Exploratory Research On The Psychological Characteristics And Emotional Regulation Ability Of Patients With Physical Symptoms

Background:Clinicians often encounter a group of "difficult patient".These patients often have repeated visits,accompanied by high level of anxiety that is not commensurate with the severity of their physical symptoms,often causing tense patient-doctor relationship and waste of medical resources.DSM-5 proposed "somatic symptom disorder(SSD)" to diagnose such patients,and added the psychologically positive B standard in clinical diagnostic criteria.Psychological characteristics and emotional regulation has become an important perspective to explore the pathological psychological mechanism of SSD patients.Objective:1.Describe the clinical features of patients with somatic symptoms;2.Explore the psychological mechanism and characteristics of SSD patients,including alexithymia,defense mechanism,etc.,and provide a basis for the psychological treatment and prevention of patients;3.Initially explore the emotional adjustment ability of SSD patients,and provide reference for further research.Methods:To recruit patients,structured clinical interview for DSM-5(SCID-5-RV)was used as the gold standard in the psychology department,gastroenterology department,and traditional Chinese medicine clinic of Peking Union Medical College Hospital.Control group was matched with gender and age.After signing the informed consent,they filled out the questionnaires:PHQ-15,WHO DAS 2.0,PHQ-9,GAD-7,WI-8,SSS-8,SSD-12,SF-12,TAS-26,DSQ-88,LES.For the subjects who agreed to be tested,the face recognition software Face Reader(version number 7.1)was used as the emotion adjustment ability identification method and tool to explore the expression recognition and emotion adjustment ability.The test shows a total of 49 facial expression images,each of which contains seven expressions:anger,disgust,fear,sadness,surprise,calmness,and happiness.After testing the entire pictures,the video would be imported to the software for emotion recognition.Result:1.There was no significant demographic and lifestyle habits difference in SSD patients compared with the control group(P>0.05).2.SSD patients have longer physical symptoms(P=0.001),more medical treatment in the past 12 months(P=0.035),lower satisfaction with treatment(P=0.032),and poorer subjective assessment(P=0.042).3.The scores of PHQ-9(Median 13.0),GAD-7(Median 12.0)and TAS-26(75.1±11.6)were higher in SSD patients(P<0.05),among which TAS-26 factor 1(19.1±5.7)and factor 2(23.2±4.8)scores were higher(P<0.01).The factor score of somatization in DSQ-88 were higher(5.56±1.90,P=0.002),so were the LES total score(Median 64.0)and negative score(Median 64.0,P=0.004、0.002).4.SSD patients scored significantly higher PHQ-15(Median 13.0),SSS-8(Median 10.5),SSD-12(Median 21.5),WHO DAS 2.0(Median 16.7)and lower PCS(Median 40.4),MCS(Median 32.3),P<0.05.5.Predictors of disability and quality of life:PHQ-9 score,somatic defense mechanism factor score are significantly correlated with PHQ-15(Change of R2:0.036、0.003,P<0.05);SSS-8,GAD-7,TAS-26 total scores are significant predictors of WHO DAS 2.0(Change of R2:0.256、0.068、0.130,P<0.05),SSS-8,SSD-12 are significant predictors of PCS score(Change of R2:0.133、0.048,P<0.05);PHQ-9 score is a significant predictors of MCS score(Change of R2:0.258,P=0.028).6.There is no significant difference in the correct rate of facial recognition in SSD patients compared with the control group(P>0.05).7.There was no significant difference in emotional distribution,valence(-0.04±0.14)and arousal intensity(0.35+0.09)between SSD patients and the control group when receiving the same stimulation(P>0.05).Emotional valence was correlated with TAS-26 factor 1 and factor 2(P=0.032、0.039).8.Predictors of emotional valence and arousal:Happy mood intensity is a significant predictor of valence(Change of R2:0.494,P<0.001),which accounts for 49.4%of variation;anger intensity is a significant predictor of arousal(Change of R2:0.452,P=0.023),which accounts for 45.2%of variation.Conclusion:1.Clinical features:Patients with somatic symptoms have more medical treatments,lower medical trust and satisfaction,subjective assessment of treatment is worse,physical burden is heavier,and quality of life is lower.2.Psychological characteristics:SSD patients have high level of anxiety and depression,alexithymia,especially the ability to distinguish between their own emotions and physical sensation,and more use of immature defense mechanisms such as somatization,and also more negative life events.3.The degree of disability and quality of life of patients with somatic symptoms are not only related to their physical load,but also significantly related to their psychological characteristics such as anxiety and depression,alexithymia and defense mechanism.Clinicians should pay attention to their social-psychological background in addition to symptoms,leading the patients’ cognition and behavior to correctly identify and accept his or her emotional and physical symptoms and improve the quality of life of patients.4.Emotional regulation:There was no significant difference in the recognition of other people’s emotions and emotional arousal between SSD patients and control group.At present,conclusions of relevant research are different.It also reminds clinicians to fully evaluate the psychological characteristics of SSD patients timely provide targeted treatment plans timely to improve the efficiency of treatment.