Journal of Psychosomatic Research
Volume 68, Issue 3 , Pages 253-262 , March 2010

Patients with medically unexplained symptoms and their significant others: Illness attributions and behaviors as predictors of patient functioning over time

  • Anja Hilbert

      Affiliations

    • Division of Clinical Psychology and Psychological Therapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
    • Corresponding Author InformationCorresponding author. Division of Clinical Psychology and Psychological Therapy, Department of Psychology, Philipps University of Marburg, Gutenbergstrasse 18, D-35032 Marburg, Germany. Tel.: +49 6421 2823787; fax: +49 6421 2828904.
    • ,
  • Alexandra Martin

      Affiliations

    • Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Erlangen, Germany
    • ,
  • Thomas Zech

      Affiliations

    • Division of Clinical Psychology and Psychological Therapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
    • ,
  • Elisabeth Rauh

      Affiliations

    • Psychosomatic Clinic, Klinikum Staffelstein, Bad Staffelstein, Germany
    • ,
  • Winfried Rief

      Affiliations

    • Division of Clinical Psychology and Psychological Therapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany

Received 20 February 2009 ,Revised 18 August 2009 ,Accepted 14 September 2009.

References 

  1. Noyes R, Stuart SP, Langbehn DR, Happel RL, Longley SL, Muller BA, et al. Test of an interpersonal model of hypochondriasis. Psychosom Med. 2003;65:292–300
  2. Ciechanowski PS, Walker EA, Katon WJ, Russo JE. Attachment theory: a model for health care utilization and somatization. Psychosom Med. 2002;64:660–667
  3. Brown RJ, Schrag A, Trimble MR. Dissociation, childhood interpersonal trauma, and family functioning in patients with somatization disorder. Am J Psychiatry. 2005;162:899–905
  4. Noyes R, Langbehn DR, Happel RL, Stout LR, Muller BA, Longley SL. Personality dysfunction among somatizing patients. Psychosomatics. 2001;42:320–329
  5. Garcia-Campayo J, Alda M, Sobradiel N, Olivan B, Pascual A. Personality disorders in somatization disorder patients. A controlled study in Spain. J Psychosom Res. 2007;62:675–680
  6. Rost KM, Atkins RN, Brown FW, Smith GR. The comorbidity of DSM-III-R personality disorders in somatization disorder. Gen Hosp Psychiatry. 1992;14:322–326
  7. Stuart S, Russell N. Attachment and interpersonal communication in somatization. Psychosomatics. 1999;40:34–43
  8. Waller E, Scheidt CE, Hartmann A. Attachment representation and illness behavior in somatoform disorders. J Nerv Ment Dis. 2004;192:200–209
  9. Leonard MT, Cano A, Johansen AB. Chronic pain in a couples context: a review and integration of theoretical models and empirical evidence. J Pain. 2006;7:377–390
  10. Geisser ME, Cano A, Leonard MT. Factors associated with marital satisfaction and mood among spouses of persons with chronic back pain. J Pain. 2005;6:518–525
  11. Rief W, Nanke A. Somatization disorder from a cognitive-psychobiological perspective. Curr Opin Psychiatry. 1999;12:733–738
  12. Barsky AJ, Ahern DK, Bailey ED, Saintfort R, Liu EB, Peekna HM. Hypochondriacal patients' appraisal of health and physical risks. Am J Psychiatry. 2001;158:783–787
  13. Butler JA, Chalder T, Wessely S. Causal attributions for somatic sensations in patients with chronic fatigue syndrome and their partners. Psychol Med. 2001;31:97–105
  14. Kolk AM, Hanewald GJ, Schagen S, Gijsbers van Wijk CM. Predicting medically unexplained physical symptoms and health care untilization. A symptom-perception approach. J Psychosom Res. 2002;52:35–44
