Social Cognition and Levels of Personality Organization in Patients With Somatoform Disorders

Abstract

Social cognition and its association with level of personality organization (PO) were examined in 163 patients with severe somatoform disorders (SFDs) and 151 psychiatric (PSA) control patients. Social cognition was measured with the Social Cognition and Object Relations Scale, which assessed both affective and cognitive facets of social cognition. Levels of PO were assessed using theory-driven profiles of the Dutch Short Form of the Minnesota Multiphasic Personality Inventory (MMPI). The SFD patients exhibited impairments in the cognitive facets of social cognition but not more so than the PSA controls. The results for the affective aspects indicated that the SFD patients exhibited lower levels of emotional investment yet higher affect tone in interactions than the PSA controls. In contrast to the control group, level of PO was not associated with social cognition in SFD. Together, the results indicated that impairments in complexity of mental representations are not specific to SFD patients, yet impairments in emotional investment may be specific to SFD.

Do Patients with Somatoform Disorders Present with Illusory Mental Health?

“…The higher level of self-reported social competence and sociability found in the present study contrasts with previous findings of Koelen et al [48], who studied social cognition among SFD-patients in an indirect way using the Social Cognition and Object Relations Scale (SCORS) [58,59]. This scale assesses cognitive (complexity of inner representations of self and others; understanding of social causality) and affective aspects of social cognition (emotional investment in relationships and affect tone of relationships).…”

“…Although the absolute number of patients with this type of PO is relatively small in this study, it suggests that there might be a sub-group of SFD-patients with a high level of structural vulnerability and low anxiety tolerance. In this subgroup of vulnerable SFD-patients with PPO, somatization may have an integration preserving function, as had been suggested [48] and has recently been found [49].…”

“…Combining the self-report results of the present study with results of [48], who used an indirect measure of sociability, suggests that SFDpatients are aware of their socially oriented behaviour, but that there is low awareness of their underlying tendency to detachment in social relationships. The discrepancy between overt sociability and covert detachment found among SFD-patients may seriously complicate the establishment of a good therapeutic relationship with these patients.…”

“…This scale assesses cognitive (complexity of inner representations of self and others; understanding of social causality) and affective aspects of social cognition (emotional investment in relationships and affect tone of relationships). SFD-patients, compared to psychiatric controls, were characterized by a combination of a relatively high level of affect tone in relationships, comparable to that of normals, implying positive expectations of social relationships, and at the same time a lower level of emotional investment in relationships [48]. The low level of indirectly assessed emotional investment in SFD contrasts with the very low level of self-reported Self-centeredness among SFD-patients and suggest that patients with SFD are selfpreoccupied and have difficulties differentiating between the needs and desires of self and others [35] but may present with "eager to please"-characteristics, i.e.…”

Mentalizing in mothers and children with type 1 diabetes

“…Similarly, in another study, these authors found that individuals with T1D with avoidant attachment showed poorer treatment adherence than those with secure or ambivalent attachment styles (Ciechanowksi et al, 2001). Furthermore, studies converge to suggest that chronic somatic disorders may lead to serious impairments and distortions in (embodied) mentalizing (Luyten and Fonagy, 2016;Fonagy, 2012, 2013;Koelen, Eurelings-Bontekoe, van Broeckhuysen-Kloth, Snellen, and Luyten, 2014;Schönenberg et al, 2014;Malberg, 2013). Such distortions are, for instance, expressed in a tendency to make catastrophic attributions in response to bodily sensations, in the incapacity to reappraise threatening situations, and in the rigid misinterpretation of others' behaviors.…”