Abstract
Purpose
To investigate the heterogeneity of illness behavior in patients with medically unexplained physical symptoms (MUPS), we clustered patients in regard to their degree of engaging in different aspects of illness behavior and identified related variables with these behaviors.
Method
A sample of N = 224 patients attending treatment in primary care with a history of MUPS (at least two symptoms) was investigated by analyzing different aspects of illness behavior with the self-reported number of doctor visits during the last 6 months and the Scale for the Assessment of Illness Behavior (SAIB; e.g., expression of symptoms).
Results
Two distinct clusters were identified by cluster analysis: a low (n = 106) and a high (n = 118) illness behavior clusters. The high illness behavior cluster exhibited a significantly higher rate of health anxiety than the low illness behavior cluster. Regression analysis revealed a particular effect of sex in the high illness behavior cluster: whereas being male was associated with increased illness behavior as measured by the SAIB, being female was linked to a higher number of doctor visits. Increased health anxiety was associated with the SAIB illness behavior in both clusters. Depression and anxiety did not show incremental associations with all aspects of illness behavior.
Conclusion
Knowledge of the pattern of illness behavior in patients with MUPS enables us to improve psychological treatments that directly address specific aspects of illness behavior or health anxiety. Differences between sexes in illness behaviors require more differentiated consideration in future research.
Similar content being viewed by others
References
Sharpe M, Mayou R, Bass C. Concepts, theories and terminology. In: Mayou R, Bass C, Sharpe M, editors. Treatment of functional somatic symptoms. Oxford: Oxford University Press; 1995. p. 3–16.
Rief W, Hessel A, Braehler E. Somatization symptoms and hypochondriacal features in the general population. Psychosom Med. 2001;63:595–602.
Jacobi F, Wittchen H-U, Holting C, Höfler M, Pfister H, Müller N, et al. Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med. 2004;34:597–611.
Steinbrecher N, Koerber S, Frieser D, Hiller W. The prevalence of medically unexplained symptoms in primary care. Psychosomatics. 2011;52:263–71.
Rief W, Hiller W, Margraf J. Cognitive aspects in hypochondriasis and the somatization syndrome. J Abnorm Psychol. 1998;107:587–95.
Rief W, Broadbent E. Explaining medically unexplained symptoms-models and mechanisms. Clin Psychol Rev. 2007;27:821–41.
Rief W, Martin A, Klaiberg A, Brähler E. Specific effects of depression, panic, and somatic symptoms on illness behavior. Psychosom Med. 2005;67:596–601.
Rief W, Ihle D, Pilger F. A new approach to assess illness behaviour. J Psychosom Res. 2003;54:405–14.
Looper KJ, Kirmayer LJ. Behavioral medicine approaches to somatoform disorders. J Consult Clin Psychol. 2002;70:810–27.
Kirmayer LJ, Young A. Culture and somatization: clinical, epidemiological, and ethnographic perspectives. Psychosom Med. 1998;60:420–30.
Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005;62:903–10.
Smith GR, Monson RA, Ray DC. Patients with multiple unexplained symptoms. Their characteristics, functional health, and health care utilization. Arch Intern Med. 1986;146:69–72.
Petrie KJ, Broadbent E. Assessing illness behaviour. J Psychosom Res. 2003;54:415–6.
Mewes R, Rief W, Brähler E, Martin A, Glaesmer H. Lower decision threshold for doctor visits as a predictor of health care use in somatoform disorders and in the general population. Gen Hosp Psychiatry. 2008;30:349–55.
Andersen NLT, Eplov LF, Andersen JT, Hjorthøj CR, Birket-Smith M. Health care use by patients with somatoform disorders: a register-based follow-up study. Psychosomatics. 2013;54:132–41.
Cleary PD, Mechanic D, Greenley JR. Sex differences in medical care utilization: an empirical investigation. J Health Soc Behav. 1982;23:106–19.
Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA. Gender differences in the utilization of health care services. J Fam Pract. 2000;49:147–52.
Barsky AJ, Delamater BA, Orav JE. Panic disorder patients and their medical care. Psychosomatics. 1999;40:50–6.
Hansen MS, Fink P, Frydenberg M, Oxhøj M-L. Use of health services, mental illness, and self-rated disability and health in medical inpatients. Psychosom Med. 2002;64:668–75.
Simon G, Ormel J, Von Korff M, Barlow W. Health care costs associated with depressive and anxiety disorders in primary care. Am J Psychiatry. 1995;152:352–7.
Tomenson B, McBeth J, Chew-Graham CA, MacFarlane G, Davies I, Jackson J, et al. Somatization and health anxiety as predictors of health care use. Psychosom Med. 2012;74:656–64.
