Psychodynamic characteristics associated with DSM-5 somatic symptom disorder in patients with persistent physical symptoms: A cross-sectional analysis.

BACKGROUND: Persistent physical symptoms (PPS) are distressing bodily complaints that persist irrespective of underlying etiology and represent a descriptive, transdiagnostic umbrella concept. Psychodynamic models highlight attachment-related affect-regulation difficulties and impaired mentalizing as potentially relevant mechanisms. With the introduction of DSM-5, somatic symptom disorder (SSD) was conceptualized as a subgroup within the PPS spectrum characterized by excessive symptom-related thoughts, feelings, and behaviors, requiring re-evaluation of previous psychodynamic findings. METHODS: This cross-sectional study (Germany, 02-12/2017) compared three matched groups (96 PPS patients with a positive SSD screen, 96 PPS patients without a positive SSD screen, and 96 healthy controls (HC)) using standardized self-report measures of psychological burden, adverse childhood experiences, attachment, mentalizing, and personality functioning. Symptom-related thoughts, feelings, and behaviors were additionally examined dimensionally across the PPS spectrum. RESULTS: Compared with patients with PPS without SSD, those screening positive for SSD showed higher attachment anxiety (η2 = 0.054; small-to-moderate effect), greater impairments in mentalizing (η2 = 0.047; small-to-moderate effect), and personality functioning (η2 = 0.069; moderate effect). Both PPS groups reported higher attachment avoidance than HC, whereas elevated attachment anxiety was specific to the SSD group. Across the PPS spectrum, psychodynamic impairments were most pronounced at high levels of symptom-related thoughts, feelings, and behaviors. CONCLUSIONS: Among patients with PPS, those screening positive for SSD showed higher attachment anxiety and impairments in mentalizing and personality functioning. These psychodynamic impairments appear to show a threshold pattern at high levels of symptom-related thoughts, feelings, and behaviors, suggesting that assessment of psychodynamic characteristics may help identify patients for more targeted interventions. TRIAL REGISTRY: [DRKS00011685].