In collaboration with Payame Noor University and Iranian Health Psychology

Document Type : research

Authors

1 Department of Psychology, Tarbiat Modares University, Tehran, Iran.

2 Department of Psychology, Tarbiat Modares University, Tehran, Iran

3 Department of Industrial Engineering, Sharif University of Technology, Tehran, Iran

10.30473/ijohp.2024.68495.1317

Abstract

Objective: Somatic symptoms consist of a wide range of symptoms and until yet clustering them has been very challenging for researchers and therapists. The present study aims to explore underlying psychological factors of various functional somatic symptoms and determine if there are any similarities or differences in these factors that could help classify these symptoms as one syndrome or discrete ones.
Method: This study adopted an association rule mining method based on data mining. 643 participants were recruited using a convenience sampling technique. Data were collected using the checklist of somatic symptoms (Lacourt et al., 2013), Attachment Questionnaire (Hazan & Shaver, 2017), Defense Style Questionnaire (Andrews et al., 1993), and Levels of Emotional Awareness Scale (Lane, 2006).
Results: Cognitive, gastrointestinal, and fatigue symptoms are related more to immature defense mechanisms. Musculoskeletal, respiratory, and cardiac symptoms are associated with neurotic defenses. Fatigue symptoms are associated with ambivalent attachment and musculoskeletal symptoms are related more to avoidant attachment. Indeed, it could be said that there are two clusters of somatic symptoms, one of which is attachment and the other is defense mechanisms. This supports the splitters’ view about somatic syndromes.
Conclusions: These findings show various types of somatic symptoms have qualitatively different risk factors. Our findings imply that psychotherapists should consider the kind of syndromes a patient has and their underlying psychological predispositions to manage the problem better.
 

Keywords

Article Title [Persian]

خوشه بندی علایم متفاوت روان تنی بر اساس عوامل روانشناختی

Authors [Persian]

  • احسان توکلیان 1
  • حجت الله فراهانی 2
  • پرویز آزادفلاح 2
  • ریحانه رضوی 3

1 Department of Psychology, Tarbiat Modares University, Tehran, Iran.

2 Department of Psychology, Tarbiat Modares University, Tehran, Iran

3 Department of Industrial Engineering, Sharif University of Technology, Tehran, Iran

Abstract [Persian]

مقدمه: در سال های اخیر طبقه بندی علایم روان تنی چالش بزرگی برای محققان بوده است که پژوهش و درمان این علائم را با مشکلاتی مواجه کرده است. هدف مطالعه حاضر بررسی عوامل روان‌شناختی زمینه‌ ساز علائم روان تنی مختلف و تعیین شباهت‌ها و تفاوت‌های این علایم بر اساس متغیرهای روان شناختی و ارائه دسته بندی این علائم می باشد. روش: پژوهش حاضر از نوع کشف قواعد وابستگی و بر اساس داده کاوی می باشد و برای این منظور نمونه گیری به روش در دسترس انجام شد. 643 شرکت کننده از شهر تهران در پژوهش شرکت نمودند.جهت جمع آوری داده ها از چک لیست علائم جسمانی، پرسشنامه دلبستگی هازان و شیور، پرسشنامه سبک دفاعی و مقیاس سطوح آگاهی هیجانی استفاده شد. یافته ها: نتایج نشان داد علائم گوارشی، خستگی و علایم شناختی با مکانیسم‌های دفاعی نابالغ، سبک دلبستگی دوسوگرا و سطوح پایین آگاهی هیجانی متمرکز بر دیگران مرتبط است. همچنین علائم اسکلتی-عضلانی، قلبی و تنفسی مربوط به مکانیسم های دفاعی روان رنجور و سبک دلبستگی اجتنابی است. نتیجه گیری: این یافته‌ها نشان می‌دهند که علائم جسمی را می‌توان بر اساس پارامترهای روان‌شناختی به خوشه‌های مختلفی طبقه‌بندی کرد و باید مداخلات روان‌پزشکی و روان‌شناختی متفاوتی را برای هر گروه از آنها در نظر گرفت.

Keywords [Persian]

