Does childhood trauma impact daily psychobiological stress in somatic symptom disorder? An ambulatory assessment study, 2022, Fischer et al

Objectives: Somatic symptom disorder is characterized by excessive thoughts, feelings, and behaviors dedicated to bodily symptoms, which are often medically unexplained. Although 13% of the population are affected by this disorder, its aetiopathogenesis is not fully understood. Research in medically unexplained conditions (e.g., fibromyalgia) points to increased psychosocial stress and alterations in stress-responsive bodily systems as a potential contributing factor. This pattern has often been hypothesized to originate from early life stress, such as childhood trauma. The aim of this study was to examine, for the first time, whether individuals with somatic symptom disorder exhibit elevated levels of self-reported daily stress and alterations in the autonomic nervous system and hypothalamic-pituitary-adrenal axis, both in comparison to healthy controls and individuals with depressive disorders, and whether reports of childhood trauma influence these alterations.

Methods: A total of N = 78 individuals were recruited into this study. Of these, n = 27 had a somatic symptom disorder, n = 23 were healthy controls, and n = 28 had a depressive disorder. All individuals underwent a 14-day measurement period at home, with five assessments of self-reported stress, salivary alpha-amylase, and cortisol per day. Childhood trauma was assessed by the Childhood Trauma Questionnaire.

Results: Individuals with somatic symptom disorder exhibited higher daily stress levels (p = 0.063) as well as a less pronounced alpha-amylase awakening response (p = 0.050), compared to healthy controls (statistical trends). Moreover, they were characterized by significantly attenuated diurnal cortisol concentrations (p < 0.001). A nearly identical pattern was observed in individuals with depression. In individuals with somatic symptom disorder and depressive disorders, childhood trauma was, by trend, associated with a more pronounced alpha-amylase awakening response (b = −0.27, p = 0.077).

Conclusions: This study provides preliminary evidence for elevated daily stress and blunted sympathetic and hypothalamic-pituitary-adrenal axis activity in individuals with somatic symptom disorder and depressive disorders. Further studies will help to uncover the conditions under which these dysregulations develop into medically unexplained vs. depressive symptoms.

Open access, https://www.frontiersin.org/articles/10.3389/fpsyt.2022.954051/full

 

They should have had an illness control because just being sick could account for differences.

Having a contested illness is stressful so the results do not give any information about whether they are cause or effect.

 

I suspect the authors have put the cart before the horse, yet again. Muddling up cause and effect seems to be an international pastime amongst researchers and scientists.

It seems much more likely to me that "somatic symptom disorder" (a condition I find it impossible to believe in) develops when people have problems with their HPA axis or their stress levels.

This is probably a common sequence of events :

Child is abused and/or neglected and/or bullied at home and school.
Child becomes stressed and cortisol levels rise as a result.
High cortisol levels have bad effects on the HPA axis.
Child ends up diagnosed with "somatic symptom disorder" and depression.

But what we are expected to believe...

Child has depression and somatic symptom disorder for no obvious reason, or just because they are a defective human being.
This leads to them being abused / neglected / bullied.
This leads to stress.
They develop high cortisol levels which affects their HPA axis.

 

Hey, we just recently had biosocial as another term in the menagerie. That leaves us with the remaining combinations: biopsycho, sociobio, sociopsycho and we could also riff with a quick swap and add biosociopsychological.

It bothers me that no one questions the obvious absurdity of this. It's one thing to make stuff up, but to apply it to such a large extent is complete dereliction of duty. Even a whole order of magnitude less would be stretching it massively. But of course that's what happens when you create an entire category out of "things we don't understand and have no intention of finding out", which is distinct from "things we don't understand but acknowledge and want to understand better".

And what's with the obsession with making cortisol the "stress hormone", then when there is low cortisol they argue stress anyway. Ridiculous. And they are doing the same nonsense they criticize us by reducing the complex idea of stress to a single hormone, which we don't even do, because this entire ideology is psychological projection. Nonsense.

 

Both low cortisol and high cortisol have effects that patients perceive as stress.

 

It continues to stun me that somatic symptom disorder is still considered a valid clinical entity that could ever legitimately guide clinical care or produce useful research findings.

The criteria for diagnosis are essentially:

• One or more physical symptoms causing distress or disrupting life
• Excessive thoughts, feelings or behaviors about those symptoms with at least one of:
  • Thoughts out of proportion with seriousness of symptoms
  • High level of anxiety about health or symptoms
  • Excessive time and energy spent on symptoms/health concerns
• At least one symptom all the time, but can be multiple and variable symptoms
• Symptoms can be "unexplained" or could be associated with a diagnosed medical condition

1. Who decides "excessive" and using what criteria?
2. How would researchers ever manage and control for the vast heterogeneity resulting from all the different medical and mental health conditions that could be swept up into such a study

Allen Frances, chair of the DSM-IV task force, said this about it:
https://twitter.com/user/status/1098268225781956609

 

I've always been puzzled by this "it's too easy as a doctor to just send those patients down the trash chute".

How? How can it be easy to do something this obviously harmful? It really shouldn't. This should not be easy for anyone, it should disgust every ethical person. And yet, it really is easy. So I wonder which way they mean it's easy: ethically, or technically? As in it takes 2 minutes and you never have to think of it, technically easy? Because it should be ethically revolting. And yet.

It's clearly harmful. The "prime directive". And yet. Easy. I just don't get it. The blatant contradictions and cognitive dissonance. None of this should be easy. And yet they keep saying how easy it is to close the door on finding people chained in a basement, knowing no one else will open that door. Like saying how easy it is to press a button that disappears people. How? Who can find that easy? What process can turn something so repulsive to human nature into, well, this: