 70% proclaim themselves Catholic. As to civil status, 57% of participants are married or have a fixed partner; 52,96% have children; 32% of individuals live with one person in the same house, 43.4% are housewives, and 14% of individuals possess health problems as a stressor. Most of the participants (35%) attended at the Emergency Unit make up to five visits; individuals attended at the HC outpatient clinics mostly (49%) make 20 visits. Hospitalized patients make between zero and five visits, with 57% of the sample. The Emergency Unit attends the largest number of patients (43%). These data characterize the patient population with Somatization Disorder as: women, married or with a fixed partner, low income, without children, housewives, age range between 43 and 53 years, white, unfinished primary education, Catholic, live with one person in the same house, born in other cities of the State of São Paulo and living in Ribeirão Preto, and visit the Emergency Unit without receiving further medical follow-up treatment. Thus, patients with psychosomatic disorder, that is, patients with somatization disorder, contributing to high health system costs and also generate high care demands. If this population s needs were adequately attended to, waiting lines could decrease and these individuals could improve their health conditions.