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Measures of Heart Rate Variability in Individuals With Somatic Symptom Disorder

Huang, Wei-Lieh MD, MS; Liao, Shih-Cheng MD, PhD; Yang, Cheryl C.H. PhD; Kuo, Terry B.J. MD, PhD; Chen, Tzu-Ting MD, MS; Chen, I-Ming MD; Gau, Susan Shur-Fen MD, PhD

doi: 10.1097/PSY.0000000000000362
Original Articles

Objective Little is known about autonomic nervous system activity in individuals with somatic symptom disorder (SSD) as defined by DSM-V criteria. The aims of this study were to investigate whether individuals with SSD differ from healthy controls in heart rate variability (HRV) measures of autonomic nervous system activity and whether sex has a moderating effect on this association.

Methods We recruited 168 individuals with SSD (35.1% men) and 106 healthy controls (27.4% men). Demographics, HRV, and psychological factors were measured using the Patient Health Questionnaire-15, Health Anxiety Questionnaire, Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory. Multiple regression analysis was used to examine the association of SSD with HRV, adjusting for demographic and psychological measures.

Results Individuals with SSD had lower levels of total-power HRV and low-frequency HRV, but no differences in high-frequency (HF)-HRV were found. HRV differences between SSD and controls varied by sex and age (triple interaction TP-HRV β = −0.222, p < .001; low-frequency HRV β = −0.332, p < .001; and HF-HRV β = −0.167, p = .006). Whole-sample multiple regression analyses revealed significant sex differences in the magnitudes of the association between BDI-II with HF-HRV (β of sex*BDI-II: 0.761, p = .005) and analyses stratified by sex indicated that HF-HRV was significantly correlated with depression in men with SSD (r = −0.491, p < .001) but not in women with SSD (r = 0.057, p = .558).

Conclusions These results suggest that patients with SSD demonstrate different patterns of HRV and the patterns of association between HRV indices and psychological factors vary between men and women.

Supplemental digital content is available in the text.

From the Department of Psychiatry (Huang, Chen), National Taiwan University Hospital, Yun-Lin Branch, Yunlin; Department of Psychiatry (Huang, Liao, Chen, Gau), National Taiwan University Hospital; Department of Psychiatry (Huang, Liao, Gau), Graduate Institute of Clinical Medicine (Huang, Gau), College of Medicine, National Taiwan University; Institute of Brain Science (Yang, Kuo), National Yang-Ming University; and Institute of Health Policy and Management (Chen), College of Public Health, National Taiwan University, Taipei, Taiwan.

Supplemental Content

Address correspondence and reprint requests to Susan Shur-Fen Gau, MD, PhD, Department of Psychiatry, National Taiwan University Hospital & College of Medicine, No. 7, Chung-Shan South Road, Taipei 10002, Taiwan. E-mail:

Received for publication June 30, 2015; revision received April 6, 2016.

Copyright © 2017 by American Psychosomatic Society
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