Somatization and Somatic Symptom Disorder and its overlap with dimensionally measured personality pathology: A systematic review

Caroline Macina; Rebecca Bendel; Marc Walter; Johannes Sebastian Wrege

doi:10.1016/j.jpsychores.2021.110646

Somatization and Somatic Symptom Disorder and its overlap with dimensionally measured personality pathology: A systematic review

J Psychosom Res. 2021 Dec:151:110646. doi: 10.1016/j.jpsychores.2021.110646. Epub 2021 Oct 22.

Authors

Caroline Macina¹, Rebecca Bendel², Marc Walter³, Johannes Sebastian Wrege⁴

Affiliations

¹ University Psychiatric Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland. Electronic address: caroline.macina@upk.ch.
² University Psychiatric Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland.
³ University Psychiatric Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland. Electronic address: marc.walter@upk.ch.
⁴ University Psychiatric Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland. Electronic address: johannes.wrege@upk.ch.

PMID: 34715494
DOI: 10.1016/j.jpsychores.2021.110646

Abstract

Objective: Difficulties in the assessments of Somatoform Disorders (SD) and Personality Disorders (PD) regarding operationalization, arbitrary thresholds, and reliability led to a shift from categorical to dimensional models in the DSM-5. Empirical research data postulates a continuous level of severity in both groups of diseases. The aim of this systematic review was to investigate the overlap between somatization and personality pathology.

Methods: Until July 2020, we conducted a systematic literature search with PubMed, Web of Science and SCOPUS. We specifically reviewed current empirical data on the Alternative Model of Personality Disorders (AMPD) and Somatic Symptom Disorder (SSD) and SD. Data was drawn out using predefined data panels. Results were reflected in the context of the Hierarchical Taxonomy of Psychopathology (HiTOP) model. Risk of bias was assessed due to blinding, randomization, selective reporting, incomplete data, and attribution bias.

Results: A total of eight studies (N = 2979) met the inclusion criteria. Whereas categorical measures revealed mixed results, positive correlations between SD/SSD and dimensionally measured personality functioning were present in four studies (N = 1741). In three studies (N = 2025) correlations between SD/SSD and neuroticism/negative affectivity (d = 0.22-1.041) were present. Moreover, harm avoidant (d = 0.526 - 0.826) and self-defeating traits (d = 0.892) revealed significant associations with somatization.

Conclusions: Dimensional personality assessments are highly neglected in patients with SSD and warrant further research. However, in line with the HiTOP model, there is tentative evidence that somatization can be described as an independent personality trait, which shows most striking overlaps with self-pathologies (Criterion A) and the trait of negative affectivity (Criterion B).

Keywords: AMPD; DSM-5; Dimensional personality diagnostic; HiTOP; ICD-11; Somatic Symptom Disorder.

Publication types

Review
Systematic Review

MeSH terms

Diagnostic and Statistical Manual of Mental Disorders
Humans
Medically Unexplained Symptoms*
Personality
Personality Disorders / diagnosis
Reproducibility of Results