“That pulled the rug out from under my feet!” – adverse experiences and altered emotion processing in patients with functional neurological symptoms compared to healthy comparison subjects

BMC Psychiatry

Brigitte Rockstroh²  Roger Schmidt¹  Johanna Fiess²  Astrid Steffen² 

[1] Neurological Rehabilitation Center Kliniken Schmieder, Eichhornstraße 68, Konstanz 78464, Germany;Department of Psychology, University of Konstanz, Konstanz 78457, Germany

关键词: Building block effect;    Emotion regulation;    Suppression;    Alexithymia;    Life events;    Adverse childhood experiences;    Dissociative movement and sensibility disorders;    Conversion;    Somatoform dissociation;    Functional neurological symptoms;   

Others  :  1217014
DOI  :  10.1186/s12888-015-0514-x

 received in 2014-12-12, accepted in 2015-06-02,  发布年份 2015

【 摘 要 】

Background

Medically unexplained movement or sensibility disorders, recently defined in DSM-5 as functional neurological symptoms (FNS), are still insufficiently understood. Stress and trauma have been addressed as relevant factors in FNS genesis. Altered emotion processing has been discussed.

The present study screened different types and times of adverse experiences in childhood and adulthood in patients with FNS as well as in healthy individuals. The relationship between stress profile, aspects of emotion processing and symptom severity was examined, with the hypothesis that particularly emotional childhood adversities would have an impact on dysfunctional emotion processing as a mediator of FNS.

Methods

Adverse childhood experiences (ACE), recent negative life events (LE), alexithymia, and emotion regulation style were assessed in 45 inpatients diagnosed with dissociative disorder expressing FNS, and in 45 healthy comparison subjects (HC).

Results

Patients reported more severe FNS, more (particularly emotional) ACE, and more LE than HC. FNS severity varied with emotional ACE and negative LE, and LE partially mediated the relation between ACE and FNS. Alexithymia and suppressive emotion regulation style were stronger in patients than HC, and alexithymia varied with FNS severity. Structural equation modeling verified partial mediation of the relationship between emotional ACE and FNS by alexithymia.

Conclusions

Early, emotional and accumulating stress show a substantial impact on FNS-associated emotion processing, influencing FNS. Understanding this complex interplay of stress, emotion processing and the severity of FNS is relevant not only for theoretical models, but, as a consequence also inform diagnostic and therapeutic adjustments.

【 授权许可】

   
2015 Steffen et al.

【 图 表 】

Fig. 1.

