Faculty Bibliography

ABSTRACT: Somatization syndromes are highly prevalent disorders with unknown etiology and are challenging to treat. Integrating previous findings on alexithymia, attachment, and trauma, we hypothesized that somatization syndromes are associated with a specific internal representation of relationships-the unmet need for closeness with others (desire for interpersonal closeness combined with the fear of being rejected, hurt, or abandoned). Twenty patients with DSM-IV somatization syndromes and 20 well-matched healthy controls completed the Relationship Anecdotes Paradigm/Core Conflictual Relationship Themes interview and measures of interpersonal relatedness, alexithymia, and history of trauma. The results showed that the unmet need for closeness with others was the main internal representation of relationships in 90% of the patients and in only 10% of controls; it was also the strongest predictor of somatization syndrome diagnosis. This suggests that somatization syndromes are strongly associated with the interpersonal representation of the unmet need for closeness with others, which has direct implications for their treatment and future research on their etiology.

Expressed Emotion has been shown to be a predictor of relapse in schizophrenia. Despite the robustness of the association between expressed emotion and relapse, little is understood regarding the underlying mechanism of the expressed emotion relapse link. The present study posits that expressed emotion may be an amalgam of attributions and coping efforts made by a family member specific to the stresses of caring for a schizophrenic relative. Using an attributional model of expressed emotion and drawing upon a stress and coping framework, this study investigated the relationship between expressed emotion and the causal attributions and coping responses reported by family members of a relative diagnosed with a first episode of schizophrenia. The sample consisted of 56 family members. Levels of expressed emotion, causal attributions about the illness, coping behaviors, and patient management strategies of the family members were evaluated at the time of hospital admission of the patient/relative. Hypothesis testing consisted of t-tests followed by a stepwise logistic regression analysis. Consistent with an attributional model of perceived controllability, the results found that family members classified as high expressed emotion were more likely to attribute the illness behaviors to controllable or moral causes than low expressed emotion family members. This finding supports earlier research showing an association between high expressed emotion and attributions to causes controllable by the patient. This was the first study to examine this relationship in a first episode diagnosis of schizophrenia. A relationship between a patient management style of yelling and criticism was also found to be significantly correlated with high expressed emotion. No associations between expressed emotion and the coping behaviors were found. Family interventions aimed at reducing high expressed emotion such as psychoeducational programs and family counseling are noted. This study contributes to the establishment of a theoretical framework for understanding the expressed emotion construct. Further research is recommended to identify the relationship between expressed emotion and coping behaviors.