Roelofs Karin, Spinhoven Philip
Section of Clinical and Health Psychology, Leiden University, the Netherlands.
Clin Psychol Rev. 2007 Oct;27(7):798-820. doi: 10.1016/j.cpr.2007.07.004. Epub 2007 Jul 17.
Medically unexplained symptoms (MUS) are frequently associated with a history of traumatization. The first purpose of the present review paper was to investigate systematically the evidence for such relation in a subset of clinical samples with MUS presenting with functional somatization: chronic pelvic pain, irritable bowel syndrome and conversion and somatization disorder. The second purpose was to critically review three dominant models explaining the relation between trauma and MUS (i.e. dissociation, conversion and hierarchical cognitive models). The latter model in particular adequately accounts for the non-volitional and non-intentional character of MUS and explains how traumata can affect the development of MUS without assuming that previous trauma is a necessary prerequisite of MUS. The cognitive model, however, lacks integration with current neurobiological findings, indicative of central stress-and central nervous system alterations in MUS. The final purpose of the present paper was, therefore, to review current neurobiological studies focused on trauma and MUS and to formulate a research agenda to integrate these neurobiological developments with cognitive models for MUS.
医学上无法解释的症状（MUS）常常与创伤史相关。本综述文章的首要目的是系统调查在表现为功能性躯体化的MUS临床样本子集中这种关联的证据：慢性盆腔疼痛、肠易激综合征以及转换和躯体化障碍。第二个目的是批判性地审视解释创伤与MUS之间关系的三种主要模型（即解离、转换和层级认知模型）。尤其是后一种模型充分说明了MUS的非自愿和非故意性质，并解释了创伤如何能够影响MUS的发展，而无需假定先前的创伤是MUS的必要先决条件。然而，认知模型缺乏与当前神经生物学研究结果的整合，这些研究结果表明MUS存在中枢应激和中枢神经系统改变。因此，本文的最终目的是回顾当前聚焦于创伤与MUS的神经生物学研究，并制定一个研究议程，将这些神经生物学进展与MUS的认知模型整合起来。
