Somatosensory amplification

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Somatosensory amplification (SSA) is a tendency to perceive normal somatic and visceral sensations as being relatively intense, disturbing and noxious. It is a common feature of hypochondriasis and is commonly found with fibromyalgia, major depressive disorder, some anxiety disorders, Asperger syndrome, and alexithymia. [1] [2] [3] [4] One common clinical measure of SSA is the Somatosensory Amplification Scale (SSAS).

Contents

The term "amplification of bodily sensations" [5] was coined by Dr. Arthur J. Barsky in 1979 [5] to explain why patients with the same medical disease experienced symptoms differently. [6] He described it as "a temporally stable, generalised feature" [6] of hypochondriasis. In the 1980s, the term "somatosensory amplification" (SSA) was first used. [5] [6]

It is unclear whether persons with SSA have a truly increased physiological sensitivity to bodily sensations. One study paradoxically found lower levels of SSA in hypochondriacs who reported being constantly aware of their own heartbeats. [3] Tentative electroencephalography results tend to indicate SSA is more likely due to differences in long-latency cognitive processing, rather than objective physiological differences in sensitivity. [7]

It is not currently known whether SSA causes or is caused by any of these conditions, only that they are comorbid conditions. One small study found that, in patients with depression, SSA may be part of the depression (i.e., treating the depression reduced the SSA). [1]

Characteristics

SSA has three main components which are both sensory ("lower-level") and cognitive-emotional ("higher-level"): [6] being overly attentive to bodily sensations, [6] [8] [9] [10] [11] "focusing on rare and weak body sensations", [6] and "the tendency to appraise ambiguous or vague visceral and somatic sensations as abnormal, pathological, and symptomatic of disease, rather than considering them to be normal." [8]

The cognitive-emotional process may be the outcome of the sensory process, leading to many criticisms towards this conceptualisation of SSA. [6] According to a study, the first component of SSA may be more accurately described as body awareness, i.e. the tendency to focus on one's body. [5] SSA leads to bodily sensations being felt as symptoms of disease and to symptoms being felt more intensely. [6]

A review conceptualises SSA as an amplification of internal and external stimuli which are perceived as threatening to the body's integrity. It states that SSA involves an emotional and automatic response to stimuli which leads them to be perceived as threatening, giving rise to worries and anxiety. This process may remain subconscious, making the individual unable to detect and describe it, linking SSA to alexithymia. [6]

According to Barsky, sensations which may be amplified are: [9]

"1) normal physiological sensations such as intestinal peristalsis, postural hypotension. and changes in heart rate; 2) benign dysfunctions and trivial, self-limited infirmities such as transient tinnitis, a twitching eyelid, or dry skin; 3) the visceral and somatic concomitants of intense affect, such as the sympathetic arousal accompanying anxiety; and 4) the symptoms of serious nonpsychiatric medical disease and end-organ pathology."

SSA has features of an enduring trait, [6] [8] [9] [10] but it is also state-like. [8] [9]

Causes

Bodily sensations may be amplified by psychological stress or through the belief that one's bodily sensations are symptoms of illness (cognition), expecting oneself or others to be ill (context), being anxious or depressed, for example (mood), or paying attention to the sensations (attention). Some individuals may "amplify all forms of distress." [9]

According to a study, high SSAS scores are predicted by depression and disease phobia in patients with panic disorder and by bodily preoccupation and health habits in patients with hypochondriasis. [11]

SSA may be acquired in childhood following adverse experiences or it may be an innate trait. [6] [9] From an individual perspective, an unstable attachment style or early adverse experiences may enhance an infant's threat-detection mechanism, this then becoming internalised despite losing its adaptive value. From an evolutionary perspective, SSA may help in assessing risk and taking the appropriate action in a demanding situation, suggesting that SSA might not be maladaptive. [6]

