Wientjes C J, Grossman P
TNO Institute for Perception, Soesterberg, The Netherlands.
Psychosom Med. 1994 Nov-Dec;56(6):533-40. doi: 10.1097/00006842-199411000-00009.
Current research has all but refuted previous suggestions about the role of hyperventilation as a proximal, common cause of psychosomatic symptoms. As an alternative, it has been proposed that the experience of psychosomatic symptoms is primarily associated with psychological mechanisms, i.e., with enhanced tendencies of distressed individuals to focus their attention on bodily sensations and to evaluate these in a catastrophic manner. Although this hypothesis has received considerable empirical support, physiological influences on symptom reporting have not, as yet, been fully explored. In this study, contributions of psychological and physiological factors were studied among a group of 83 normal healthy male subjects by an assessment of the interindividual relationships between symptom experience in daily life, situational and dispositional anxiety, baseline end-tidal partial carbon dioxide pressure (PCO2), and heart rate. Trait anxiety and end-tidal PCO2 each contributed separately to the prediction of the psychosomatic symptom score. Trait anxiety explained nearly one third of the symptom variance, and an additional 4% was explained by PCO2. Psychological symptoms were more strongly associated with anxiety and somatic symptoms, more strongly with PCO2. Heart rate only tended to be correlated with symptom reporting. Analysis of covariance among subgroups of extreme-symptom reporters supported the correlational findings by demonstrating that the association between hyperventilation and symptom reporting remained intact when psychological influences were factored out. The findings suggest that reports of psychosomatic symptoms represent two distinct components: one that is primarily psychological (and is unrelated to physiological factors) and a second that reflects objective variance in physiological functioning. The influence of the first component is probably greater than that of the second.
当前的研究几乎已经驳斥了先前有关过度换气是心身症状的直接常见原因的观点。作为一种替代观点，有人提出心身症状的体验主要与心理机制相关，即与处于痛苦中的个体更倾向于将注意力集中在身体感觉上并以灾难性的方式对这些感觉进行评估有关。尽管这一假设已获得相当多的实证支持，但生理因素对症状报告的影响尚未得到充分探究。在本研究中，通过评估日常生活中的症状体验、情境性和特质性焦虑、基线呼气末二氧化碳分压（PCO₂）以及心率之间的个体间关系，对83名正常健康男性受试者群体中心理和生理因素的作用进行了研究。特质焦虑和呼气末PCO₂各自分别对心身症状评分的预测有贡献。特质焦虑解释了近三分之一的症状变异，PCO₂额外解释了4%。心理症状与焦虑和躯体症状的关联更强，与PCO₂的关联也更强。心率仅倾向于与症状报告相关。对极端症状报告者亚组的协方差分析通过表明在排除心理影响后过度换气与症状报告之间的关联仍然存在，支持了相关研究结果。这些发现表明，心身症状报告代表两个不同的成分：一个主要是心理成分（与生理因素无关），另一个反映生理功能的客观变异。第一个成分的影响可能大于第二个成分。
