Int J Clin Exp Med 2016;9(9):18564-18568

www.ijcem.com /ISSN:1940-
5901/IJCEM0026387

Original Article Psychological status and

coping strategy of somatization disorders

Haijie Zhang, Zhihua Zhang, Danning

Zhang

Shandong Mental Health Center, Jinan, P. R.

China

Received February 22, 2016; Accepted June 4, 2016; Epub September 15, 2016; Published September 30,
2016

Abstract: Objective: To evaluate the psychological status of patients with somatization disorders by using
question- naire survey and professional mental scale, aiming to provide effective coping strategies for
psychological and physical recovery. Methods: Fifty patients diagnosed with somatization disorder and 50
corresponding family mem- bers were assigned into the study group. Fifty healthy subjects and 50 their
family members were allocated into the control group. All participants received comprensive evaluation by
using SCL-90, SSRS and CSQ. Results: In the study group, the average scores of a majority of items in the
SAS and SDS were significantly higher than those in the control group (all P<0.05). The mean scores of
overall social and subjective support in patients with somatization disorder were considerably lower than
those in their counterparts (all P<0.05). In the study group, the average score of negative factor was
significantly higher whereas that of the positive factor was apparently lower compared with the values
obtained in the control group (all P<0.05). Conclusion: Patients diagnosed with somatization disorder and
their family members present with evident psychological symptoms, lack of social support and effective strat-
egy against the symptoms of somatization disorder.

