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Annemiek van Dijke, Sandra Lenstra, Jaco Wineke and Julian D Ford
Objective: Literature on cognitive-emotional functioning reflects indications that patients with somatic symptomor related disorder may suffer from diminished affective mentalizing/ psychological mindedness that is impairment in the ability for reflectivity about psychological processes, relationships and meanings. Affective mentalizing/ psychological mindedness seems to play an important role in cognitive-emotional functioning especially in a social context as engaging in group-psychotherapy. The present study investigated psychological mindedness in somatic symptoms- and conversion disorder (SSCD) patients, by examining similarities and differences between self-reports and their psychotherapists’ observations of social-cognitive-emotional functioning i.e. dysfunctional self-regulation.
Methods: A cross-sectional design was applied to 43 patients with SSCD and their psychotherapists, who independently rated the patient’s (dysfunctional) emotional-, dissociative-, and interpersonal self-regulation.
Results: Compared to the psychotherapists’ observations, patients under reported their degree of dysfunctional emotional self-regulation i.e. under-regulation of affect, interpersonal self-regulation (fears of abandonment and closeness, lack of interpersonal trust) and dissociative self-regulation (somatoform- and psychoform dissociation). Patients over reported problems dysfunctional emotional self-regulation, i.e., insight into their own emotions and problems with verbalizing of emotions. Patients were generally consistent with their psychotherapists regarding difficulties emotional self-regulation, i.e., analyzing of affect and insight into others’ emotions. Although patients who disclosed a history of childhood traumatic experiences involving a primary caregiver (TPC) reported higher levels of problems with under-regulation of affect and lack of interpersonal trust than patients denying such childhood trauma, TPC was not associated with deficits in psychological mindedness in this sample of somatoform disorder patients.
Conclusion: It seems of clinical relevance to add clinical observations to self-reported dysfunctional selfregulation in somatic symptom- and conversion disorder patients to assess affective mentalizing/ psychological mindedness. It seems that patient- compared to clinician ratings are in agreement on emotional constriction (difficulty in analyzing own- and understanding others’ emotions), but under–rate problems with dissociative-, interpersonaland emotional/hyperarousal self-regulation, and over-rate their problems with insight and verbalizing emotions.