title: A concept mapping study on perpetuating factors of functional somatic symptoms from clinicians' perspective.
abstract: The aim of this concept mapping study was to identify the structure and alleged importance of perpetuating factors of functional somatic symptoms (FSS) from the perspective of professionals. Further, we examined to which extent these factors have been addressed in scientific literature.
  
  
  
  Ninety-nine perpetuating factors were sorted with respect to content using a card-sorting task by 61 experienced clinicians (62.3% psychologists, 75.4% female, mean age: 45.7 [SD: 10.6] years, mean duration of experience in treating FSS patients: 10.5 [SD: 7.6] years). These factors had been derived from in-depth interviews with 12 clinicians, with extensive experience in treating FSS. Thirty-eight clinicians rated the importance of the 99 factors on a scale ranging from 1 ('not important at all') to 10 ('extremely important').
  
  
  
  Hierarchical cluster analysis revealed three overarching domains of perpetuating factors: 'Hypochondria', 'Social and relational problems' and 'Symptom-related emotions and habits'. These domains comprised 16 clusters, which were rated on importance between 6.1, 'Adverse physical factors and counterproductive lifestyle', and 7.8, 'Frustration and despair regarding the symptoms'. All clusters have been addressed in scientific literature.
  
  
  
  This study revealed an encompassing hierarchical structure of somatic, emotional, cognitive, behavioral, and social factors of importance in the perpetuation of FSS based on expert opinions. This structure will guide the development of personalized treatment of FSS.
authors.affiliation: University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands. Electronic address: k.a.m.janssens@umcg.nl.
authors.forename: Karin A M
authors.initials: KA
authors.lastname: Janssens
authors.affiliation: University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands.
authors.forename: Jan H
authors.initials: JH
authors.lastname: Houtveen
authors.affiliation: University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands; Dimence, Institute for Mental Health Care, Deventer, The Netherlands.
authors.forename: Lineke M
authors.initials: LM
authors.lastname: Tak
authors.affiliation: University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands.
authors.forename: Irma J
authors.initials: IJ
authors.lastname: Bonvanie
authors.affiliation: University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands.
authors.forename: Anna
authors.initials: A
authors.lastname: Scholtalbers
authors.affiliation: University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands.
authors.forename: Anne
authors.initials: A
authors.lastname: van Gils
authors.affiliation: Utrecht University, Department of Clinical and Health Psychology, Utrecht, The Netherlands; Altrecht Psychosomatic Medicine, Zeist, the Netherlands.
authors.forename: Rinie
authors.initials: R
authors.lastname: Geenen
authors.affiliation: University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands.
authors.forename: Judith G M
authors.initials: JG
authors.lastname: Rosmalen
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D008297:Male; D000071896:Medically Unexplained Symptoms; D008875:Middle Aged; D010820:Physicians; D011584:Psychology; D011613:Psychotherapy; D013001:Somatoform Disorders / Q000145:classification* / Q000503:physiopathology*
keywords: Functional somatic symptoms; Hierarchical cluster analysis; Ontology; Perpetuating factors