Department of Clinical Medicine, Aarhus University, Denmark; Department of Psychology and Behavioural Sciences, Aarhus University, Denmark.
Research Unit for General Practice, UiT, The Arctic University of Norway, Norway.
J Psychosom Res. 2014 Feb;76(2):99-104. doi: 10.1016/j.jpsychores.2013.11.005. Epub 2013 Nov 16.
Patients with somatoform disorders could be vulnerable to stressors and have difficulties coping with stress. The aim was to explore what the patients experience as stressful and how they resolve stress in everyday life.
A cross-sectional retrospective design using 24 semi-structured individual life history interviews. Data-analysis was based on grounded theory.
A major concern in patients was a longing for existential recognition. This influenced the patients' self-confidence, stress appraisals, symptom perceptions, and coping attitudes. Generally, patients had difficulties with self-confidence and self-recognition of bodily sensations, feelings, vulnerability, and needs, which negatively framed their attempts to obtain recognition in social interactions. Experiences of recognition appeared in three different modalities: 1) "existential misrecognition" covered the experience of being met with distrust and disrespect, 2) "uncertain existential recognition" covered experiences of unclear communication and a perception of not being totally recognized, and 3) "successful existential recognition" covered experiences of total respect and understanding. "Misrecognition" and "uncertain recognition" related to decreased self-confidence, avoidant coping behaviours, increased stress, and symptom appraisal; whereas "successful recognition" related to higher self-confidence, active coping behaviours, decreased stress, and symptom appraisal.
Different modalities of existential recognition influenced self-identity and social identity affecting patients' daily stress and symptom appraisals, self-confidence, self-recognition, and coping attitudes. Clinically it seems crucial to improve the patients' ability to communicate concerns, feelings, and needs in social interactions. Better communicative skills and more active coping could reduce the harm the patients experienced by not being recognized and increase the healing potential of successful recognition.
躯体形式障碍患者可能容易受到压力源的影响，并且在应对压力方面存在困难。本研究旨在探讨患者所经历的压力源以及他们在日常生活中如何应对压力。
采用 24 例半结构式个体生活史访谈的横断面回顾性设计。数据分析基于扎根理论。
患者的主要关注点是对存在的认可的渴望。这影响了患者的自信心、压力评估、症状感知和应对态度。通常，患者在自信心和对身体感觉、情绪、脆弱性和需求的自我认知方面存在困难，这对他们在社交互动中获得认可的尝试产生了负面影响。认可的体验以三种不同的方式出现：1）“存在性误认”涵盖了被不信任和不尊重对待的体验，2）“不确定的存在性认可”涵盖了沟通不清晰和感知没有被完全认可的体验，3）“成功的存在性认可”涵盖了完全尊重和理解的体验。“误认”和“不确定的认可”与自信心下降、回避应对行为、压力增加和症状评估有关；而“成功的认可”与自信心提高、积极应对行为、压力降低和症状评估有关。
不同模式的存在性认可影响了自我认同和社会认同，从而影响了患者的日常压力和症状评估、自信心、自我认知和应对态度。临床上，改善患者在社交互动中表达关切、感受和需求的能力似乎至关重要。更好的沟通技巧和更积极的应对方式可以减少患者因未被认可而遭受的伤害，并增加成功认可的治疗潜力。