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【 参考文献 】

• [1]Van der Kruijs SJM, Bodde NMG, Varrette E, Lazeron RHC, Vonck KEJ, Boon PAJM, et al.: Neurophysiological correlates of dissociative symptoms. J Neurol Neurosurg Psychiatry 2012.
• [2]Stone J, Carson A, Sharpe M: Functional symptoms and signs in neurology: Assessment and diagnosis. Journal of Neurology, Neurosurgery and Psychiatry 2005, 76.[10.1136/jnnp.2004.061655]
• [3]Sar V, Akyüz G, Kundakci T, Kiziltan E, Dogan O: Childhood trauma, dissociation, and psychiatric comorbidity in patients with conversion disorder. Am J Psychiatr 2004, 161:2271-2276.
• [4]Kozlowska K: Healing the disembodied mind: Contemporary models of conversion disorder. Harvard Review Of Psychiatry 2005, 13:1-13.
• [5]Spitzer C, Freyberger HJ: Dissoziative Störungen (Konversionsstörungen). Psychotherapeut 2007, 52:223-235.
• [6]Cloninger CR, Dokucu M, Fatemi SH, Clayton P: Somatoform and dissociative disorders. In The Medical Basis of Psychiatry. 3rd edition. Humana Press, Totowa; 2008:181-194.
• [7]Spiegel D, Loewenstein RJ, Lewis-Fernández R, Sar V, Simeon D, Vermetten E, et al.: Dissociative disorders in DSM-5. Depression And Anxiety 2011, 28:824-852.
• [8]Van der Hart O, Horst R: The dissociation theory of Pierre Janet. J Trausma Stress 1989, 2:397-412.
• [9]Nijenhuis ERS, Spinhoven P, Van Dyck R, Van der Hart O, Vanderlinden J: Degree of somatoform and psychological dissociation in dissociative disorder is correlated with reported trauma. J Trauma Stress 1998, 11:711-730.
• [10]Draijer N, Langeland W: Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients. Am J Psychiatry 1999, 156:379-385.
• [11]Roelofs K, Spinhoven P, Sandijck P, Moene FC, Hoogduin KAL: The impact of early trauma and recent life-events on symptom severity in patients with conversion disorder. J Nerv Ment Dis 2005, 193:508-514.
• [12]Sack M, Boroske-Leiner K, Lahmann C: Association of nonsexual and sexual traumatizations with body image and psychosomatic symptoms in psychosomatic outpatients. Gen Hosp Psychiatry 2010, 32:315-320.
• [13]Taylor GJ: Affects, trauma, and mechanisms of symptom formation: A tribute to John C. Nemiah, MD (1918–2009). Psychother Psychosom 2010, 79:339-349.
• [14]Nijenhuis ERS, Den Boer JA, Dell PF, O’Neil JA: Psychobiology of traumatisation and trauma-related structural dissociation of the personality. In Dissociation and the dissociative disorders: DSM-V and beyond. Routledge, New York; 2009:337-367.
• [15]Van der Hart O, Van Dijke A, Van Son M, Steele K: Somatoform dissociation in traumatized World War I combat soldiers: A neglected clinical heritage. Journal of Trauma and Dissociation 2000, 1:33-66.
• [16]Nijenhuis ERS, Van der Hart O, Steele K: Trauma-related structural dissociation of the personality. Activas Nervosa Superior 2010, 52:1-23.
• [17]Schauer M, Elbert T: Dissociation following traumatic stress etiology and treatment. J Psychol 2010, 218:109-127.
• [18]Hauffa R, Rief W, Brähler E, Martin A, Mewes R, Glaesmer H: Lifetime traumatic experiences and posttraumatic stress disorder in the German population: Results of a representative population survey. J Nerv Ment Dis 2011, 199:934-939.
• [19]Schalinski I, Elbert T, Schauer M: Female dissociative responding to extreme sexual violence in a chronic crisis setting: The case of Eastern Congo. J Trauma Stress 2011, 24:235-238.
• [20]Andersen SL, Teicher MH: Stress, sensitive periods and maturational events in adolescent depression. Trends Neurosci 2008, 31:183-191.
• [21]Andersen SL, Teicher MH: Desperately driven and no breaks. Neurosci Biobehav Rev 2009, 33:516-524.
• [22]Andersen SL, Tomada A, Vincow ES, Valente E, Polcari A, Teicher MH: Preliminary evidence for the sensitive periods in the effect of childhood sexual abuse on regional brain development. J Neuropsychiatry Clin Neurosci 2008, 20:292-301.
