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Beyond the Unexplainable Pain: Relational World of Patients With Somatization Syndromes

Landa, Alla PhD*; Bossis, Anthony P. PhD; Boylan, Laura S. MD‡§; Wong, Philip S. PhD

The Journal of Nervous and Mental Disease: May 2012 - Volume 200 - Issue 5 - p 413–422
doi: 10.1097/NMD.0b013e3182532326
Original Articles

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.

*Department of Psychiatry, Columbia University, New York, NY; †Department of Psychiatry, New York University School of Medicine, New York, NY; ‡Department of Neurology, New York University School of Medicine, New York, NY; §Department of Veterans Affairs, NY Harbor Healthcare, NY; and ∥Department of Psychology, Long Island University, Brooklyn, NY.

Send reprint requests to Alla Landa, PhD, Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 40, New York, NY 10032. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.