Bibliography: leaves 233-306. A study of the phenomenon of somatization as it occurs in the primary care setting. The phenomenon was studied in terms of aspects of illness behaviour and risk of psychiatric morbidity. It is suggested that abnormal illness behaviour in the form of somatization may be an important factor in the non-recognition of mild non-psychotic psychiatric illness in the primary care setting. The results of the study indicate that an assessment of the patients' attitudes and beliefs about symptoms, and an exploration of psychosocial issues, may lead to a better understanding of why the patients have sought help, and may lead to early identification and appropriate treatment of somatizing behaviour and the psychiatric morbidity underlying such behaviour.

The aims of this thesis were to estimate the lifetime prevalence of physical, sexual, and psychological abuse in a random population-based sample of women aged 18-60 years; to estimate current suffering thereof; and to investigate associations between abuse and health problems, more specifically to study abuse related variables associated with somatization and PTSD, respectively. The studies had a cross-sectional design. Studies I and II comprised 4150 women 18-60 years. Study III included 547 women, and study IV consisted of 213 women, randomly selected from the population-based sample of the first two studies. The first study found lifetime prevalence rates of 19.4% for physical abuse, 9.2% for sexual abuse, and 18.2% for psychological abuse. Abused women reported more ill-health and a less advantageous social situation than non-abused women. There was an association between magnitude of abuse and health problems. Even a low magnitude of abuse was substantially associated with ill-health. In the second study we found that of the 27.5% of women who had reported any kind of abuse in the first study, 69.5 % reported current suffering thereof. Abused suffering women reported more health problems than abused non-suffering women and non-abused women, and abused non-suffering women reported more health problems than non-abused women. In study three, psychological abuse and sexual abuse without penetration were found to be associated with somatization. Physical abuse and sexual abuse with penetration were not associated with somatization, when adjustments for other kinds of abuse were made. In study four, PTSD and somatization were found to be separately reported phenomena in abused women, although PTSD was positively associated with having somatic symptoms. Women with PTSD reported higher total magnitude of abuse and a higher number of perpetrators than women with somatization. Sexually abused women with PTSD more often described their experience as an act of abuse compared with sexually abused women with somatization. The present thesis demonstrates that even a low magnitude of abuse is associated with health problems. It also shows that a majority of the abused women, when investigating lifetime history of abuse, reported current suffering thereof, which warrants considering abuse an important societal problem. The relationship between somatization and posttraumatic stress in abused women is discussed in relation to abuse variables. Other factors than severity of abuse, such as whether the abused woman herself perceives her experience as abuse, seem to be more decisive for development of somatization in abused women. The findings suggest that PTSD is not a necessary mediator between abuse and somatization.

Bibliography: leaves 233-306. / xvii, 306 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / A study of the phenomenon of somatization as it occurs in the primary care setting. The phenomenon was studied in terms of aspects of illness behaviour and risk of psychiatric morbidity. It is suggested that abnormal illness behaviour in the form of somatization may be an important factor in the non-recognition of mild non-psychotic psychiatric illness in the primary care setting. The results of the study indicate that an assessment of the patients' attitudes and beliefs about symptoms, and an exploration of psychosocial issues, may lead to a better understanding of why the patients have sought help, and may lead to early identification and appropriate treatment of somatizing behaviour and the psychiatric morbidity underlying such behaviour. / Thesis (Ph.D.)--University of Adelaide, Depts. of Psychiatry and General Practice, 2001

Thesis (Ph.D.) -- University of Adelaide, Depts. of Psychiatry and General Practice, 2001. / Bibliography: leaves 233-306.

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.