• [23]Paus T, Keshavan M, Giedd JN: Why do many psychiatric disorders emerge during adolescence? Nat Rev Neurosci 2008, 9:947-957.
• [24]Roelofs K, Keijsers GP, Hoogduin KA, Näring GW, Moene FC: Childhood abuse in patients with conversion disorder. Am J Psychiatr 2002, 159:1908-1913.
• [25]Sar V, Islam S, Öztürk E: Childhood emotional abuse and dissociation in patients with conversion symptoms. Psychiatry of Clinical Neuroscience 2009, 63:670-677.
• [26]Matz K, Pietrek C, Rockstroh B: Stress in der Kindheit sensitiviert für Stress im Erwachsenenalter: Eine Studie mit psychiatrischen Patienten [Stress during childhood sensitizes to stress in adult life: A study with psychiatric patients]. Z Klin Psychol Psychother 2010, 39:45-55.
• [27]Schilte AF, Portegijs PJM, Blankenstein AH, Van der Horst HE, Latour MBF, Van Eijk JTM, et al.: Randomised controlled trial of disclosure of emotionally important events in somatisation in primary care. Br Med J 2001, 323:86-89.
• [28]Waller E, Scheidt CE: Somatoform disorders as disorders of affect regulation: A development perspective. Int Rev Psychiatry 2006, 18:13-24.
• [29]Nemiah JC, Freyberger H, Sifneos PE: Alexithymia: a view of the psychosomatic process. In Modern Trends in Psychosomatic Medicine. 3rd edition. Edited by Hill OW. Butterworths, London; 1976:430-439.
• [30]Brosig B, Kupfer JP, Wölfelschneider M, Brähler E: Prävalenz und soziodemographische Prädiktoren der Alexithymie in Deutschland - Ergebnisse einer Repräsentativerhebung. Zeitschrift für Klinische Psychologie und Psychiatrie 2004, 52(3):237-251.
• [31]Gross JJ: Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology 2002, 39(3):281-291.
• [32]Taylor GJ, Nyklicek I, Temoshok L, Vingerhoets A: Alexithymia: Twenty-five years of theory and research. In Emotional Expression and Health: Advances in Theory, Assessment and Clinical Applications. Brunner-Routledge, Andover; 2004.
• [33]Quinn M, Schofield M, Middleton W: Conceptualisation and treatment of psychogenic non-epileptic seizures. Journal of Trauma and Dissociation 2008, 9(1):63-84.
• [34]Van Dijke A, Ford JD, van der Hart O, van Son M, van der Heijden P, Bühring M: Affect dysregulation in borderline personality disorder and somatoform disorder: Differentiating under-and over-regulation. J Pers Disord 2010, 24(3):296-311.
• [35]Ackenheil M, Stotz G, Dietz-Bauer R, Vossen A: Deutsche Fassung des Mini-International Neuropsychiatric Interview. Psychiatrische Universitätsklinik, Munich; 1999.
• [36]Nijenhuis ERS, Spinhoven P, Van Dyck R, Van Der Hart O: The development and psychometric characteristics of the Somatoform Dissociation Questionnaire (SDQ-20). J Nerv Ment Dis 1996, 184:688-694.
• [37]Mueller-Pfeiffer C, Schumacher S, Martin-Soelch C, Pazhenkottil AP, Wirtz G, Fuhrhans C, et al.: The validity and reliability of the German version of the Somatoform Dissociation Questionnaire (SDQ-20). Journal of Trauma and Dissociation 2010, 11:337-357.
• [38]Derogatis LR: Symptom-Check-List SCL-90-R: Self-report symptom inventory. In Internationale Skalen für Psychiatrie. Beltz, Weinheim; 1986.
• [39]Derogatis LR, Savitz KL: The SCL-90-R and the Brief Symptom Inventory (BSI) in primary care. In Handbook of psychological assessment in primary care settings. Edited by Maruish ME. Lawrence Erlbaum Associates, Mahwah; 2000:297-334.
• [40]Foa EB, Cashman L, Jaycox L, Perry K: The validation of a self-report measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale. Eur J Psychol Assess 1997, 9:445-451.
• [41]Foa EB, Tolin DF: Comparison of the PTSD symptom scale interview version and the clinician administered PTSD scale. Jounal of Traumatic Stress 2000, 13:181-191.
• [42]Bremner JD, Bolus R, Mayer EA: Psychometric properties of the Early Trauma Inventory-Self Report. J Nerv Ment Dis 2007, 195:211-218.
