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1.  Intra- and extra-familial adverse childhood experiences and a history of childhood psychosomatic disorders among Japanese university students 
Japan has been witnessing a considerable increase in the number of children with psychosomatic disorders. The purpose of this study is to examine the relationship between the risk of psychosomatic disorder in adolescents and intra- and extra-familial adverse childhood experiences (ACEs).
A retrospective cohort study of 1592 Japanese university students (52% male, mean age 19.9 years) who completed a survey about intra- and extra-familial ACEs and the incidence of childhood psychosomatic disorders. Intra-familial ACEs included domestic violence, physical violence, emotional abuse, illness in household, parental divorce, no parental affection, and dysfunctional family. Extra-familial ACEs included physical violence or negative recognition by teachers, being bullied in elementary or junior high school, or sexual violence.
The frequency of psychosomatic disorders among the respondents was 14.8%. Among the 7 intra-familial ACEs, emotional abuse (relative risk, RR = 1.9) and illness in household (RR = 1.7) increased the risk of psychosomatic disorders. Estimates of the relative risk for the 5 extra-familial ACEs were statistically significant and ranged from 1.5 for being bullied in elementary school or physical violence from teachers to 2.4. Students who had 3 or more intra-familial ACEs and 2 or more extra-familial ACEs had a 3.0 relative risk for psychosomatic disorder.
These results suggest that intra- and extra-familial ACEs are associated with the development of psychosomatic disorders. Therefore, sufficient evaluation of ACEs should be performed in adolescent patients with psychosomatic disorder.
PMCID: PMC1852322  PMID: 17407551
2.  Psychosomatic complaints and sense of coherence among adolescents in a county in Sweden: a cross-sectional school survey 
Over the last five to ten years there has been an increase in psychosomatic complaints (PSC) in Swedish children. The objective of the study was to examine the relation between PSC and sense of coherence (SOC).
A cross-sectional school survey in the county of Västmanland, Sweden. All 16- and 19-year old adolescents present at school on the day of the survey were asked to complete a questionnaire in their classrooms during a one-lesson hour session under the supervision of their teachers. Totally 3,998 students in both private and public schools, studying in ninth grade elementary school or third grade secondary school participated.
The results from our study show that there is a statistically significant relation between PSC and SOC among adolescents. It also shows that adolescents with a weak SOC score have more symptoms of PSC.
Our study indicates that SOC can help the adolescents to choose a coping strategy that is appropriate for the situation and thereby may prevent them from developing PSC. However, additional studies are needed to confirm our findings.
PMCID: PMC2265297  PMID: 18261203
3.  A possible connection between psychosomatic symptoms and daily rhythmicity in growth hormone secretion in healthy Japanese students 
Students suffering from psychosomatic symptoms, including drowsiness and feelings of melancholy, often have basic lifestyle problems. The aim of this study was to investigate whether psychosomatic complaints may be related to circadian dysfunction.
We examined 15 healthy students (4 men and 11 women) between 21 and 22 years old. To assess the presence of psychosomatic symptoms among the subjects, we developed a self-assessment psychosomatic complaints questionnaire consisting of five items pertaining to physical symptoms and five items concerning mental symptoms. The subjects rated their psychosomatic symptoms twice a day (08:00 and 20:00 h). We also assessed growth hormone secretion patterns by fluorescence enzyme immunoassay (FEIA). Salivary samples were collected from the subjects at home five times a day (20:00, 24:00, 04:00, 08:00, and 12:00 h) in Salivette tubes.
The results indicated a relationship between the self-assessment scores and the salivary levels of growth hormone. Subjects with high self-assessment scores showed significant variability in growth hormone secretion over the day, whereas subjects with low self-assessment scores did not.
Psychosomatic symptoms may be associated with circadian dysfunction, as inferred from blunted rhythmicity in growth hormone secretion.
