Duddu Venugopal, Isaac Mohan K, Chaturvedi Santosh K
Avondale unit, Royal Preston Hospital, Preston, UK.
Int Rev Psychiatry. 2006 Feb;18(1):25-33. doi: 10.1080/09540260500466790.
Somatic symptoms have been conceptualized in many different ways in literature. Current classifications mainly focus on the numbers of symptoms, with relative neglect of the underlying psychopathology. Researchers have emphasized the importance of a number of experiential, perceptual and cognitive-behavioural aspects of somatization. This review focuses on existing literature on the role of somatosensory amplification, attribution styles, and illness behaviour in somatization. Evidence suggests that somatosensory amplification is neither sensitive nor specific to somatizing states, and that other factors like anxiety, depression, neuroticism, alexithymia may also have an influence. Attribution research supports the existence of multiple causal attributions, which are related to the numbers of somatic symptoms. While somatizing patients have more organic attributions, depressed patients have more psychological attributions. A global somatic attribution style is associated with the number of obscure somatic symptoms, while a psychological attribution style is associated with both--psychological and somatic-- symptoms of depression and anxiety. There are conflicting findings with respect to the role of normalizing attributions in reducing physician recognition of anxiety and depression. Specific symptom attributions appear to explain physician recognition of psychological distress, but global attribution styles do not appear to explain any further variance in physician recognition beyond that explained by specific causal attributions. Illness behaviour has been studied in two distinct ways in literature. Research focusing on attendance rates as a form of illness behaviour suggests that somatization is associated with high levels of health care utilization. There is also some evidence that health care utilization, amplification and attributions styles may be interrelated among somatizing patients. More structured ways to assess illness behaviour have found high levels of abnormal illness behaviour in this population. Overall, research appears to suggest a complex (and as yet unclear) relationship between somatic symptoms and underlying cognitions/illness behaviours. While it is clear that somatization is closely related to a number of perceptual and cognitive-behavioural factors, the precise nature of these relationships are yet to be elucidated.
在文献中，躯体症状有多种不同的概念化方式。当前的分类主要关注症状数量，相对忽视了潜在的精神病理学。研究人员强调了躯体化在体验、感知和认知行为等多个方面的重要性。本综述聚焦于关于躯体感觉放大、归因方式和疾病行为在躯体化中作用的现有文献。有证据表明，躯体感觉放大对躯体化状态既不敏感也不具有特异性，焦虑、抑郁、神经质、述情障碍等其他因素也可能产生影响。归因研究支持多种因果归因的存在，这些归因与躯体症状的数量有关。躯体化患者有更多的器质性归因，而抑郁患者有更多的心理归因。整体的躯体归因方式与不明原因的躯体症状数量相关，而心理归因方式与抑郁和焦虑的心理及躯体症状都相关。关于正常化归因在降低医生对焦虑和抑郁的识别方面的作用，存在相互矛盾的研究结果。特定症状归因似乎可以解释医生对心理困扰的识别，但整体归因方式似乎并不能解释医生识别中超出特定因果归因所解释的任何进一步差异。在文献中，疾病行为有两种不同的研究方式。以就诊率作为疾病行为形式的研究表明，躯体化与高医疗利用率相关。也有一些证据表明，在躯体化患者中，医疗利用率、放大作用和归因方式可能相互关联。更具结构性的评估疾病行为的方法发现，这一人群中存在高水平的异常疾病行为。总体而言，研究似乎表明躯体症状与潜在认知/疾病行为之间存在复杂（且尚未明确）的关系。虽然很明显躯体化与许多感知和认知行为因素密切相关，但这些关系的确切性质尚待阐明。
