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Social Stigma Towards People with Medically Unexplained Symptoms: the Somatic Symptom Disorder

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Abstract

The majority of previous studies on mental health stigma have focused on medically explained symptoms and the studies on medically unexplained symptoms (MUS) have only assessed the consequences of internalized stigma. A new category in DSM 5, named as somatic symptom disorder (SSD), includes multiple somatic disorders with medically-explained or -unexplained somatic symptoms. This study aimed to test the effects of social stigma on people with SSD with MUS depending on the attribution model. In a class environment, 348 college students from different regions in Turkey were presented with a vignette on a person with SSD with MUS and asked to complete a survey including demographics and attitudes towards that person. Along the same lines with previous findings for other mental disorders, the path analysis using AMOS revealed that stigma-related cognitions (i.e., dependency, dangerousness and responsibility) shaped people’s affective (i.e., anger and pity) and behavioral responses (i.e., social distance) to these people. The most important predictor of social distance was pity and the level of contact was not related to social distance. In conclusion, anti-stigma interventions towards SSD with MUS should involve building empathy towards these patients and educating people about this disorder contrary to the recommended interventions for other mental health disorders stressing the importance of contact.

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References

  1. Goffman E. Stigma: notes on the Management of Spoiled Identity. Engelwood Cliffs: Prentice-Hall; 1963.

    Google Scholar 

  2. Crocker J, Major B, Steele C. Social Stigma. 1998;2.

  3. Major B, O'brien LT. The social psychology of stigma. Annu Rev Psychol. 2005;56:393–421.

    Article  Google Scholar 

  4. Mai Q, Holman CDAJ, Sanfilippo FM, Emery JD. The impact of mental illness on potentially preventable hospitalisations: a population-based cohort study. BMC Psychiatry. 2011;11(1):163.

    Article  Google Scholar 

  5. Murray CL, Lopez AD. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020 Cambridge. Cambridge: Harvard University; 1996.

    Google Scholar 

  6. Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Arch Gen Psychiatry. 2007;64(10):1123–31. https://doi.org/10.1001/archpsyc.64.10.1123.

    Article  PubMed  Google Scholar 

  7. Corrigan PW, Kerr A, Knudsen L. The stigma of mental illness: explanatory models and methods for change. Appl Prev Psychol. 2005;11(3):179–90.

    Article  Google Scholar 

  8. Livingston JD, Boyd JE. Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Soc Sci Med. 2010;71(12):2150–61.

    Article  Google Scholar 

  9. Link BG, Struening EL, Rahav M, Phelan JC, Nuttbrock L. On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. J Health Soc Behav. 1997;38:177–90.

    Article  CAS  Google Scholar 

  10. Ritsher JB, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res. 2003;121(1):31–49.

    Article  Google Scholar 

  11. Nettleton S. ‘I just want permission to be ill’: towards a sociology of medically unexplained symptoms. Soc Sci Med. 2006;62(5):1167–78.

    Article  Google Scholar 

  12. Weiner B. A cognitive (attribution)-emotion-action model of motivated behavior: an analysis of judgments of help-giving. J Pers Soc Psychol. 1980;39(2):186.

    Article  Google Scholar 

  13. Weiner B. May I borrow your class notes? An attributional analysis of judgments of help giving in an achievement-related context. J Educ Psychol. 1980;72(5):676.

    Article  Google Scholar 

  14. Weiner B, Graham S, Chandler C. Pity, anger, and guilt: an attributional analysis. Personal Soc Psychol Bull. 1982;8(2):226–32.

    Article  Google Scholar 

  15. Corrigan PW. Mental health stigma as social attribution: implications for research methods and attitude change. Clin Psychol Sci Pract. 2000;7(1):48–67.

    Article  Google Scholar 

  16. Angermeyer MC, Matschinger H. Social distance towards the mentally ill: results of representative surveys in the Federal Republic of Germany. Psychol Med. 1997;27(1):131–41.

    Article  CAS  Google Scholar 

  17. Weiner B, Perry RP, Magnusson J. An attributional analysis of reactions to stigmas. J Pers Soc Psychol. 1988;55(5):738–48.

    Article  CAS  Google Scholar 

  18. Puhl RM, Brownell KD. Psychosocial origins of obesity stigma: toward changing a powerful and pervasive bias. Obes Rev. 2003;4(4):213–27.

    Article  CAS  Google Scholar 

  19. Musher-Eizenman DR, Holub SC, Miller AB, Goldstein SE, Edwards-Leeper L. Body size stigmatization in preschool children: the role of control attributions. J Pediatr Psychol. 2004;29(8):613–20.

    Article  Google Scholar 

  20. Angermeyer MC, Matschinger H. The stigma of mental illness: effects of labelling on public attitudes towards people with mental disorder. Acta Psychiatr Scand. 2003;108(4):304–9.

    Article  CAS  Google Scholar 

  21. Corrigan PW, Penn DL. Lessons from social psychology on discrediting psychiatric stigma. Am Psychol. 1999;54(9):765–76.

    Article  CAS  Google Scholar 

  22. Couture S, Penn D. Interpersonal contact and the stigma of mental illness: a review of the literature. J Ment Health. 2003;12(3):291–305.