PMCID: PMC2731727  PMID: 19656410
4.  Social capital in relation to depression, musculoskeletal pain, and psychosomatic symptoms: a cross-sectional study of a large population-based cohort of Swedish adolescents 
BMC Public Health  2010;10:715.
Social capital has lately received much attention in health research. The present study investigated whether two measures of subjective social capital were related to psychosomatic symptoms, musculoskeletal pain, and depression in a large population of Swedish adolescents.
A total of 7757 13-18 year old students anonymously completed the Survey of Adolescent Life in Vestmanland 2008 which included questions on sociodemographic background, neighbourhood social capital, general social trust, and ill health.
Low neighbourhood social capital and low general social trust were associated with higher rates of psychosomatic symptoms, musculoskeletal pain, and depression. Individuals with low general social trust had more than three times increased odds of being depressed, three times increased odds of having many psychosomatic symptoms, and double the odds of having many symptoms of musculoskeletal pain.
The findings make an important contribution to the social capital - health debate by demonstrating relations between social capital factors and self-reported ill health in a young population.
PMCID: PMC3091587  PMID: 21092130
5.  Psychosomatic syndromes and anorexia nervosa 
BMC Psychiatry  2013;13:14.
In spite of the role of some psychosomatic factors as alexithymia, mood intolerance, and somatization in both pathogenesis and maintenance of anorexia nervosa (AN), few studies have investigated the prevalence of psychosomatic syndromes in AN. The aim of this study was to use the Diagnostic Criteria for Psychosomatic Research (DCPR) to assess psychosomatic syndromes in AN and to evaluate if psychosomatic syndromes could identify subgroups of AN patients.
108 AN inpatients (76 AN restricting subtype, AN-R, and 32 AN binge-purging subtype, AN-BP) were consecutively recruited and psychosomatic syndromes were diagnosed with the Structured Interview for DCPR. Participants were asked to complete psychometric tests: Body Shape Questionnaire, Beck Depression Inventory, Eating Disorder Inventory–2, and Temperament and Character Inventory. Data were submitted to cluster analysis.
Illness denial (63%) and alexithymia (54.6%) resulted to be the most common syndromes in our sample. Cluster analysis identified three groups: moderate psychosomatic group (49%), somatization group (26%), and severe psychosomatic group (25%). The first group was mainly represented by AN-R patients reporting often only illness denial and alexithymia as DCPR syndromes. The second group showed more severe eating and depressive symptomatology and frequently DCPR syndromes of the somatization cluster. Thanatophobia DCPR syndrome was also represented in this group. The third group reported longer duration of illness and DCPR syndromes were highly represented; in particular, all patients were found to show the alexithymia DCPR syndrome.
These results highlight the need of a deep assessment of psychosomatic syndromes in AN. Psychosomatic syndromes correlated differently with both severity of eating symptomatology and duration of illness: therefore, DCPR could be effective to achieve tailored treatments.
PMCID: PMC3556145  PMID: 23302180
Anorexia nervosa; Eating disorders; Psychosomatic syndromes; Illness denial; Alexithymia
6.  Treatment of Psychosomatic Disorders 
Canadian Medical Association Journal  1964;90(18):1055-1060.
Goals, potentialities and limitations of treatment of psychosomatic disorders are reviewed. Removal of a disturbing psychosomatic symptom may be all that can be accomplished. The bulk of patients suffering from psychosomatic disorders should be treated by physicians other than psychiatrists. Difficulties arise, owing to differences in approach, when treatment is carried out by a general physician as well as a psychiatrist. In appraising the prospects of treatment, the age on examination, intelligence, duration of illness, degree of insight, nature of illness, environmental stress and personality structure of the patients should be considered. Psychiatric measures which have been employed include: electroconvulsive therapy, psychotropic drugs, hypnosis, drug abreaction, group therapy, supportive psychotherapy and psychoanalysis. Psychoanalysis provides the best understanding of the psychodynamics of psychosomatic illness but is, for a variety of reasons, applicable only to a small number of patients. Alternations and removal of disturbing symptoms can be accomplished by the other therapeutic means.
