ISSN 2586-0151 (Print)
ISSN 2586-0046 (Online)
Volume 16, Number 2 (2/2020)
Original Article <page. 49-56 >

Anger-Related Characteristics and Childhood Adversity in Somatic Symptom Disorder

Sung-Hyuk Kang, MD1;Chun Il Park, MD2;Hae Won Kim, MD, PhD3;Se Joo Kim, MD, PhD1; and Jee In Kang, MD, PhD1;

1;Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, 2;Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, 3;Department of Medical Education, Yonsei University College of Medicine, Seoul, Korea

Objective : The present study aims to investigate differences in anger-related features in patients with somatic symptom disorder (SSD) compared to healthy controls, and to examine whether anger trait and anger regulation strategy are associated with clinical characteristics in patients with SSD. In addition, we examined the relationship between childhood adversity and SSD.

Methods : 26 patients with SSD and 28 healthy controls were included. Anger-related features were assessed with State-Trait Anger Expression Inventory (STAXI). Clinical somatic symptoms were assessed using the somatization subscale of the Symptom Checklist-90-Revised and the Somatosensory Amplification Scale. Childhood adversity was assessed by the Childhood Traumatic Events Scale. Multivariate analysis of covariance was performed.

Results : Disease status of SSD had a significant overall effect on anger-related features (Wilks λ=0.725, F(5, 44)=3.332, p=0.012). Patients with SSD showed a significantly high Trait-Anger (p=0.017) and they had a high score in both Anger-Out (p=0.013) and Anger-In (p=0.001) of anger expression styles. In particular, a directed inward style of anger expression was significantly associated with somatization symptom severity (p=0.003). Regarding childhood adversity, more childhood extreme illness was experienced by the SSD group than the control group (p=0.012). Within the SSD group, childhood extreme illness was associated with higher Trait-Anger (p=0.027) and Anger-Out (p=0.001).

Conclusion : The present findings suggest that trait anger, anger expression styles, and childhood adversity of extreme illness may be involved in SSD. Further studies are needed to explore the role of anger-related features and its relationship with childhood adversity in the pathophysiology of SSD.


Key words : Emotion;Anger expression;Childhood adversity;Somatization;Somatic symptom disorder.

Anxiety and Mood

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