Keywords: Somatization disorder, psychological health,

strategy

Introductio novel devel- opments and advancements

n have been accom- plished in terms of
somatization disorder, which is among the
Somatization disorder, also known as most challenging of psychiatric disorders
Briquet’s syndrome, is defined as a mental encountered in clinical experiences. Multiple
disorder clini- cally characterized by diagnostic criteria have been revised to
recurring, multiple and clinically significant facilitate the clinical diagnosis and corre-
complaints about somatic symptoms [1-3]. It sponding strategy. At present, differential
has been recognized in the DSM-IV-TR diag- nostic tools mainly include neurologic
classification scale, which is com- bined with disor- ders, systemic medical disorders, and
undifferentiated somatoform disor- der to alter- native psychiatric disorders, such as
become somatic symptom disorder in the mental anxiety disorders, conversion
latest version DSM-5, in which the diagnos- disorder, malin- gering, and factitious
tic criteria does not require a specific disorder, etc. Previous
number of somatic symptoms [4-7]. Multiple studies have reported that a large proportion
of patients present with more than one of been reported to assess the discrepancy
such ill- nesses complicated with between the patients and their family
somatization disorder [8-11]. In clinical members in terms of mental and psycho-
practice, somatization disor- der requires logical issues. In this study, multiple
comprehensive and novel psycho- social evaluation scales have been utilized to
treatment designed by the professional assess the mental and psychological status,
neurologists and psychiatrists and explore the major problems and identify
alternative mental experts. effective interventional strategies to radically
resolve these issues from both social and
However, most previous investigations family perspectives, which probably elevate
mainly focus upon evaluating the mental the mental recovery and qual- ity of life of
status of patients diagnosed with patients suffering from somatiza- tion
somatization disorder. Few studies have disorder.
Psychological status and coping strategy of somatization disorders
Materials and methods
Study subjects
In total, 50 patients diagnosed with somatiza- tion disorder admitted to XXX hospital between September
2014 and October 2015 and their family members (n=50) were recruited into the study group. All patients
were diagnosed acc- ording to International Statistical Classification of Diseases and Related Health
Problems [xxx] (ICD-10).
Among 50 patients, there were 13 males and 37 females, aged from 16 to 73 years, with mean age 43.8
± 10.7 years. Twelve patients had educational level of elementary school or below, 25 with junior middle
school, 9 with spe- cialized middle school or senior high school and 4 with college or university
background or above. Adult family members who could under- stand the survey contents, normal mental
state, without severe physical or psychological diseases or systemic illnesses were eligible for
subsequent analysis. Seven pairs of partici- pants were spouses, 11 were mother-and-son relationship,
12 were mother-and-daughter relationship, 6 were father-and-daughter rela- tionship, 6 were father-and-
son relationship, 5 were brother or sister relationship and 3 were mother and daughter-in-law relationship.
In the control group, 50 normal controls were all staff from XXX hospital. Meantime, 50 family members of
these 50 control individuals were also enrolled in this study. Adult family mem- bers who were able to
comprehend the survey contents, with normal mental state, without severe physical or psychological
diseases or systemic illnesses were eligible for subsequent survey.
Among 50 healthy controls, there were 14 males and 36 females, aged from 16 to 71 years, with mean
age 41.4 ± 10.3 years. Nine had educational level of elementary school or below, 17 with junior middle
school, 19 with specialized middle school or senior high school and 5 with college or university
educational lev- els or above. Ten pairs of participants were spouses, 12 were mother-and-son
relationship, 10 were mother-and-daughter relationship, 5 were father-and-daughter relationship, 5 were
father-and-son relationship, 6 were brother or sister relationship and 2 were mother and daughter-in-law
relationship.
18565 Int J Clin Exp Med 2016;9(9):18564-18568 The gender, age, educational background and patient-
family member relationship were totally matched with no statistical significance bet- ween the study and
control groups (all P>0.05).
Survey questionnaire
Symptom checklist-90 scale: The Symptom Ch- ecklist-90-R (SCL-90-R) is a relatively brief psy-
chometric instrument self-reported by the patients. SCL-90 is specially designed for indi- viduals aged 13
years and older, which consists of 90 items and takes 12-15 minutes to accom- plish all questions,
generating 9 scores along primary symptom dimensions and 3 scores among global distress indices.
Primary symp- tom dimensions that are assessed include somatization, obsessive-compulsive, interper-
sonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoti- cism, and a
category of “additional items” whi- ch assists the physicians to thoroughly evalu- ate alternative
perspectives of the symptoms of enrolled patients.
Social support rating scale: Social support rat- ing scale (SSRS) is composed of 10 items which are
divided into objective support, subjective support and social support covering three dimensions in total.
The questionnaire consists of problems and difficulties based on psycho- logical stress of patients and
multiple choices according to the sources of social support.
Coping style questionnaire: Coping style ques- tionnaire (CSQ) includes 62 items which are classified into
6 subscales, such as problem resolving, self-complain, seeking help, fantasy, escape and rationalization.
The score scale ranges from 0 or 1 system. Trait coping style questionnaire (TCSQ) and simplified coping
style questionnaire (SCSQ) were adopted to assess the negative and positive coping stra- tegies.
Results
Comparisons of SCL-90 scores between the study and control groups
As illustrated in Table 1, the mean scores of 8 items in patients diagnosed with somatization disorder and
their family members were signifi- cantly higher than those values in the healthy counterparts (all P<0.05).
However, the mean score of hostility item did not significantly differ between two groups (P>0.05).
Psychological status and coping strategy of somatization disorders
Table 1. Comparison of SCL-90 scores between the study and control groups
Study group (n=50) Control group (n=50) P Patient Family member Healthy subject Family member Somatization
disorder 2.93 ± 0.71 1.74 ± 0.56 1.36 ± 0.67 1.37 ± 0.48 <0.05 Obsessive-compulsive 2.91 ± 0.89 1.97 ± 0.43 1.67 ±
0.56 1.68 ± 0.53 <0.05 Interpersonal sensitivity 2.21 ± 0.77 1.97 ± 0.68 1.68 ± 0.80 1.65 ± 0.62 <0.05 Anxiety 2.49 ±
0.60 2.28 ± 0.43 1.42 ± 0.56 1.35 ± 0.39 <0.05 Depression 2.80 ± 0.67 1.83 ± 0.62 1.49 ± 0.77 1.61 ± 0.64 <0.05
Hostility 2.16 ± 0.56 1.52 ± 0.44 1.98 ± 0.69 1.48 ± 0.48 >0.05 Phobia 1.70 ± 0.82 1.64 ± 0.56 1.27 ± 0.68 1.25 ± 0.51
<0.05 Paranoid ideation 2.62 ± 0.56 1.80 ± 0.55 1.43 ± 0.67 1.42 ± 0.63 <0.05 Psychoticism 1.89 ± 0.49 1.32 ± 0.50
1.28 ± 0.55 1.28 ± 0.46 <0.05
Table 2. Comparison of SSRS scores between the study
Discussion and control groups
Study group
Control (n=50)
P
group (n=50) Total score 34.60 ± 7.89 38.96 ± 7.21 <0.05 Objective support score 9.12 ± 4.83 7.63 ± 5.37 >0.05
The results in this study indicated that patients diagnosed with somatization disorder constantly suffer
from psy- chological problems. Patients with somatization disorder suffer from Subjective support score
18.73 ± 5.34 24.01 ± 6.27 <0.05
severe financial challenge to the Availability 9.25 ± 3.36 9.54 ± 3.35 >0.05
health service due to the fact that symptoms are often intractable and
Table 3. Comparison of CSQ scores between the study and control groups
require long-term care. During hospi- talization, the physicians and nurses place much attention to the
patients, Study group
Control group (n=50)
P
(n=50)
whereas neglect the education to- wards the family members of the Positive coping style score 24.34 ± 7.85
36.14 ± 8.04 <0.05
patients, which may negatively affects Negative coping style score 34.45 ± 5.7 24.86 ± 6.13 <0.05
the recovery of the quality of life of patients.
Comparisons of SSRS scores between the study and control groups
As revealed in Table 2, the total score and sub- jective support score in the study groups were
significantly lower compared with those values in the control group (both P<0.05). However, the objective
support score and the availability score did not considerably differ between the study and control groups
(both P>0.05).
Comparisons of CSQ scores between the study and control groups
As illustrated in Table 3, the mean score of pos- itive coping style in the study group was signifi- cantly
lower than that in the control group (P<0.05), whereas the average score of nega- tive coping style in the
study group was consid- erably higher than that in the control group (P<0.05).
18566 Int J Clin Exp Med 2016;9(9):18564-18568 Through administering questionnaire, the true
psychological status of patients was acknowl- edged by the medical staff under the prerequi- site of
eliminating the anxiety emotion and obtaining mutual trust between patients and physicians. If the patients
were unable to com- plete the survey independently, relevant nurses should provide certain assistance to
help them to accomplish the task.
Upon admission, the nurses were responsible for explaining the specialized knowledge regard- ing
somatization to the patients via multiple channels, such as online chat tool, Weibo blog and alternative
online platforms. Furthermore, the patients were informed about the diagno- sis, treatment strategy and
process. Such assistance could not only make the patients better understand somatization disorder, but
also increase their confidence in the treatment and recovery.
Psychological status and coping strategy of somatization disorders
Besides the patients themselves, their family
Address correspondence to: Danning Zhang, Shan- members are likely to suffer from emotional
dong Mental Health Center, 49 Wen Hua Dong Road, problems due to high medical cost and long-
Jinan 250014, P. R. China. E-mail: doczdn@126.com term taking care of the patients. These eco- nomic and
psychological burdens may nega-
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