Despite a wealth of literature on the aetiology of somatic distress or somatization, somatic theory has failed to expand beyond a dualistic epistemology of causation. Within the primary health context where medically unexplained symptoms are characteristically articulated as literal, symbolic gestures of internal psychological processes, individuals' subjective accounts of somatic distress are reduced to objective phenomena and thus articulated on the grounds of absence. Within this context, the body as a lived, meaningful, perceiving subjectivity is silenced in favour of the corpse, thus rendering the somatizing individual's lived and subjective experience, expression and knowledge of somatic distress inaccessible. Instead, the somatizing individual is positioned within a domain of perturbed silence - a domain in which the professional's turning away or retreat from engaging somatization on the grounds of unique, subjective and corporeal experience, positions the patient/client as a passive, silent recipient whose somatic expressions as lived are overlooked. This study attempts to initiate a theoretical focus of departure from existing articulations of somatic distress through the development of a theoretical and epistemological framework that addresses some of the tensions inherent to contemporary somatic theory. In so doing, it employs embodiment philosophy and narrative methodology as a basis for a preliminary and critical investigation into a relatively neglected area of somatization research. / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in

The association between psychogenic knee pain in adolescent girls and parent-child behavior that involves (1) a high degree of control on the part of parents and (2) a high degree of submission on the part of adolescent daughters was investigated. The subjects, between the ages of 13 and 16 years, were patients of five doctors whom they were consulting about chronic knee pain. The doctors categorized each patient as either having "organic evidence" associated with their pain complaint (n=18) or "no organic evidence" (n=12). Each patient completed the Intrex Questionnaire: Short Forms B and C (Benjamin, 1988) which provided a set of data that descibed the daughters' perceptions of .their mothers' and fathers' behavior in relation to them and also the daughters' own behavior in relation to both parents. Similarity of the groups in terms of age, socioeconomic status and severity of pain was confirmed. Between-groups comparisons of the Intrex data yielded two significant differences. Daughters in the psychogenic pain group perceived their mothers as being both more controlling toward and more submissive to their daughters than did daughters in the organic group. Hypothesized differences between the groups regarding fathers' controlling behavior and daughters' submissive behavior were not supported. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

Somatization, the presentation of physical symptoms without an identifiable cause, is among the most common problems in primary medical care. Treatment approaches are typically offered within the medical consultation interview once the medical provider distinguishes between physical and emotional etiology. This dualistic strategy is especially troublesome for patients whose physical complaints cannot be validated and who are recommended for only mental health therapy. The aim of this study was to examine how medical practitioners can instead motivate patients to consider both physical and emotional treatment. An analogue intervention consisting of an enhanced consultation interview was compared to a care as usual consultation interview on the key outcome of motivation to engage in mental health treatment. A total of 129 participants with medically unexplained symptoms were randomly assigned to these two conditions. Motivation to engage in mental health treatment was evaluated with the FMP Questionnaire, Credibility and Expectancy Questionnaire, and the newly developed Motivation to Engage in Therapy questionnaire (MET). Results of ANCOVA revealed significant differences between the two analogue consultation interviews on 3 out of 5 outcome measures. The largest effect was found for the MET followed by the credibility and expectancy subscales (1.6, .9, and .8). This finding suggests that a particular type of discourse between medical provider and patient can lead to increased motivation for holistic care treatment for those with somatization.

Somatoform disorder is a prevalent mental health disorder in the United States. This disorder costs the United States one billion dollars annually. Medical providers report somatoform disorder is difficult to treat. Previous studies have shown that Cognitive Behavioral Therapy (CBT) is effective at reducing symptoms of somatoform disorder. Unfortunately, little research has been done on treatment outcomes and cost of somatoform disorder, particularly by profession to reduce health care costs for somatoform patients and providers. Administrative data from CIGNA for 149 somatoform disorder cases were analyzed to determine the cost, number of sessions, dropout rates, and recidivism rates for somatoform disorder. These same variables for somatoform disorder were also analyzed by profession for medical doctors, psychologists, master's nurses, master's social workers, marriage and family therapists, and professional counselors. Descriptive statistics showed that the recidivism rates and number of sessions for somatoform disorder is higher than average. Drop-out rates were consistent with the average. Analyses revealed no significant difference in total cost by profession, but did indicate a significant difference in cost per session for medical doctors. Analyses indicate lower level (M.S.) providers have no significant difference in drop-out rates and recidivism rates compared to higher level (Ph.D.) providers.

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