  15. Rief W, Nanke A, Emmerich J, Bender A, Zech T. Causal illness attributions in somatoform disorders - Associations with comorbidity and illness behavior. J Psychosom Res. 2004;57:367–371
  16. Robbins JM, Kirmayer LJ. Attributions of common somatic symptoms. Psychol Med. 1991;21:1029–1045
  17. Kolk AMM, Schagen S, Hanewald G. Multiple medically unexplained physical symptoms and health care utilization outcome of psychological intervention and patient-related predictors of change. J Psychosom Res. 2004;57:379–389
  18. Gauthier N, Thibault P, Sullivan MJ. Individual and relational correlates of pain-related empathic accuracy in spouses of chronic pain patients. Clin J Pain. 2008;24:669–677
  19. Fordyce WE. Behavioral methods for chronic pain and illness. St. Louis: Mosby; 1976;
  20. Paulsen JS, Altmaier EM. The effects of perceived versus enacted social support on the discriminative cue function of spouses for pain behaviors. Pain. 1995;60:103–110
  21. Romano JM, Turner JA, Friedman LS, Bulcroft RA, Jensen MP, Hops H, et al. Sequential analysis of chronic pain behaviors and spouse responses. J Consult Clin Psychol. 1992;60:777–782
  22. Romano JM, Turner JA, Jensen MP, Friedman LS, Bulcroft RA, Hops H, et al. Chronic pain patient-spouse behavioral interactions predict patient disability. Pain. 1995;63:353–360
  23. Pence LB, Thorn BE, Jensen MP, Romano JM. Examination of perceived spouse responses to patient well and pain behavior in patients with headache. Clin J Pain. 2008;24:654–661
  24. Flor H, Turk DC. Psychophysiology of chronic pain: Do chronic pain patients exhibit symptom-specific psychophysiological responses?. Psychol Bull. 1989;105:215–259
  25. Kerns RD, Haythornthwaite J, Southwick S, Giller EL. The role of marital interaction in chronic pain and depressive symptom severity. J Psychosom Res. 1990;34:401–408
  26. Turk DC, Kerns RD, Rosenberg R. Effects of marital interaction on chronic pain and disability: Examining the down side of social support. Rehabil Psychol. 1992;37:259–274
  27. Rief W, Martin A, Rauh E, Zech T, Bender A. Evaluation of a general practitioners' training: How to manage patients with unexplained physical symptoms. Psychosomatics. 2006;47:304–311
  28. Rief W, Zenz M, Schweiger U, Rüddel H, Henningsen P, Nilges P. Redefining (somatoform) pain disorder in ICD-10: A compromise of different interest groups in Germany. Curr Opin Psychiatry. 2008;21:178–181
  29. Hiller W, Zaudig M, Mombour W. International Diagnostic Check Lists for ICD-10 and DSM-IV. Bern: Huber; 1997;
  30. Rief W, Hiller W. Screening für Somatoforme Störungen (SOMS). Bern: Huber; 1997;
  31. Weinman J, Petrie KJ, Moss-Morris R, Horne R. The illness perception questionnaire. A new method for assessing the cognitive representation of illness. Psychol Health. 1996;11:431–445
  32. Kröner-Herwig B. Rückenschmerz. In:  Schulte D,  Hahlweg K,  Margraf J,  Vaitl D editor. Fortschritte der Psychotherapie - Manuale für die Praxis. vol. 10:Göttingen: Hogrefe; 2000;
  33. Beck AT, Steer RA. Beck Depression Inventory. Manual. San Antonio: The Psychological Cooperation; 1987;
  34. Hautzinger M, Bailer M, Worall H, Keller F. Beck Depressionsinventar. 2. Aufl. Bern: Huber; 1995;
  35. Beck A, Steer R. Beck Anxiety Inventory Manual. San Antonio: The Psychological Corporation; 1993;
  36. Margraf J, Ehlers A. Das Beck Angst-Inventar (BAI). Bern: Huber; 2007;
  37. Cohen J. A power primer. Psychol Bull. 1992;112:155–159