SSA and other conditions

SSA is related to many features of diseases. [6] SSA is associated with hypochondriasis, [5] [6] [11] alexithymia, [6] [8] and somatic symptoms. [5] [6] [10] Alexithymia, characterised by difficulty with introspection, was measured by the Toronto Alexithymia Scale (TAS), a self-report scale, so the result may be less reliable. [6] SSA, neuroticism, and negative affectivity (the latter two being risk factors of psychopathology) are related, potentially linking SSA with psychopathology. [6] SSA is linked to anxiety and depression, [6] [8] as well as idiopathic environmental intolerances (IEI), expectations and intensity of symptoms, side effects, and modern health worries (MHWs). [6]

Usefulness

Hypochondriasis

SSA has been hypothesised to be the mechanism which links the perception of bodily sensations with the development of hypochondriasis. [8] [9] [10] [11] Patients with hypochondriasis may be more sensitive to bodily sensations, hence feeling them more intensely. They might therefore believe they have a disease and focus on sensations confirming their belief while ignoring those which don't, further reinforcing their belief. [9]

Somatisation

SSA might aid in the understanding of somatisation. [8] [9] [10] [11] Health-related information or knowing that somebody else has an illness could lead to the belief that sensations previously not understood are symptoms of disease. This makes the sensations feel more disturbing which increases focus on the body. The individual begins searching for proof they are ill by re-attributing previously subconscious or normal sensations to their presumed illness, further reinforcing their belief. [10]

Symptom variation

SSA may explain why patients experience symptoms differently to other patients with the same condition, or more intensely than their organ pathology indicates. [5] [8] [9] [11]

Other

If internal or external stimuli are perceived as threatening, but their source is unknown, the most easily available information (from the media, for example) will be used to find the source. "This can lead to more attribution errors as in the case of idiopathic environmental intolerances or non-specific medication side effects." When amplified stimuli are attributed to modern technologies or electromagnetic fields (EMFs), MHWs and IEI-EMF may develop, respectively. [6]

According to a study, "Our results suggest that SSA may be involved in the development of nocebo effects through an increased internal focus, elevated subjective symptom report, and anxiety." [5] It may also play a role in the development of conditions which are not well-understood, such as "irritable bowel syndrome, fibromyalgia, hypoglycemia, and chronic fatigue syndrome." [9] SSA may be present in psychiatric conditions, including those which involve somatic symptoms, such as panic disorder or depression. [8] [9] [11]

According to a review, SSA allows for the study of symptoms independently, which would lead to a greater understanding of how patients experience symptoms and how to alleviate them. Furthermore, it may facilitate understanding of the placebo effect, and why some patients are unaware of their symptoms and seek treatment for their illness late ("minimizers"). [9]

See also

Related Research Articles

<span class="mw-page-title-main">Hypochondriasis</span> Medical condition

Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. Hypochondria is an old concept whose meaning has repeatedly changed over its lifespan. It has been claimed that this debilitating condition results from an inaccurate perception of the condition of body or mind despite the absence of an actual medical diagnosis. An individual with hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.

<span class="mw-page-title-main">Somatization disorder</span> Mental disorder consisting of clinically significant somatic symptoms

Somatization disorder was a mental and behavioral disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic symptoms. It was recognized in the DSM-IV-TR classification system, but in the latest version DSM-5, it was combined with undifferentiated somatoform disorder to become somatic symptom disorder, a diagnosis which no longer requires a specific number of somatic symptoms. ICD-10, the latest version of the International Statistical Classification of Diseases and Related Health Problems, still includes somatization syndrome.

<span class="mw-page-title-main">Alexithymia</span> Subclinical deficiency in understanding, processing, or describing emotions

Alexithymia, also called emotional blindness, is a neuropsychological phenomenon characterized by significant challenges in recognizing, expressing, and describing one's own emotions. It is associated with difficulties in attachment and interpersonal relations. While there is no scientific consensus on its classification as a personality trait, medical symptom, or mental disorder, alexithymia is highly prevalent among individuals with autism spectrum disorder (ASD), ranging from 50% to 85% of prevalence.

