Personality Traits and Coping Styles

Despite the recognized relationship between adverse life events and somatoform disorders, not all children who experience traumatic stress develop these disorders. Difficult temperament appears to place children at higher risk for these disorders (Tschann et al. 1996). Krishnakumar et al. (2006) found that children with conversion disorders not only had experienced more adverse life events than normal children but also scored lower on threshold of responsiveness, emotionality, and persistence. This combination of being more sensitive to change in environment, having more negative affect, and not persisting in the completion of tasks may place a child at risk for conversion disorders (Krishnakumar et al. 2006).

A negative attachment style may make patients who have experienced significant life traumas more vulnerable to the development of somatoform disorders. Evidence indicates that survivors of sexual abuse are more likely to have insecure adult attachment styles (Alexander 1993; Stalker 1995; Styron and Janoff-Bulman 1997). These early childhood experiences may lead children to develop beliefs that the self is unworthy and that support from others is unreliable. When these beliefs persist into adulthood, they may cause individuals to minimize negative affect and possibly compensate by overreporting physical complaints (Waldinger et al. 2006).

Shapiro (1996) postulated that somatization occurs in individuals who are unable to verbalize emotional distress and instead express their distress in the form of physical symptoms. Children with heightened pain and other somatic complaints have been shown to use fewer and/or less effective coping strategies (Bonner and Finney 1996; Rector and Roger 1996; Walker et al. 2001) and to report higher levels of anger (Jellesma et al. 2006; Miers et al. 2007; Rieffe et al. 2004). Introspective or internalizing personality traits, poor self-concept, and pessimistic thinking have been associated with somatiza-tion (Abbey 2005). The term alexithymia has been used to describe individuals with somatic concerns who do not have a verbal vocabulary to describe their moods (Stoudemire 1991).

Somatizing children and adolescents have often been described as conscientious, obsessional, sensitive, insecure, anxious, and/or high achieving (Gar-ralda 1999). It has been postulated and is a common clinical observation that childhood physical complaints may be a result of and/or be exacerbated by an excessive concern with academic achievement (Garralda 1999).

Somatic complaints in adults have been linked to what has been termed somatosensory amplification, or the tendency to experience normal somatic sensations as "intense, noxious and disturbing" (Barsky et al. 1988b, p. 510). Patients with this form of soma-tization tend to be hypervigilant to their own bodily sensations, overreact to these sensations, and interpret them as indicating physical illness (Barsky et al. 1988b). Electroencephalographic examinations of evoked potentials suggest that somatizing patients are not able to discriminate between relevant and irrelevant physical stimuli and have an inability to habituate to repetitive stimuli (James et al. 1989).

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