  • علایم روان تنی
  • خوشه بندی
  • مکانیزم های دفاعی
  • سبک دلبستگی
  • سطوح آگاهی هیجانی
Afshari, Afrooz, & Mir Mohammadi, Mahboobeh. (2019). The role of psychological symptoms, attachment styles and Cognitive Emotion Regulation of mothers in prediction of anthropometric indices in Children. Health Psychology, 8(30), 54-68. https://doi.org/10.30473/hpj.2019.40593.4015
Aggarwal, Vishal R, McBeth, John, Zakrzewska, Joanna M, Lunt, Mark, & Macfarlane, Gary J. (2006). The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors? International journal of epidemiology, 35(2), 468-476. https://doi.org/10.1093/ije/dyi265
Andrews, G., Singh, M., & Bond, M. (1993). The defense style questionnaire. Journal of Nervous and mental Disease. 181(4), 246-256. https://doi.org/10.1097/00005053-199304000-00006
Berezowski, Lukas, Ludwig, Lea, Martin, Alexandra, Löwe, Bernd, & Shedden-Mora, Meike C. (2022). Early psychological interventions for somatic symptom disorder and functional somatic syndromes: a systematic review and meta-analysis. Psychosomatic medicine, 84(3), 325. https://doi.org/10.1097%2FPSY.0000000000001011
Besharat, Mohammad Ali. (2011). Development and validation of adult attachment inventory. Procedia-Social and Behavioral Sciences, 30, 475-479. https://doi.org/10.1016/j.sbspro.2011.10.093
Dol, Sunita M, & Jawandhiya, Pradip M. (2023). Classification Technique and its Combination with Clustering and Association Rule Mining in Educational Data Mining—A survey. Engineering Applications of Artificial Intelligence, 122, 106071. https://doi.org/10.1016/j.engappai.2023.106071
Fink, Per, Rosendal, Marianne, & Olesen, Frede. (2005). Classification of somatization and functional somatic symptoms in primary care. Australian & New Zealand Journal of Psychiatry, 39(9), 772-781. https://doi.org/10.1080/j.1440-1614.2005.01682.x
Gillath, Omri, & Karantzas, Gery. (2019). Attachment security priming: A systematic review. Current opinion in psychology, 25, 86-95. https://doi.org/10.1016/j.copsyc.2018.03.001
Govrin, Aner. (2022). When Mutual Imbeddedness is Impossible–Persecutory Anxiety and Splitting in Times of Perceived Danger-A Discussion of “Mutual Imbeddedness: The Foundation for a Relational World” by Daniel Perlitz. Psychoanalysis, Self and Context, 17(1), 23-29. https://doi.org/10.1080/24720038.2021.1996579
Hazan, Cindy, & Shaver, Phillip. (2017). Romantic love conceptualized as an attachment process Interpersonal Development (pp. 283-296): Routledge.
Heidari Nasab, L, Mansouri, M, Azadfallah, P, & Shaieeri, MR. (2007). Validity and reliability of Defens Style Questionaire (DSQ-40) in Iranian samples. Clinical Psychology and Personality, 5(1), 11-27. https://dorl.net/dor/20.1001.1.23452188.1386.5.1.2.6
Hennissen, Vicky Christina, Meganck, Reitske, Van Nieuwenhove, Kimberly, Norman, Ufuoma Angelica, Loeys, Tom, & Desmet, Mattias. (2019). Therapists’ responses toward dependent (anaclitic) and self-critical (introjective) depressed outpatients: A multilevel approach. Psychotherapy, 56(2), 193. https://psycnet.apa.org/doi/10.1037/pst0000213
Huang, Wei-Lieh, Chang, Shu-Sen, & Liao, Shih-Cheng. (2022). The psychological features of distinct somatic syndromes: A cluster analysis according to population-based somatic symptom profiles in Taiwan. Journal of the Formosan Medical Association, 121(9), 1813-1822. https://doi.org/10.1016/j.jfma.2022.03.009
Jadhakhan, Ferozkhan, Romeu, Daniel, Lindner, Oana, Blakemore, Amy, & Guthrie, Elspeth. (2022). Prevalence of medically unexplained symptoms in adults who are high users of healthcare services and magnitude of associated costs: a systematic review. BMJ open, 12(10), e059971. http://dx.doi.org/10.1136/bmjopen-2018-027922
Kalamatianos, A, & Canellopoulos, L. (2022). The congruency hypothesis and symptom specificity in depression The relationship between personality vulnerability and stress. Archives of Hellenic Medicine/Arheia Ellenikes Iatrikes, 39(2).
Kaushik, Minakshi, Sharma, Rahul, Peious, Sijo Arakkal, Shahin, Mahtab, Yahia, Sadok Ben, & Draheim, Dirk. (2021). A systematic assessment of numerical association rule mining methods. SN Computer Science, 2(5), 1-13. https://doi.org/10.1007/s42979-021-00725-2
Kitselaar, Willeke M, Van Der Vaart, Rosalie, Perschl, Johanna, Numans, Mattijs E, & Evers, Andrea WM. (2023). Predictors of persistent somatic symptoms in the general population: a systematic review of cohort studies. Psychosomatic medicine, 85(1), 71-78. http://creativecommons.org/licenses/by/4.0/