Cyberchondria, otherwise known as compucondria, is the unfounded escalation of concerns about common symptomology based on review of search results and literature online. Articles in popular media position cyberchondria anywhere from temporary neurotic excess to adjunct hypochondria. Cyberchondria is a growing concern among many healthcare practitioners as patients can now research any and all symptoms of a rare disease, illness or condition, and manifest a state of medical anxiety.

<span class="mw-page-title-main">Sensory overload</span> State of overwhelm caused by an excess of sensory input

Sensory overload occurs when one or more of the body's senses experiences over-stimulation from the environment.

Pseudodysphagia, in its severe form, is the irrational fear of swallowing or, in its minor form, of choking. The symptoms are psychosomatic, so while the sensation of difficult swallowing feels authentic to the individual, it is not based on a real physical symptom. It is important that dysphagia be ruled out before a diagnosis of pseudodysphagia is made.

Medically unexplained physical symptoms are symptoms for which a treating physician or other healthcare providers have found no medical cause, or whose cause remains contested. In its strictest sense, the term simply means that the cause for the symptoms is unknown or disputed—there is no scientific consensus. Not all medically unexplained symptoms are influenced by identifiable psychological factors. However, in practice, most physicians and authors who use the term consider that the symptoms most likely arise from psychological causes. Typically, the possibility that MUPS are caused by prescription drugs or other drugs is ignored. It is estimated that between 15% and 30% of all primary care consultations are for medically unexplained symptoms. A large Canadian community survey revealed that the most common medically unexplained symptoms are musculoskeletal pain, ear, nose, and throat symptoms, abdominal pain and gastrointestinal symptoms, fatigue, and dizziness. The term MUPS can also be used to refer to syndromes whose etiology remains contested, including chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity and Gulf War illness.

Dysesthesia is an unpleasant, abnormal sense of touch. Its etymology comes from the Greek word "dys," meaning "bad," and "aesthesis," which means "sensation". It often presents as pain but may also present as an inappropriate, but not discomforting, sensation. It is caused by lesions of the nervous system, peripheral or central, and it involves sensations, whether spontaneous or evoked, such as burning, wetness, itching, electric shock, and pins and needles. Dysesthesia can include sensations in any bodily tissue, including most often the mouth, scalp, skin, or legs.

Somatization is a tendency to experience and communicate psychological distress as bodily and organic symptoms and to seek medical help for them. More commonly expressed, it is the generation of physical symptoms of a psychiatric condition such as anxiety. The term somatization was introduced by Wilhelm Stekel in 1924.

Phobophobia is a phobia defined as the fear of phobias, or the fear of fear, including intense anxiety and unrealistic and persistent fear of the somatic sensations and the feared phobia ensuing. Phobophobia can also be defined as the fear of phobias or fear of developing a phobia. Phobophobia is related to anxiety disorders and panic attacks directly linked to other types of phobias, such as agoraphobia. When a patient has developed phobophobia, their condition must be diagnosed and treated as part of anxiety disorders.

Nosophobia, also known as disease phobia or illness anxiety disorder, is the irrational fear of contracting a disease, a type of specific phobia. Primary fears of this kind are fear of contracting HIV infection, pulmonary tuberculosis (phthisiophobia), venereal diseases, cancer (carcinophobia), heart diseases (cardiophobia), and catching the common cold or flu.

Amplification is used to describe a judged tendency of a person to amplify physical symptoms based on psychological factors such as anxiety or depression. Distinct interpretations of this type of presentation could be sensory processing disorder involving differences in the way a person reacts to sensory input which is regarded as a pervasive developmental disorder related to the autism spectrum; or there is an alternative psychological concept of 'innate sensitiveness' as a personality trait coined by Carl Jung later developed into the highly sensitive person trait. In one instance where amplification is used as a handle or point of reference or diagnosis it is said "somatosensory amplification refers to the tendency to experience somatic sensation as intense, noxious, and disturbing. What may be a minor 'twinge' or mild 'soreness' to the stoic, is a severe, consuming pain to the amplifier."

