SOMATIC SYMPTOM DISORDER AND PERCEIVED SUSCEPTIBILITY TO ILLNESS Anikó Viktória Varga A Thesis Submitted to the Graduate College of Bowling Green State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS December 2019 Committee: William H. O'Brien, Advisor Abby L. Braden Dara R. Musher-Eizenman ii ABSTRACT William H. O’Brien, Advisor Somatic Symptom Disorder (SSD) is characterized by persistent somatic symptoms and associated cognitive, affective, and behavioral factors. Perceived susceptibility to illness may contribute to the maintenance of SSD and treatment seeking intent and behavior. There are limited studies examining perceived susceptibility to illness and treatment seeking intent in people with SSD features. The primary aim of the current study was to determine whether individuals with SSD features differ from individuals without SSD features with respect to perceived susceptibility to illness and treatment seeking intent when faced with health-related information. After completing pre-video measures, participants were randomly assigned to watch either a chronic inflammation video or a nature video. Subsequently, participants’ mood, perceived susceptibility to illness, and treatment-seeking intent was assessed using self-report measures. One hundred and thirty (N = 130) participants out of three hundred and fifty-eight (N = 358) were identified as meeting criteria for SSD. Results indicated that participants with SSD features reported greater perceived susceptibility to illness and treatment seeking intent. Additionally, the chronic inflammation video was associated with higher perceived susceptibility to illness. However, there was no interaction between video condition and SSD features on perceived susceptibility to illness and treatment seeking intent. The current study provides novel evidence that people with SSD features experience greater perceived susceptibility to illness than people without SSD features, regardless of the type of information (health-related vs non-health related) they are exposed to. iii Keywords: Somatic Symptom Disorder, perceived susceptibility to illness, treatment seeking intent, health-related information iv TABLE OF CONTENTS Page INTRODUCTION ...... ...................................................................................................... 1 Somatic symptom disorder .................................................................................... 2 Epidemiology…………………………… .............................................................. 3 Perceived susceptibility to illness and somatic symptom disorder .......................... 5 Summary and hypotheses ...................................................................................... 8 METHOD……………. ..................................................................................................... 10 Participants….. ...................................................................................................... 10 Health-related video .............................................................................................. 10 Non-health-related video ....................................................................................... 11 Measures……........................................................................................................ 11 Demographic variables and medical history ............................................... 11 Patient health questionnaire-15 (PHQ-15) .................................................. 12 Somatic symptom disorder - B criteria scale (SSD-12) ............................... 13 Treatment seeking frequency...................................................................... 14 Mood…….................................................................................................. 14 Perceived susceptibility to illness and treatment seeking intent ................... 15 Procedure……. ...................................................................................................... 16 RESULTS……………...................................................................................................... 18 Comparisons on pre-video measures of the two video conditions……………… .... 18 Comparisons on pre-video measures of participants with and without SSD features 18 v Manipulation check: Effect of video exposure on perceived susceptibility, treatment seeking intent, and mood ....................................................................................... 19 Effects of video condition and SSD features on perceived susceptibility to illness and treatment seeking intent ......................................................................................... 20 Effects of video condition and SSD features on mood ............................................ 22 Relationship between post-video mood, perceived susceptibility to illness, and treatment seeking intent.......................................................................................................... 24 Relationship between perceived susceptibility to illness, treatment seeking intent, and treatment seeking frequency .................................................................................. 24 Correlations between perceived susceptibility, treatment seeking intent, and chronic inflammation video factors……………. ................................................................ 25 Summary of results….. .......................................................................................... 26 DISCUSSION .................................................................................................................. 27 Limitations............................................................................................................ 32 Future directions and concluding comments .......................................................... 34 REFERENCES ................................................................................................................. 36 APPENDIX A. DEMOGRAPHICS SURVEY ................................................................. 46 APPENDIX B. PATIENT HEALTH QUESTIONNAIRE - 15 (PHQ-15) ......................... 56 APPENDIX C. SOMATIC SYMPTOM DISORDER - B CRITERIA SCALE (SSD-12) .. 58 APPENDIX D. TREATMENT SEEKING FREQUENCY ................................................ 60 APPENDIX E. MOOD SCALE ........................................................................................ 63 APPENDIX F. ABSOLUTE RISK RATING FORM (ARRF) ........................................... 64 APPENDIX G. TREATMENT SEEKING INTENT RATING FORM .............................. 66 vi APPENDIX H. HSRB APPROVAL ................................................................................. 68 APPENDIX I. TABLES .................................................................................................... 69 APPENDIX I. FIGURES .................................................................................................. 93 Running head: SSD AND PERCEIVED SUSCEPTIBILITY TO ILLNESS 1 INTRODUCTION Somatic symptoms with ambiguous aetiology have been intriguing scholars throughout history. Accordingly, ancient Egyptians, Greeks, and Romans associated somatic symptoms to a dislocated uterus. The 17th-century physician, Thomas Sydenham generalized somatic symptoms to all genders by denoting the psychological origins of such afflictions. Scholars of the 19th century, including Pierre Briquet, Jean-Martin Charcot, and Pierre Janet, maintained the psychological explanation of somatic symptoms, while also introducing new terms such as “conversion disorder” and “dissociation” to the field (Smith, 1991; Kleinstauber & Rief, 2017; Heinrich, 2004). Probably the most salient figure in the field of distressing somatic symptoms was Sigmund Freud, who approached the disorder by the exploration of defense mechanisms and the unconscious (Freud, 1964). The term “somatization”, discussed by Zbigniew Lipowski (1988), was officially introduced in the Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III) within the category of Somatoform Disorders. The category was kept in the subsequent DSM-IV as well. The current term used to refer to complaints defined by distressing somatic symptoms and associated psychological features is Somatic Symptom Disorder (The American Psychiatric Association, 1980; 2000; 2013). When reviewing the literature on somatic symptoms, it becomes apparent that experts have used different terms to describe Somatic Symptom Disorder, including hysteria, somatization, medically unexplained symptoms, functional somatic syndromes (fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome, etc.), bodily distress syndrome, etc. The lack of consistency in terminology brings about difficulties with generalizability of findings. SSD AND PERCEIVED SUSCEPTIBILITY TO ILLNESS 2 Additionally, it poses obstacles to the development of a coherent model that addresses the underlying mechanisms of Somatic Symptoms Disorder. Given that Somatic Symptom Disorder (SSD) is a recent terminology and thus there is limited research in this field, the current paper relies on studies that use former terms (e.g. medically unexplained symptoms, Somatization Disorder, bodily distress syndrome, etc.). Nonetheless, in order to preserve uniformity, the term SSD will be used throughout the paper. Additionally, as explained below, the diagnostic category of SSD has shifted its focus from negative to positive criteria, thus eradicating one of the primary