title: Somatization is associated with deficits in affective Theory of Mind.
abstract: OBJECTIVE
  To determine whether deficits in mental representation of emotion may constitute a mechanism for somatization.
  
  
  METHODS
  In this case-control study, we obtained measures of cognitive and affective Theory of Mind, emotional awareness, positive and negative affect, depression, anxiety, and physical symptoms and determined psychiatric diagnoses in consecutive outpatients, aged 19 to 60, with Conversion Disorder (n=29), Functional Somatic Syndromes (n=30), or "explained" Medical Disorders (Controls) (n=30). Main outcome measure was the Animations-L score, i.e., use of words describing emotional content while performing the Frith-Happé Animations (video) Task, an established Theory of Mind measure in which the emotional content of a story is conveyed through movement.
  
  
  RESULTS
  Groups were similar in number of physical symptoms, negative affect, and ability to describe emotional experiences on a written measure that specifically solicited such descriptions. Conversion Disorder and Functional Somatic Syndrome groups scored lower on Animations-L, endorsed significantly less positive affect, and had more anxiety than Medical Controls. Animations-L and positive affect scores were predictive of group membership, with lower scores predicting somatizing conditions.
  
  
  CONCLUSIONS
  Relative to Medical Controls, a deficit in the encoding and reporting of emotion when the emotional content of the stimulus is conveyed in action occurs equally in Conversion Disorder and Functional Somatic Syndrome patients and is consistent with previous findings in somatoform disorder inpatients. Difficulty with "conversion" from implicit (action, somatic) to explicit (representational) processing of emotions, exacerbated by anxiety, may constitute a mechanism for somatization.
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Arizona, United States. stonnington.cynthia@mayo.edu
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Stonnington
authors.forename: Dona E C
authors.initials: DE
authors.lastname: Locke
authors.forename: Chiu-Hsieh
authors.initials: CH
authors.lastname: Hsu
authors.forename: Cheryl
authors.initials: C
authors.lastname: Ritenbaugh
authors.forename: Richard D
authors.initials: RD
authors.lastname: Lane
mesh_terms: D000328:Adult; D000339:Affect / Q000502:physiology*; D001008:Anxiety Disorders / Q000523:psychology; D003291:Conversion Disorder / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D013001:Somatoform Disorders / Q000523:psychology*; D011795:Surveys and Questionnaires; D056345:Theory of Mind / Q000502:physiology*