This was a study of physicians' narratives regarding their medical experiences with children with persistent medically unexplained physical illness. The goal was to better understand those attitudes and beliefs that are involved in the construction of meaning regarding the child's symptoms of illness or pain. The study also sought to learn more about physicians' early life experiences with health and illness and their potential to shape diagnostic thinking and treatment. Ten physician participants were interviewed using an open-ended, semistructured interview methodology. Interviews were analyzed using an alternative narrative approach described by Mishler (1986, 1991) to identify key themes within and across interviews for comparative analysis. The subjective experience and dynamic discourse between interviewer and participant were also analyzed (Mishler, 1991; Paget, 1983). Four key themes emerged: (1) the experience of certainty and uncertainty; (2) physician search for restitution; (3) the path to truth and the construction of the physician's illness narrative; and (4) the parallel anxiety between physician and parent. Findings suggested a "stages of training" model or developmental career theme associated with the ways in which physicians make meaning of persistent medically unexplained illness or pain in the child. Implications for diagnosis and treatment include the possibility that the nature of the relationship between physicians and parents-- particularly the ability to negotiate trust, intimacy, and power--may lead to a hidden and collaborative meaning making of symptoms that occurs in exclusion, of the child, Certain early life experiences of the physician may also be brought to bear in the medical encounter with parent and child. Physicians would benefit from training in neutrality and negotiation of therapeutic goals with parents of sick children, as well as training to enhance self-awareness and understanding of the ways in which alliances and conflicts with patients and parents may occur as a result of family of origin issues.

Die vorliegende Arbeit beschreibt, wie depressive und somatoforme Beschwerden auf die global konzeptualisierte Lebenszufriedenheit wirken. Anhand einer bevölkerungsrepräsentativen Stichprobe (N=2510) wird diese Fragestellung analysiert. Ziel ist es zum einen zu klären, ob bereits subklinische Beschwerden zu deutlichen Einschränkungen der Lebenszufriedenheit führen und zum anderen, wie sich die beiden Beschwerdegruppen im Zusammenspiel auf die Lebenszufriedenheit auswirken. Somatische und depressive Symptome werden dimensional (subklinische Symptome eingeschlossen) untersucht und somatoforme und depressive Syndrome kategorial (auf ICD-10 Diagnose-Ebene) analysiert – quantifiziert jeweils mit dem Patient Health Questionnaire (PHQ). Lebenszufriedenheit wird mit den Fragen zur Lebenszufriedenheit (FLZ-M) gemessen. Univariate Kovarianzanalysen dienen zur statistischen Prüfung. Die Ergebnisse werden in einer Publikation dargestellt. Unter Berücksichtigung komorbider depressiver Symptome/Syndrome wirken sich somatische Symptome und somatoforme Syndrome nur auf einige Bereiche der Lebenszufriedenheit negativ aus. Eine dimensionale Auswertung ist sinnvoll, um den Einfluss subklinischer Symptome zu beschreiben.

No description available.

Epidemiological studies show that China has a lower prevalence rate of major depression than that of Western countries. The disparity in prevalence is commonly attributed to the tendency of Chinese to somatize depression. Empirical evidence of Chinese somatization has yielded mixed results. The present study thus aimed to 1) examine differences in somatic and psychological symptom reporting between Chinese from Macau and Americans in America and 2) identify cultural and psychological variables that would predict somatization. Independent and interdependent self-construals, sociotropy, and emotional approach coping were hypothesized to predict somatization of depression. Participants included 353 Chinese and 491 American college students who completed self-report measures online. Contrary to prediction, results indicated that Americans endorsed a higher proportion of somatic symptoms than Chinese did. Sociotropy predicted both relative endorsement and severity of somatic symptoms for the American sample, whereas emotional expression coping was related to somatization in the Chinese sample. The findings challenge the common assumption of greater Chinese somatization and highlight the importance of context in understanding the relationships between somatization and cultural and psychological variables. Implications of the present study and future directions are discussed.

In this dissertation, the author provides an account of his therapeutic interaction and experience, as an intern clinical psychologist, in working with a patient in psychotherapy who was eventually diagnosed with a “factitious disorder”. This study descriptively addresses how the therapeutic interaction impacted upon the therapist’s thinking of the process both diagnostically and in terms of therapeutic goals. This study consists of a single case, qualitative research design. It concerns the interactions and experiences of the therapist with a specific patient (diagnosed with a factitious disorder) in the context of a multidisciplinary academic hospital setting. The study aims to be predominantly descriptive of this therapy, and as such employs the psychological phenomenological method of Giorgi (1985) in order to provide a specific description of the situated structure of the therapy. As such, this study is able to contribute to the sparse psychological and therapeutic information available on factitious disorders. There are few detailed accounts of actual therapeutic interactions – specifically from a psychological perspective – for patients diagnosed with factitious disorders. The specific description of the situated structure of the therapy is also compared to the available literature on factitious disorders. Although the aim of this study was not evaluative in nature, the author does provide some tentative comments on the aetiology and therapeutic considerations for factitious disorders – with regards to this particular case. The author suggests a strong link to personality and character deficits underlying factitious behaviour. The author further suggests the importance of acknowledging the “sick role”; allowing for “face-saving” strategies; providing consistency (on behalf of the therapist); and the setting of rigid, overt, therapeutic boundaries in the psychotherapeutic treatment of factitious disorders. / Dissertation (MA (Clinical Psychology))--University of Pretoria, 2005. / Psychology / unrestricted