• [43]Heim C: Deutsche Version des Early Trauma Inventory: Inventar zur Erfassung früher traumatischer Lebensereignisse (IFTL). Unpublished manuscript, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA; 2000.
• [44]Wingenfeld K, Driessen M, Mensebach C, Rullkoetter N, Schaffrath C, Spitzer C, et al.: Die deutsche Version des ‘Early Trauma Inventory’ (ETI). Diagnostica 2011, 57:27-38.
• [45]Sarason IG, Johnson JH, Siegel JM: Assessing the impact of life changes: Development of the Life Experiences Survey. J Consult Clin Psychol 1978, 46:932-946.
• [46]Norbeck JS: Modification of Life Event Questionnaires for use with female respondents. Res Nurs Health 1984, 7:61-71.
• [47]Bagby RM, Parker JDA, Taylor GJ: The twenty-item Toronto Alexithymia scale-I: Item selection and cross-validation of the factor structure. J Psychosom Res 1994, 38(1):23-32.
• [48]Bagby RM, Taylor GJ, Parker JDA: The twenty-item Toronto Alexithymia scale- II: Convergent, discriminant, and concurrent validity. J Psychosom Res 1994, 38(1):33-40.
• [49]Kupfer J, Brosig B, Brähler E: Toronto-Alexithymie-Skala-26. Deutsche Version (TAS-26). Manual. Hogrefe, Göttingen; 2001.
• [50]Abler B, Kessler H: Emotion Regulation Questionnaire: Eine deutschsprachige Fassung des ERQ von Gross und John. Diagnostica 2009, 55(3):144-152.
• [51]Faul F, Erdfelder E, Lang A-G: Buchner, A: G*Power 3: A flexible statistical power analysis for the social, behavioral, and biomedical sciences. Behav Res Methods 2007, 39:175-191.
• [52]Faul F, Erdfelder E, Buchner A, Lang A-G: Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods 2009, 41:1149-1160.
• [53]Preacher K, Hayes A: Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 2008, 40(3):879-891.
• [54]Neuner F, Schauer M, Karunakara U, Klaschik C, Robert C, Elbert T: Psychological trauma and evidence for enhanced vulnerability for posttraumatic stress disorder through previous trauma among West Nile refugees. BMC Psychiatry 2004, 4:34. BioMed Central Full Text
• [55]Kessler RC, Davis CG, Kendler KS: Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. Psychol Med 1997, 27:1101-1119.
• [56]Pietrek C, Elbert T, Weierstall R, Müller O, Rockstroh B: Childhood adversities in relation to psychiatric disorders. Psychiatry Res 2013, 206(1):103-110.
• [57]Fiess J, Steffen A, Pietrek C, Rockstroh B: Belastungen in der Kindheit und dissoziative Symptomatik bei Patienten mit psychischen Störungen [Childhood adversities and dissociative symptoms in patients with psychological disorders]. Z Klin Psychol Psychother 2013, 42(1):1-10.
• [58]Danese A, Moffitt TE, Pariante CM, Ambler A, Poulton R, Caspi A: Elevated inflammation levels in depressed adults with a history of childhood maltreatment. Arch Gen Psychiatry 2008, 65:409-415.
• [59]Afifi TO, Boman J, Fleisher W, Sareen J: The relationship between child abuse, parental divorce, and lifetime mental disorders and suicidality in a nationally representative adult sample. Child Abuse Negl 2009, 33:139-147.
• [60]Roelofs K, Spinhoven P: Trauma and medically unexplained symptoms. Towards an integration of cognitive and neuro-biological accounts. Clin Psychol Rev 2007, 27:798-820.
• [61]Brown RJ, Danquah AN, Miles E, Holmes E, Poliakoff E: Attention to the body in non-clinical somatoform dissociators depends on emotional state. J Psychosom Res 2010, 69:249-257.
• [62]Demartini B, Petrochilos P, Ricciardi L, Price G, Edwards MJ, Joyce E: The role of alexithymia in the development of functional motor symptoms (conversion disorder). Journal of Neurology Neurosurgery Psychiatry 2014, 85(10):1132-1137.
• [63]Hessel A, Schumacher J, Geyer M, Brähler E: Symptom-Checkliste SCL-90-R: Testtheoretische Überprüfung und Normierung an einer bevölkerungsrepräsentativen Stichprobe. Diagnostica 2001, 47:27-39.