title: Personality traits, defense mechanisms and hostility features associated with somatic symptom severity in both health and disease.
abstract: OBJECTIVE
  Somatic symptoms are widespread in clinical practice. The association of somatic symptom severity with impaired health status holds both when symptoms are medically unexplained and when they are medically explained. The role of personality dimensions in the formation of somatic symptoms in patients with established, chronic diseases when compared to healthy participants had not been investigated prior to this study.
  
  
  METHODS
  In samples of 411 healthy subjects and 810 participants with any of 9 established, chronic medical conditions, we measured psychological distress (SCL-90-R), personality traits (Zuckerman-Kuhlman Personality Questionnaire), defensive profiles (Defense Style Questionnaire), individual defenses (Life Style Index) and hostility features (Hostility and Direction of Hostility Questionnaire). Hierarchical multivariate models were used to assess the independent associations between personality dimensions and somatic symptom severity in both samples. The SCL-90-R somatization scale served as the outcome variable.
  
  
  RESULTS
  In both samples, older age, less education, higher neuroticism, adoption of the displacement defense and depressive symptoms were independently and positively associated with somatic symptom severity. Higher somatic symptom severity was also associated with more "introverted" features (i.e., the self-sacrificing defensive style and self-criticism) among participants with established, chronic medical conditions.
  
  
  CONCLUSIONS
  These data suggest that similar personality traits and defense mechanisms are associated with somatic symptom severity in health and disease, indicating that somatic symptoms are not simply consequences of having a medical condition. The specific associations of the self-sacrificing defensive profile and self-criticism with somatic symptom severity in the patient sample may have important clinical implications.
authors.affiliation: Department of Psychiatry, Medical School, University of Ioannina, Greece. Electronic address: tyfantis@cc.uoi.gr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hyphantis
authors.forename: Panagiota
authors.initials: P
authors.lastname: Goulia
authors.forename: Andre F
authors.initials: AF
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001008:Anxiety Disorders; D003674:Defense Mechanisms; D004522:Educational Status; D005260:Female; D006791:Hostility; D006801:Humans; D008297:Male; D008875:Middle Aged; D000075384:Neuroticism; D010551:Personality; D010554:Personality Disorders / Q000150:complications; D010555:Personality Inventory; D012307:Risk Factors; D012720:Severity of Illness Index; D013001:Somatoform Disorders / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications; D011795:Surveys and Questionnaires
keywords: Defense mechanisms; Hostility; Medical illness; Personality; Somatic symptoms; Somatization