Research Article: Emotion regulation in patients with somatic symptom and related disorders: A systematic review

Date Published: June 7, 2019

Publisher: Public Library of Science

Author(s): Zeynep Emine Okur Güney, Heribert Sattel, Michael Witthöft, Peter Henningsen, Laura Barca.


Somatic symptoms and related disorders (SSD) are prevalent phenomena in the health-care system. Disturbances in emotion regulation (ER) are commonly observed in patients suffering from SSD.

This review aimed to examine ER processes that characterize SSD by a systematic analysis of the available empirical studies.

PsycINFO and PubMed databases for the articles published between January 1985 and June 2018.

“emotion/al regulation” or “affect regulation” and various forms of SSD.

Empirical studies that a) assigned adolescent or adult patients suffering from SSD based on a clinical diagnosis, and b) examined the relationship between ER and SSD, were included.

A tabular summary of the articles was generated according to study characteristics, study quality, variables, and findings. The findings were organized based on ER variables used in the articles and diagnoses of SSD, which were then re-organized under the main constituents of ER (attention, body, and knowledge).

The findings of the 64 articles largely supported the association between SSD and disturbances in ER, which are usually shared by different diagnoses of SSD. The results indicate that patients show a reduced engagement with cognitive content of emotions. On the other hand, bodily constituents of ER seem to depict an over-reactive pattern. Similarly, the patients tend to encounter difficulties in flexibly disengaging their (spontaneous) attention from emotional material.

There is a scarcity of longitudinal designs, randomized controlled trials, experiments, and diary studies suited to investigate the short- and long-term causal relationship between ER and SSD. Symptoms of SSD and measures to assess emotion regulation are heterogeneous.

Assessment of ER processes is potentially useful to understand SSD and for treatment planning. Furthermore, a concurrent investigation of the dynamic interaction of the ER modalities promises insights for better understanding of the role of ER in development, course, and maintenance of SSD.

Partial Text

The flow diagram for the 64 included articles is shown in Fig 1.

Different models and approaches to chronic somatic symptom distress agree on the central role of affective processes in the maintenance of this condition (see the reviews from [24,139]). This present review aimed at systematically investigating the existing literature with regard to the question, how patients with somatic symptom and related disorders (SSD) regulate their emotions. This was intended by 1) assessing which ER processes in SSD were examined in the body of literature, 2) scrutinizing whether relationships between ER processes, and somatic and psychological symptoms in SSD could be established and 3) whether these ER processes differ between patients with SSD, healthy controls and patients with other mental or physical disorders and finally, 4) by a comprehensive description of the characteristic ER processes of patients with SSD. Although there is a vast amount of research that has examined facets of emotion regulation in patients with SSD, to our knowledge none of the previous studies have synthesized the findings systematically. A potential reason for such a gap might be the challenge of bringing two complex and interdisciplinary concepts together: emotion regulation and SSD [10,140]. In fact, the present review ended up with diverse diagnoses and ER constructs as a consequence of the various different terms and measurement methods.




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