Adult Somatic Preoccupation and Its Relationship to Childhood Trauma
Sansone, Randy A., Wiederman, Michael W., Sansone, Lori A., Violence and Victims
Somatic preoccupation has been associated with a variety of comorbid psychiatric conditions including childhood trauma, personality disorder, and depression. The current study was undertaken to simultaneously explore the inter-relationship of these psychiatric variables as conceptualized in a path model. Participants (N = 120), both men and women, seen for nonemergent health care in a resident-staffed internal medicine clinic, were given questionnaires exploring the presence of childhood trauma, borderline personality symptomatology, current depression, worry, and somatic preoccupation. With one exception, all simple correlation coefficients among study variables were relatively substantial. By sequencing variables into an a priori model and using a path analytic approach, several indirect and direct relationships among variables were evident. Most important, childhood trauma exhibited a direct effect on somatic preoccupation as well as indirect effects through borderline personality disturbance and current depression. These data suggest that childhood trauma may be a precursor for somatic preoccupation during adulthood.
Somatic preoccupation is a descriptive term that applies to a broad range of heterogeneous patients who report physical complaints without medically confirmed or complementary physical findings (i.e., findings, if present, do not correspond to the degree of complaint). Thus, the term somatic preoccupation might apply to individuals who
1. manifest psychological conflicts in a somatic fashion;
2. have notable psychological factors that accompany or complicate a genuine physical disorder; or
3. have psychophysiologic symptoms in which psychological factors play a major role (Righter & Sansone, 1999).
In clinical practice, the majority of these individuals do not meet DSM-IV (American Psychiatric Association, 1994) criteria for somatoform disorders (i.e., they appear to have subthreshold syndromes; Righter & Sansone, 1999).
The etiology of somatic preoccupation remains unclear, but psychiatric syndromes appear to be concurrent in many cases (Righter & Sansone, 1999). Whether psychiatric syndromes are primary or secondary is unknown. Comorbid psychiatric syndromes include both depression (Kellner, 1991; Lipowski, 1990; Simon, Gator, Kisely, & Piccinelli, 1996) and anxiety (Simon et al., 1996; Spinhoven & van der Does, 1997); early developmental trauma, including sexual (Collett, Cordle, Stewart, & Jagger, 1998; Farley & Keaney, 1997; Morse, Suchman, & Frankel, 1997; Polusny & Follette, 1995) and physical (Badura, Reiter, Altmaier, Rhomberg, & Elas, 1997) abuse (multiple forms of maltreatment appear most predictive; Arnold & Privitera, 1996; Walker, Keegan, Gardner et al., 1997); and personality disorder (Bass & Murphy, 1995; Lipowski, 1990). With regard to the latter, Hudziak and colleagues (1996) found that 25% of patients with borderline personality disorder (BPD) met criteria for somatization disorder. Surprisingly, the relationship between somatic preoccupation and worry, a common accompanying feature of depression, is not well studied.
Among these comorbid psychiatric variables, two hypothetical relationships to somatic preoccupation seem plausible. First, each of these variables may distinguish separate and discrete subsets of patients with somatic preoccupation. In other words, somatic preoccupation may be independently related to each variable.
Second, there may be an inter-relationship among the variables with a possible sequential relationship among some. For these particular variables, the following sequential model of factors seemed most plausible, based upon available research. Childhood trauma would appear to be the initial event in a sequential model. One possible outcome of childhood trauma is borderline personality symptomatology (Zanarini & Frankenburg, 1997). Indeed, numerous researchers have reported associations between BPD and specific types of childhood trauma such as sexual abuse (Bryer, Nelson, Miller, & Kroll, 1987; Fossati, Madeddu, & Maffei, 1999), combined sexual and physical abuse (Brown & Anderson, 1991; Goldman, D'Angelo, DeMaso, & Mezzacappa, 1991; Ogata etal. …