PMCID: PMC1922663  PMID: 14146853
7.  PA01.61. Vrishya dravya- tool in shaping the corner stones of healthy society 
Ancient Science of Life  2012;32(Suppl 1):S111.
The principle aim of Ayurvedic aphrodisiac therapy Vrishya chikitsa is the birth of mentally and physically healthy children as they are the corner stones of a healthy future society. Modern life style is full of stress and competition thus interferes with physical mechanism of body creating psychosomatic impact leading to sexual inefficiency. Ayurvedic aphrodisiacs that enhance the vitality and give sexual power to couples, which enable them to give birth to healthy children. Western medicine relies on aggressive prescription of drugs and surgery to deal with many problems related to sexual dysfunction which in turn have unwanted and even dangerous side effects. In regards to this Scientists are searching for a safe and effective phytomedicine from Ayurveda.
Review of classical text and research data reported in various journals and monographs.
Vrishya chikitsa described in Ashtang Ayurveda mentions the reasons for sexual inefficiency and directs the use of several aphrodisiac herbs and minerals to enhance the vitality. Charaka has prescribed the use of aphrodisiacs that enhance the potency of a person. Ex. Ashwagandha, Mushali, Shatavari, Kapikacchu etc. Researches prove that, they enhance the reproductive capabilities and vigor of men while strengthening the body and overall well-being. In Ashwagandha main contain is withanolides, which are steroid lactones and have a quick and pronounced hormonal effect, which stimulate the development of testicular cells. Kapikacchu has been shown to increase sperm count. L dopa, a precursor of the neurotransmitter dopamine, isolated from Kapikacchu, has been shown to increase sperm production. The Vrishya chikitsa resorts to herb preparations and minerals, including nonpharmacological measures mentioned by Charaka like Sadvrutta palana and Aacharrasayana, also attain to enhance reproductive capabilities and vigor of men.
The herbs mentioned above and Sadavrutta, Achararasayana stands as an answer to solve problem of sexual inefficiency and enhance the potency of a person.
PMCID: PMC3800865
8.  Relationship between psychosomatic complaints and circadian rhythm irregularity assessed by salivary levels of melatonin and growth hormone 
In university health care settings, students with psychosomatic complaints often have chronotypic problems. For this reason, we investigated a potential connection between psychosomatic complaints and circadian rhythm irregularity assessed by salivary levels of melatonin and growth hormone.
Fifteen healthy students between 21 and 22 years of age were examined for physiological parameters of chronotypes based on melatonin and growth hormone secretion patterns, using a fluorescence enzyme immunoassay. Salivary samples were collected from subjects at home five times each day (20:00, 24:00, 04:00, 08:00, and 12:00 h). In addition, the subjects rated their psychosomatic symptoms twice (at 08:00 and 20:00 h).
A group with irregular circadian rhythm of melatonin (ICR) showed more psychosomatic complaints than a group with the regular circadian rhythm (RCR), especially for anxiety.
Psychosomatic symptoms, particularly anxiety, may be associated with irregularity in melatonin and growth hormone rhythms, which can be altered by basic lifestyle habits even in healthy students.
PMCID: PMC3179741  PMID: 21914213
chronotypes (morningness-eveningness); circadian rhythms; phase difference; healthy students; growth hormone; melatonin; psychosomatic complaints.
9.  Associations between scores of psychosomatic health symptoms and health-related quality of life in children and adolescents 
The aims of the present study are to investigate whether there are differences in health-related quality of life (HRQoL) between girls and boys in two different age groups, to study how much of children’s variance in HRQoL can be explained by common psychosomatic health symptoms, and to examine whether the same set of psychosomatic symptoms can explain differences in HRQoL, both between girls and boys and between older and younger school children.