Robert Michael Bagby is a Canadian psychologist, senior clinician scientist and director of clinical research at the Centre for Addiction and Mental Health (CAMH). He is a full professor in the Department of Psychiatry, University of Toronto. He became a full professor of psychology at the University of Toronto Scarborough campus in July 2011.

<span class="mw-page-title-main">Atypical trigeminal neuralgia</span> Medical condition

Atypical trigeminal neuralgia (ATN), or type 2 trigeminal neuralgia, is a form of trigeminal neuralgia, a disorder of the fifth cranial nerve. This form of nerve pain is difficult to diagnose, as it is rare and the symptoms overlap with several other disorders. The symptoms can occur in addition to having migraine headache, or can be mistaken for migraine alone, or dental problems such as temporomandibular joint disorder or musculoskeletal issues. ATN can have a wide range of symptoms and the pain can fluctuate in intensity from mild aching to a crushing or burning sensation, and also to the extreme pain experienced with the more common trigeminal neuralgia.

Functional disorder is an umbrella term for a group of recognisable medical conditions which are due to changes to the functioning of the systems of the body rather than due to a disease affecting the structure of the body.

Somatic symptom disorder, also known as somatoform disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not purposefully produced or feigned, and they may or may not coexist with a known medical ailment. Manifestations of Somatic symptom disorder are variable and symptoms can be widespread, specific, and often fluctuate. Somatic symptom disorder corresponds to the way an individual views and reacts to symptoms as rather than the symptoms themselves. Somatic symptom disorder may develop in those who suffer from an existing chronic illness or medical condition.

The Patient Health Questionnaire (PHQ) is a multiple-choice self-report inventory that is used as a screening and diagnostic tool for mental health disorders of depression, anxiety, alcohol, eating, and somatoform disorders. It is the self-report version of the Primary Care Evaluation of Mental Disorders (PRIME-MD), a diagnostic tool developed in the mid-1990s by Pfizer Inc. The length of the original assessment limited its feasibility; consequently, a shorter version, consisting of 11 multi-part questions - the Patient Health Questionnaire was developed and validated.

The Somatic Symptom Scale - 8 (SSS-8) is a brief self-report questionnaire used to assess somatic symptom burden. It measures the perceived burden of common somatic symptoms. These symptoms were originally chosen to reflect common symptoms in primary care but they are relevant for a large number of diseases and mental disorders. The SSS-8 is a brief version of the popular Patient Health Questionnaire - 15 (PHQ-15).

The term functional somatic syndrome (FSS) refers to a group of chronic diagnoses with no identifiable organic cause. This term was coined by Hemanth Samkumar. It encompasses disorders such as chronic fatigue syndrome, fibromyalgia, chronic widespread pain, temporomandibular disorder, irritable bowel syndrome, lower back pain, tension headache, atypical face pain, non-cardiac chest pain, insomnia, palpitation, dyspepsia and dizziness. General overlap exists between this term, somatization and somatoform.

<span class="mw-page-title-main">Interoception</span> Sensory system that receives and integrates information from the body

Interoception is the collection of senses providing information to the organism about the internal state of the body. This can be both conscious and subconscious. It encompasses the brain's process of integrating signals relayed from the body into specific subregions—like the brainstem, thalamus, insula, somatosensory, and anterior cingulate cortex—allowing for a nuanced representation of the physiological state of the body. This is important for maintaining homeostatic conditions in the body and, potentially, facilitating self-awareness.