Lacourt, Tamara, Houtveen, Jan, & van Doornen, Lorenz. (2013). “Functional somatic syndromes, one or many?”: an answer by cluster analysis. Journal of psychosomatic research, 74(1), 6-11. https://doi.org/10.1016/j.jpsychores.2012.09.013
Lane, R. D. (2006, April). Theory of emotional awareness and brain processing of emotion. In International Congress Series (Vol. 1287, pp. 116-121). Elsevier. https://doi.org/10.1016/j.ics.2005.12.041
Lane, Richard D, & Smith, Ryan. (2021). Levels of emotional awareness: Theory and measurement of a socio-emotional skill. Journal of Intelligence, 9(3), 42. https://doi.org/10.3390/jintelligence9030042
Luyten, Patrick, Campbell, Chloe, & Fonagy, Peter. (2019). Reflections on the contributions of Sidney J. Blatt: The dialectical needs for autonomy, relatedness, and the emergence of epistemic trust. Psychoanalytic Psychology, 36(4), 328. https://psycnet.apa.org/doi/10.1037/pap0000243
Luyten, Patrick, Campbell, Chloe, & Fonagy, Peter. (2021). Rethinking the relationship between attachment and personality disorder. Current Opinion in Psychology, 37, 109-113. https://doi.org/10.1016/j.copsyc.2020.11.003  
McHugh, Laura, & Egan, Jonathan. (2023). Psychological and somatic manifestations of dissociation: The role of childhood trauma, attachment, and alexithymia. European Journal of Trauma & Dissociation, 100316. https://doi.org/10.1016/j.ejtd.2023.100316
Monden, Rei, Rosmalen, Judith GM, Wardenaar, Klaas J, & Creed, Francis. (2022). Predictors of new onsets of irritable bowel syndrome, chronic fatigue syndrome and fibromyalgia: the lifelines study. Psychological medicine, 52(1), 112-120. https://doi.org/10.1017/S0033291720001774
Nimnuan, Chaichana, Hotopf, Matthew, & Wessely, Simon. (2001). Medically unexplained symptoms: an epidemiological study in seven specialities. Journal of psychosomatic research, 51(1), 361-367. https://doi.org/10.1016/S0022-3999(01)00223-9
Nohi, Soheila, & Hasani, Jafar. (2017). The relationship between cognitive emotion regulation strategies and defense mechanisms with borderline personality disorder. Thoughts and Behavior in Clinical Psychology, 12(43), 57-66.
Reis, Samantha, & Grenyer, Brin FS. (2002). Pathways to anaclitic and introjective depression. Psychology and Psychotherapy: Theory, Research and Practice, 75(4), 445-459. https://doi.org/10.1348/147608302321151934
Rief, Winfried, & Martin, Alexandra. (2014). How to use the new DSM-5 somatic symptom disorder diagnosis in research and practice: a critical evaluation and a proposal for modifications. Annual Review of Clinical Psychology, 10, 339-367. https://doi.org/10.1146/annurev-clinpsy-032813-153745
Romeo, Annunziata, Benfante, Agata, Geminiani, Giuliano Carlo, & Castelli, Lorys. (2022). Personality, defense mechanisms and psychological distress in women with fibromyalgia. Behavioral Sciences, 12(1), 10. https://doi.org/10.3390/bs12010010
Santoso, M Hamdani. (2021). Application of Association Rule Method Using Apriori Algorithm to Find Sales Patterns Case Study of Indomaret Tanjung Anom. Brilliance: Research of Artificial Intelligence, 1(2), 54-66. https://doi.org/10.47709/brilliance.v1i2.1228
Sattel, Heribert, Häuser, Winfried, Schmalbach, Bjarne, Brähler, Elmar, Henningsen, Peter, & Hausteiner-Wiehle, Constanze. (2023). Functional Somatic Disorders, Their Subtypes, and Their Association With Self-Rated Health in the German General Population. Psychosomatic Medicine, 85(4), 366-375. https://doi.org/10.1097/PSY.0000000000001187
Schauenburg, Henning, Willenborg, Verena, Sammet, Isa, & Ehrenthal, Johannes C. (2007). Self‐reported defence mechanisms as an outcome measure in psychotherapy: A study on the German version of the Defence Style Questionnaire DSQ 40. Psychology and Psychotherapy: Theory, Research and Practice, 80(3), 355-366. https://doi.org/10.1348/147608306X146068
Subic-Wrana, Claudia, Thomas, Walther, Huber, Michael, & Köhle, Karl. (2001). Levels of emotional awareness scale (LEAS). Psychotherapeut, 46(3), 176-181. https://doi.org/10.1007/s002780100157
Tsai, Chung-Huang. (2010). Factor analysis of the clustering of common somatic symptoms: a preliminary study. BMC Health Services Research, 10, 1-8. https://doi.org/10.1186/1472-6963-10-160
Wessely, Simon, Nimnuan, Chaichana, & Sharpe, Michael. (1999). Functional somatic syndromes: one or many? The Lancet, 354(9182), 936-939. https://doi.org/10.1016/S0140-6736(98)08320-2
Yousefi, Farideh. (2004). Levels of emotional awareness scale among Iranian gifted and nongifted high school students. Psychological reports, 95(2), 504-506. https://doi.org/10.2466/pr0.95.2.504-506