The Attribution of Somatization in Schizophrenia Patients: A Naturalistic Follow-Up Study
J Clin Psychiatry 2003;64:1370-1378
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Knowledge is limited concerning
somatic symptoms that cannot be accounted for by detectable
somatic illness among schizophrenia patients. This study aimed to
explore the prevalence, correlates, and predictors of
somatization among schizophrenia patients.
Method: Initial data on all consecutively
admitted adult patients with DSM-IV schizophrenia,
schizoaffective disorder, major depressive disorder, or bipolar
disorder were collected between August 1998 and August 2000.
Standardized measures of psychopathology, somatization, emotional
distress, adverse effects, insight, and stress process-related
(psychosocial) variables were administered to 237 schizophrenia
patients at admission and at least 12 months thereafter (N =
148). Partial correlation and multiple regression analyses were
Results: The frequency of somatization, defined
as the presentation of 5 or more medically unexplained somatic
symptoms (Somatic Symptom Index-5), among the inpatient
population (27%) did not change significantly after at least 12
months (30%; p = .61). Regression analysis showed that
somatization scores were best predicted by the combination of
scores for emotional distress attributed to psychopathology and
side effects, expressed emotion, and insight. This combined model
explains at least 40% of the variance in somatization scores.
Self-esteem and social support showed negative association with
somatization scores. Somatization scores were not associated with
gender, age, education, age at onset, observed severity of
psychopathology, subtype and duration of illness, number of
admissions and treatment settings, or type and dose of
Conclusions: Somatization is a prevalent problem
among schizophrenia patients and is associated with emotional
distress attributed to psychopathology, side effects of
antipsychotic agents, and family members' attitudes toward
schizophrenia patients. This study suggests that insight,
self-esteem, and social support may protect against somatization
in schizophrenia patients.