References

  1. 1 2 Sayar, Kemal; Barsky, Arthur J.; Gulec, Huseyin (2005). "Does Somatosensory Amplification Decrease with Antidepressant Treatment?". Psychosomatics. 46 (4): 340–4. doi: 10.1176/appi.psy.46.4.340 . PMID   16000677.
  2. ↑ Nakao, Mutsuhiro; Barsky, Arthur J.; Kumano, Hiroaki; Kuboki, Tomifusa (2002). "Relationship Between Somatosensory Amplification and Alexithymia in a Japanese Psychosomatic Clinic". Psychosomatics. 43 (1): 55–60. doi:10.1176/appi.psy.43.1.55. PMID   11927759. S2CID   9738550. INIST:13566951.
  3. 1 2 Mailloux, Jennifer; Brener, Jasper (2002). "Somatosensory amplification and its relationship to heartbeat detection ability". Psychosomatic Medicine. 64 (2): 353–7. doi:10.1097/00006842-200203000-00020. PMID   11914453. S2CID   20107812.
  4. ↑ Muramatsu, Kumiko; Miyaoka, Hitoshi; Muramatsu, Yoshiyuki; Fuse, Katsuya; Yoshimine, Fumitoshi; Kamijima, Kunitoshi; Gejyo, Fumitake; Sakurai, Koji (2002). "The amplification of somatic symptoms in upper respiratory tract infections". General Hospital Psychiatry. 24 (3): 172–5. doi:10.1016/S0163-8343(02)00177-9. PMID   12062142.
  5. 1 2 3 4 5 6 7 8 Köteles, Ferenc; Doering, Bettina K (2016-07-10). "The many faces of somatosensory amplification: The relative contribution of body awareness, symptom labeling, and anxiety". Journal of Health Psychology. 21 (12): 2903–2911. doi:10.1177/1359105315588216. ISSN   1359-1053. PMID   26060240. S2CID   39140893.
  6. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Köteles, Ferenc; Witthöft, Michael (2017-10-01). "Somatosensory amplification – An old construct from a new perspective". Journal of Psychosomatic Research. 101: 1–9. doi:10.1016/j.jpsychores.2017.07.011. ISSN   0022-3999. PMID   28867412.
  7. ↑ Nakao, Mutsuhiro; Barsky, Arthur J.; Nishikitani, Mariko; Yano, Eiji; Murata, Katsuyuki (2007). "Somatosensory amplification and its relationship to somatosensory, auditory, and visual evoked and event-related potentials (P300)". Neuroscience Letters. 415 (2): 185–9. doi:10.1016/j.neulet.2007.01.021. PMID   17267120. S2CID   42803595.
  8. 1 2 3 4 5 6 7 8 9 10 Nakao, Mutsuhiro; Barsky, Arthur J. (2007-10-09). "Clinical application of somatosensory amplification in psychosomatic medicine". BioPsychoSocial Medicine. 1 (1): 17. doi: 10.1186/1751-0759-1-17 . ISSN   1751-0759. PMC   2089063 . PMID   17925010.
  9. 1 2 3 4 5 6 7 8 9 10 11 12 13 Barsky, Arthur J. (1992-02-01). "Amplification, Somatization, and the Somatoform Disorders". Psychosomatics. 33 (1): 28–34. doi:10.1016/S0033-3182(92)72018-0. ISSN   0033-3182. PMID   1539100.
  10. 1 2 3 4 5 6 Duddu, Venugopal; Isaac, Mohan K.; Chaturvedi, Santosh K. (2006-01-01). "Somatization, somatosensory amplification, attribution styles and illness behaviour: A review". International Review of Psychiatry. 18 (1): 25–33. doi:10.1080/09540260500466790. ISSN   0954-0261. PMID   16451877. S2CID   25186439.
  11. 1 2 3 4 5 6 7 Martínez, M. Pilar; Belloch, Amparo; Botella, Cristina (1999). "Somatosensory amplification in hypochondriasis and panic disorder". Clinical Psychology & Psychotherapy. 6 (1): 46–53. doi:10.1002/(SICI)1099-0879(199902)6:1<46::AID-CPP183>3.0.CO;2-H. ISSN   1099-0879.
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