Jyväsjärvi S, Joukamaa M, Väisänen E, Larivaara P, Kivelä SL, Keinänen-Kiukaanniemi S. Somatizing frequent attenders in primary health care. J Psychosom Res. 2001;50:185–92.
Nanke A, Rief W. Zur Inanspruchnahme medizinischer Leistungen bei Patienten mit somatoformen Störungen [Features of health care utilization in patients with somatoform disorders]. Psychotherapeut. 2003;48:329–35.
Katon W, Lin E, Von Korff M, Russo J, Lipscomb P, Bush T. Somatization: a spectrum of severity. Am J Psychiatry. 1991;148:34–40.
Kapur N, Hunt I, Lunt M, McBeth J, Creed F, Macfarlane G. Psychosocial and illness related predictors of consultation rates in primary care—a cohort study. Psychol Med. 2004;34:719–28.
Hiller W, Fichter MM. High utilizers of medical care: a crucial subgroup among somatizing patients. J Psychosom Res. 2004;56:437–43.
Rief W, Martin A, Rauh E, Zech T, Bender A. Evaluation of general practitioners’ training: how to manage patients with unexplained physical symptoms. Psychosomatics. 2006;47:304–11.
Dimsdale JE. Medically unexplained symptoms: a treacherous foundation for somatoform disorders? Psychiatr Clin North Am. 2011;34:511–3.
Meng F, Cui Y, Shen Y. Preliminary investigation on clinical features of somatoform disorders in general hospital. Chin Ment Heal J. 1999;13:67–9.
Kroenke K, Mangelsdorff D. Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. Am J Med. 1989;86:262–6.
Rief W, Hiller W, Heuser J. SOMS—Das screening für somatoforme störungen. Manual zum fragebogen [SOMS—the screening for somatoform symptoms]. Bern: Huber-Verlag; 1997.
Rief W, Hiller W. A new approach to the assessment of the treatment effects of somatoform disorders. Psychosomatics. 2003;44:492–8.
Pilowsky I. Dimensions of hypochondriasis. Br J Psychiatry. 1967;113:89–93.
Beck AT, Steer RA. Beck depression inventory. Manual. Washington: Washington Press; 1978.
Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893–7.
Aldenderfer MS, Blashfield RK. Cluster analysis. Newbury Park: SAGE Publishing; 1984.
Clatworthy J, Buick D, Hankins M, Weinman J, Horne R. The use and reporting of cluster analysis in health psychology : a review. Br J Health Psychol. 2005;10:329–58.
Schendera CFG. Clusteranalyse mit SPSS. Mit Faktorenanalyse. München: Oldenbourg Wissenschaftsverlag; 2009.
Field A. Discovering statistics using IBM SPSS statistics. 4th ed. London: Sage; 2013.
Bergmann E, Kamtsiuris P. Inanspruchnahme medizinischer Leistungen [Utilization of medical services]. Gesundheitswesen. 1999;61:138–44.
Rief W, Nanke A, Emmerich J, Bender A, Zech T. Causal illness attributions in somatoform disorders: associations with comorbidity and illness behavior. J Psychosom Res. 2004;57:367–71.
Robbins JM, Kirmayer LJ. Attributions of common somatic symptoms. Psychol Med. 1991;21:1029–45.
Martin A, Rief W. Relevance of cognitive and behavioral factors in medically unexplained syndromes and somatoform disorders. Psychiatr Clin North Am. 2011;34:565–78.
Kroenke K, Spitzer RL, DeGruy FV, Hahn SR, Linzer M, Williams JBW, et al. Multisomatoform disorder: an alternative to undifferentiated somatoform disorder for the somatizing patient. Arch Gen Psychiatry. 1997;54:352–8.
Mechanic D. Sex, illness, illness behavior, and the use of health services. Soc Sci Med. 1978;12:207–14.
Sierra Hernandez CA, Han C, Oliffe JL, Ogrodniczuk JS. Understanding help-seeking among depressed men. Psychol Men Masculinity. 2014;15:346–54.
Acknowledgments
This study has been supported by a grant from the German Ministry of Education and Research BMBF (Head of the Project W. Rief).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
This study was approved by the Philipps University of Marburg Ethics Committee. All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.
Conflict of Interest
The authors declare that they have no conflict of interest.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Weiss, F.D., Rief, W., Martin, A. et al. The Heterogeneity of Illness Behaviors in Patients with Medically Unexplained Physical Symptoms. Int.J. Behav. Med. 23, 319–326 (2016). https://doi.org/10.1007/s12529-015-9533-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12529-015-9533-8