Представления о болезни и её причинах у пациентов с соматоформными расстройствами: связь с соматическими жалобами и субъективным благополучием

Background. Severe emotional reactions to the disease, an erroneous understanding of the true causes of the disease, a focus on a decrease in the functional state of the body, a low level of personal control are factors in the deterioration of the quality of life and the chronification of both somatic and mental diseases, and in patients with somatoform disorders (SD) they may be associated with more pronounced psycho-emotional instability and features of psychopathological symptoms. Objective: identify the features of ideas about the disease and the causes of its formation and dynamics in patients with SD and to determine their association with the severity of psychosomatic complaints and subjective psychological well-being. Material. Based on the psychiatric (crisis) department of the A.K. Eramishantsev City Clinical Hospital of the Moscow Department of Health and the outpatient department of the private Medical Center “Irbis” between 2016 and 2020 100 patients aged 18-68 years, male and female, diagnosed according to ICD-10 SD (F45) and dissociative (conversion) disorder (F44) were examined. Methods. A battery of psychodiagnostic tests was used: the Somatoform Symptom Screening Scale, the Quality of Life and Satisfaction Questionnaire, the Disease Perceptions Questionnaire, and the Health Behavior Assessment Scale. Results. In patients with SD, despite their formally expressed confidence in the need for treatment, their mood for therapy of behavioral disorders and satisfaction with its results, the mechanisms for understanding the formation, development and prognosis of the disease are disturbed. The tendency of patients with SD to psycho-emotional experiences explains the stereotype of ideas about the disease: the lack of a correct interpretation of specific facts causes absence of selfconfidence and confidence in others, an attitude towards a long course of the disease, and an overestimation of the negative consequences of the disease. In chronic pain syndrome and conversion against the background of complaints of moderate severity, there is an erroneous one-sided understanding of the real causes of the disease, a pronounced emotional response in the form of in-confidence in a possible improvement in the course of the disease and avoidance of cooperation with the therapist. Patients with SD consider various psychological factors to be the key factors determining the onset, development, and outcome of the disease. Impersonal attribution of the disease is more common in patients with undifferentiated SD. The idea of the disease as a cyclical and deepening process, caused by a series of adverse random events and characterized by negative consequences, prevails in patients with more pronounced complaints of somatoform symptoms. The representation of the disease as a long-term process of a life test, with irreparable consequences for the body, with a pronounced emotional reaction to a “dangerous” disease, projective attribution of the disease by external psychological factors determines the worst satisfaction with life and social functioning. Patients who are confident in the negative consequences of the disease and with a pronounced emotional reaction to it are characterized by signs of hypochondriacal behavior with an exaggerated focus on themselves and personal problems. The ability to establish constant personal control over the course of therapy, an adequate understanding of the disease is associated with greater satisfaction with health. Conclusions. Ideas about negative consequences, emotional response, personal control, understanding of the disease and attribution of the disease by a psychological factor are targets for psycho-correctional work with a contingent of patients with SD.