title: Physical symptom attributions: a defining characteristic of somatoform disorders?
abstract: OBJECTIVE
  We examined whether primary care patients were more likely to perceive a current health problem as 'physical illness only' as opposed to entailing psychological difficulties if they had a comorbid somatoform disorder compared to patients who had (a) both comorbid somatoform disorder and anxiety/depression or (b) comorbid anxiety and/or depression, and a reference group of (c) patients with well-defined physical disease. We examined whether attributions predicted future health expenditures.
  
  
  METHODS
  A total of 1209 of 1785 patients completed questions on patient-perceived illness. The physicians diagnosed the current health problem. A stratified subsample was interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. Health expenditure was obtained from registers for a 2-year period.
  
  
  RESULTS
  The belief that the current health problem was only physical was endorsed by 86% of patients presenting physical disease, 58% of patients with somatoform disorders, 29% of patients with both somatoform disorders and anxiety/depression and 24% of patients with anxiety or depressive disorders (χ2=269.2, df=3, P<.0001). In a multiple regression model, a 'physical illness only' perception predicted lower health expenditures [β = -0.31, 95% confidence interval (-0.55; -0.07), P=.013].
  
  
  CONCLUSIONS
  The prevalent assumption that physical symptom attributions are a central aspect in somatoform disorders is not supported by the current study.
authors: The Research Clinic for Functional Disorders and Psychosomatics, Noerrebrogade 44, Aarhus University Hospital, DK-8000 Aarhus C, Denmark. Electronic address: lisbfros@rm.dk.
authors: Lisbeth
authors: L
authors: Frostholm
authors: The Research Clinic for Functional Disorders and Psychosomatics, Noerrebrogade 44, Aarhus University Hospital, DK-8000 Aarhus C, Denmark.
authors: Eva
authors: E
authors: Ørnbøl
authors: The Research Clinic for Functional Disorders and Psychosomatics, Noerrebrogade 44, Aarhus University Hospital, DK-8000 Aarhus C, Denmark.
authors: Per K
authors: PK
authors: Fink
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D003866:Depressive Disorder / Q000191:economics / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D013001:Somatoform Disorders / Q000453:epidemiology / Q000523:psychology*
keywords: Anxiety disorders; Causal attributions; Depressive disorders; Health expenditures; Somatoform disorders