  38. Schmaling KB, Fiedelak JI, Katon WJ, Bader JO, Buchwald DS. Prospective study of the prognosis of unexplained chronic fatigue in a clinic-based cohort. Psychosom Med. 2003;65:1047–1054
  39. Flor H, Kerns RD, Turk DC. The role of spouse reinforcement, perceived pain, and activity levels of chronic pain patients. J Psychosom Res. 1987;31:251–259
  40. Cano A, Weisberg JN, Gallagher RM. Marital satisfaction and pain severity mediate the association between negative spouse responses to pain and depressive symptoms in a chronic pain patient sample. Pain Med. 2000;1:35–43
  41. Ciechanowski P, Sullivan M, Jensen M, Romano J, Summers H. The relationship of attachment style to depression, catastrophizing and health care utilization in patients with chronic pain. Pain. 2003;104:627–637
  42. MacLeod AK, Haynes C, Sensky T. Attributions about common bodily sensations: Their associations with hypochondriasis and anxiety. Psychol Med. 1998;28:225–228
  43. Christensen A. Dysfunctional interaction patterns in couples. In:  Noller P,  Fitzpatrick MA editor. Perspectives on marital interaction. Clevedon: Multilingual Matters; 1988;p. 31–52
  44. Rehman US, Holtzworth-Munroe A. A cross-cultural analysis of the demand-withdraw marital interaction: observing couples from a developing country. J Consult Clin Psychol. 2006;74:755–766
  45. Peters ML, Sorbi MJ, Kruise DA, Kerssens JJ, Verhaak PF, Bensing JM. Electronic diary assessment of pain, disability and psychological adaptation in patients differing in duration of pain. Pain. 2000;84:181–192
  46. Davis MC, Affleck G, Zautra AJ, Tennen H. Daily interpersonal events in pain patients: applying action theory to chronic illness. J Clin Psychol. 2006;62:1097–1113
  47. Cano A, Barterian JA, Heller JB. Empathic and nonempathic interaction in chronic pain couples. Clin J Pain. 2008;24:678–684
  48. Goubert L, Craig KD, Vervoort T, Morley S, Sullivan MJ, de C Williams AC, et al. Facing others in pain: the effects of empathy. Pain. 2005;118:285–288
  49. Strand EB, Zautra AJ, Thoresen M, Ødegård S, Uhlig T, Finset A. Positive affect as a factor of resilience in the pain-negative affect relationship in patients with rheumatoid arthritis. J Psychosom Res. 2006;60:477–484
  50. Johansen AB, Cano A. A preliminary investigation of affective interaction in chronic pain couples. Pain. 2007;132(Suppl 1):86–95
  51. Schwartz L, Jensen MP, Romano JM. The development and psychometric evaluation of an instrument to assess spouse responses to pain and well behavior in patients with chronic pain: the Spouse Response Inventory. J Pain. 2005;6:243–252
  52. Salmon P, Wissow L, Carroll J, Ring A, Humphris GM, Davies JC, et al. Doctors' responses to patients with medically unexplained symptoms who seek emotional support: criticism or confrontation?. Gen Hosp Psychiatry. 2007;29:454–460
  53. Dowrick CF, Ring A, Humphris GM, Salmon P. Normalisation of unexplained symptoms by general practitioners: a functional typology. Br J Gen Pract. 2004;54:165–170
  54. Aiarzaguena JM, Grandes G, Gaminde I, Salazar A, Sánchez A, Ariño J. A randomized controlled clinical trial of a psychosocial and communication intervention carried out by GPs for patients with medically unexplained symptoms. Psychol Med. 2007;37:283–294
  55. Morriss R, Gask L, Dowrick C, Dunn G, Peters S, Ring A, et al. Randomized trial of reattribution on psychosocial talk between doctors and patients with medically unexplained symptoms. Psychol Med. 2009;2:1–9

PII: S0022-3999(09)00375-4

doi: 10.1016/j.jpsychores.2009.09.012

Journal of Psychosomatic Research
Volume 68, Issue 3 , Pages 253-262 , March 2010

Article Tools