Die vorliegende Arbeit beschreibt, wie depressive und somatoforme Beschwerden auf die global konzeptualisierte Lebenszufriedenheit wirken. Anhand einer bevölkerungsrepräsentativen Stichprobe (N=2510) wird diese Fragestellung analysiert. Ziel ist es zum einen zu klären, ob bereits subklinische Beschwerden zu deutlichen Einschränkungen der Lebenszufriedenheit führen und zum anderen, wie sich die beiden Beschwerdegruppen im Zusammenspiel auf die Lebenszufriedenheit auswirken. Somatische und depressive Symptome werden dimensional (subklinische Symptome eingeschlossen) untersucht und somatoforme und depressive Syndrome kategorial (auf ICD-10 Diagnose-Ebene) analysiert – quantifiziert jeweils mit dem Patient Health Questionnaire (PHQ). Lebenszufriedenheit wird mit den Fragen zur Lebenszufriedenheit (FLZ-M) gemessen. Univariate Kovarianzanalysen dienen zur statistischen Prüfung. Die Ergebnisse werden in einer Publikation dargestellt. Unter Berücksichtigung komorbider depressiver Symptome/Syndrome wirken sich somatische Symptome und somatoforme Syndrome nur auf einige Bereiche der Lebenszufriedenheit negativ aus. Eine dimensionale Auswertung ist sinnvoll, um den Einfluss subklinischer Symptome zu beschreiben.

Refugees from war zones often have missing significant others. A loss without confirmation is described as an ambiguous loss. This physical absence with simultaneous mental persistence can be accompanied by economic, social or legal problems, boundary ambiguity (i.e., uncertainty about who belongs to the family system), and can have a negative impact on mental health. The aim of this study was to identify sociodemographic and loss-related predictors for prolonged grief, anxiety, depression, post-traumatic stress disorder (PTSD) and somatization in treatment-seeking Syrian refugees with post-traumatic stress symptoms in Germany experiencing ambiguous loss. For the present study, data were based on the treatment-seeking baseline sample of the “Sanadak” randomized-controlled trial, analyzing a subsample of 47 Syrian refugees with post-traumatic stress symptoms in Germany experiencing ambiguous loss. Sociodemographic and loss-related questions were applied, along with standardized instruments for symptoms of prolonged grief (ICG), anxiety (GAD-7), depression (PHQ-9), PTSD (PDS-5) and somatization (PHQ-15). Linear regression models were used to predict mental health outcomes. Having lost a close family member and higher boundary ambiguity showed a statistically significant association with higher severity in prolonged grief. The overall model for somatization reached statistical significance, while no predictor independently did. Boundary ambiguity showed a statistically significant positive association with depression, while the overall model showed no statistically significant associations. Boundary ambiguity and missing family members seemed to be important predictors for prolonged grief. These findings support the importance of reunification programs and suggest an inclusion of the topic into psychosocial support structures, e.g., including psychoeducational elements on boundary ambiguity in support groups for traumatized individuals and families experiencing ambiguous loss. Further research is needed for a more detailed understanding of the impact of ambiguous loss on refugee populations.

No description available.

Abstract not available

Objetivo: Analizar propiedades psicométricas de la versión española del Screening for Somatoform Symptoms (SOMS-2) en muestra de pacientes de Atención Primaria de España. Método: Se administró la traducción Española de la versión original de la SOMS-2 junto con la Entrevista Psiquiátrica Estructurada Polivalente (EPEP) a una muestra 165 pacientes de Atención Primaria. 74 pacientes realizaron un tratamiento cognitivo-conductual de 10 sesiones semanales de hora y media de duración. Se evaluó la fiabilidad test-retest a 6 y 12 meses de finalizar el tratamiento. Resultados: La SOMS-2 de 53 ítems y con punto de corte de 4 presenta sensibilidad del 97%, especificidad de 68%, Valor Predictivo Positivo (VPP) de 85% y Valor Predictivo Negativo (VPN) de 92% y α de Cronbach de 0,82. Conclusiones: La versión española de la SOMS-2 muestra buena consistencia interna, sensibilidad y especificidad. Resulta un instrumento de cribaje útil para evaluar el trastorno de somatización en Atención Primaria.