    Article  Google Scholar 

  23. Nimnuan C, Hotopf M, Wessely S. Medically unexplained symptoms: an epidemiological study in seven specialities. J Psychosom Res. 2001;51(1):361–7.

    Article  CAS  Google Scholar 

  24. Fink P. The use of hospitalizations by persistent somatizing patients. Psychol Med. 1992;22:173–80.

    Article  CAS  Google Scholar 

  25. Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005;62(8):903–10.

    Article  Google Scholar 

  26. Bermingham SL, Cohen A, Hague J, Parsonage M. The cost of somatisation among the working-age population in England for the year 2008–2009. Ment Health Fam Med. 2010;7(2):71–84.

    PubMed  PubMed Central  Google Scholar 

  27. Looper KJ, Kirmayer LJ. Perceived stigma in functional somatic syndromes and comparable medical conditions. J Psychosom Res. 2004;57(4):373–8.

    Article  Google Scholar 

  28. Taft TH, Keefer L, Leonhard C, Nealon-Woods M. Impact of perceived stigma on inflammatory bowel disease patient outcomes. Inflamm Bowel Dis. 2009;15(8):1224–32.

    Article  Google Scholar 

  29. Taft TH, Riehl ME, Dowjotas KL, Keefer L. Moving beyond perceptions: internalized stigma in the irritable bowel syndrome. Neurogastroenterol Motil. 2014;26(7):1026–35.

    Article  CAS  Google Scholar 

  30. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: Author; 2013.

    Book  Google Scholar 

  31. Rief W, Martin A. How to use the new DSM-5 somatic symptom disorder diagnosis in research and practice: a critical evaluation and a proposal for modifications. Annu Rev Clin Psychol. 2014;10.

  32. Corrigan P, Markowitz FE, Watson A, Rowan D, Kubiak MA. An attribution model of public discrimination towards persons with mental illness. J Health Soc Behav. 2003:162–79.

  33. Jorm AF, Griffiths KM. The public’s stigmatizing attitudes towards people with mental disorders: how important are biomedical conceptualizations? Acta Psychiatr Scand. 2008;118(4):315–21.

    Article  CAS  Google Scholar 

  34. Corrigan PW, Green A, Lundin R, Kubiak MA, Penn DL. Familiarity with and social distance from people who have serious mental illness. Psychiatr Serv. 2001;52(7):953–8.

    Article  CAS  Google Scholar 

  35. Reisenzein R. A structural equation analysis of Weiner's attribution—affect model of helping behavior. J Pers Soc Psychol. 1986;50(6):1123.

    Article  Google Scholar 

  36. Jorm AF, Nakane Y, Christensen H, Yoshioka K, Griffiths KM, Wata Y. Public beliefs about treatment and outcome of mental disorders: a comparison of Australia and Japan. BMC Med. 2005;3(1):12.

    Article  Google Scholar 

  37. Cunningham JA, Sobell LC, Chow VM. What's in a label? The effects of substance types and labels on treatment considerations and stigma. J Stud Alcohol. 1993;54(6):693–9.

    Article  CAS  Google Scholar 

  38. Kermode M, Bowen K, Arole S, Pathare S, Jorm AF. Attitudes to people with mental disorders: a mental health literacy survey in a rural area of Maharashtra, India. Soc Psychiatry Psychiatr Epidemiol. 2009;44(12):1087–96.

    Article  Google Scholar 

  39. Griffiths KM, Nakane Y, Christensen H, Yoshioka K, Jorm AF, Nakane H. Stigma in response to mental disorders: a comparison of Australia and Japan. BMC Psychiatry. 2006;6:21.

    Article  Google Scholar 

  40. Griffiths KM, Christensen H, Jorm AF. Predictors of depression stigma. BMC Psychiatry. 2008;8:25.

    Article  Google Scholar 

  41. Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA. Public conceptions of mental illness: labels, causes, dangerousness, and social distance. Am J Public Health. 1999;89(9):1328–33.

    Article  CAS  Google Scholar 

  42. Holmes EP, Corrigan PW, Williams P, Canar J, Kubiak MA. Changing attitudes about schizophrenia. Schizophr Bull. 1999;25(3):447–56.

    Article  CAS  Google Scholar 

  43. Schreiber JB, Nora A, Stage FK, Barlow EA, King J. Reporting structural equation modeling and confirmatory factor analysis results: a review. J Educ Res. 2006;99(6):323–38.

    Article  Google Scholar 

  44. Link BG, Yang LH, Phelan JC, Collins PY. Measuring mental illness stigma. Schizophr Bull. 2004;30(3):511–41.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Psychology, Hacettepe University, 06800 Beytepe, Ankara, Turkey

    Melike Eger Aydogmus

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  1. Melike Eger Aydogmus
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Correspondence to Melike Eger Aydogmus.

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The authors declare that they have no conflict of interest.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Hacettepe University Ethics Commission (Reference number (35,853,172/431–917) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Eger Aydogmus, M. Social Stigma Towards People with Medically Unexplained Symptoms: the Somatic Symptom Disorder. Psychiatr Q 91, 349–361 (2020). https://doi.org/10.1007/s11126-019-09704-6

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  • DOI: https://doi.org/10.1007/s11126-019-09704-6

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