A cross-sectional study was conducted of 253 children, 99 of ages 11–12 years (n=51 girls, n=48 boys) and 154 of ages 15–16 years (n=82 girls, n=72 boys), in Swedish schools. The KIDSCREEN-52 instrument, which covers 10 dimensions of HRQoL and additional questions about psychosomatic health symptoms, were used. Analyses of variance were conducted to investigate differences between the genders and age groups, and in interaction effects on the KIDSCREEN-52 dimensions. Regression analyses were used to investigate the impacts of psychosomatic symptoms on gender and age group differences in HRQoL.
Boys rated themselves higher than girls on the KIDSCREEN dimensions: physical and psychological well-being, moods and emotions, self-perception, and autonomy. Main effects of age group were found for physical well-being, psychological well-being, moods and emotions, self-perception, autonomy, and school environment, where younger children rated their HRQoL more highly than those aged 15–16 years. Girls rated their moods and emotions dramatically lower than boys in the older age group, but the ratings of emotional status were more similar between genders at younger ages. Psychosomatic symptoms explained between 27% and 50% of the variance in the children’s HRQoL. Sleeping difficulties were a common problem for both girls and boys. Depression and concentration difficulties were particularly associated with HRQoL among girls whereas stomach aches were associated with HRQoL among boys.
Girls and adolescents experience poorer HRQoL than boys and younger children, but having psychosomatic symptoms seem to explain a substantial part of the variation. Strategies to promote health among school children, in particular to alleviate sleep problems among all children, depression and concentration difficulties among girls, and stomach aches among boys, are of great importance.
PMCID: PMC3831247  PMID: 24148880
Health; Quality of life; Gender; School; Children; Adolescents; Psychosomatic symptoms; Sleep problems; KIDSCREEN
10.  Lifestyles and psychosomatic symptoms among elementary school students and junior high school students 
To examine the relationship between lifestyles and psychosomatic symptoms in children, we conducted a self-administered questionnaire survey of elementary school students and junior high school students in Japan.
We designed an original questionnaire to investigate the lifestyles and psychosomatic symptoms of children. In 1997, responses to the questionnaires were elicited from public elementary school fourth grade students (then aged 9–10) and public junior high school seventh grade students (then aged 12–13). The survey was repeated annually for three years as the students advanced through school.
For both boys and girls, each cross-sectional analysis revealed a strong relationship between lifestyle behaviors and psychosomatic symptoms. Psychosomatic, symptoms scores varied according to daily hours of sleep, eating of breakfast, having strong likes and dislikes of food, bowel habits, and daily hours of television watching. Both boys and girls with “good” lifestyle, behaviors evaluated by the HPI (Health Practice Index) showed lower scores for psychosomatic symptoms.
These findings show that the lifestyle behaviors of children are significantly associated with psychosomatic symptoms and suggest that poor lifestyle behaviors are likely to increase physical and psychological health risks.
PMCID: PMC2723516  PMID: 21432317
lifestyles; psychosomatic symptoms; elementary school; junior high school; health practice index
11.  Bullying involvement in primary school and common health problems 
Archives of Disease in Childhood  2001;85(3):197-201.
AIMS—To examine the association of direct (e.g. hitting) and relational (e.g. hurtful manipulation of peer relationships) bullying experience with common health problems.
METHODS—A total of 1639 children (aged 6-9 years) in 31 primary schools were studied in a cross sectional study that assessed bullying with a structured child interview and common health problems using parent reports. Main outcome measures were common physical (e.g. colds/coughs) and psychosomatic (e.g. night waking) health problems and school absenteeism.
RESULTS—Of the children studied, 4.3% were found to be direct bullies, 10.2% bully/victims (i.e. both bully and become victims), and 39.8% victims. Direct bully/victims, victims, and girls were most likely to have physical health symptoms (e.g. repeated sore throats, colds, and coughs). Direct bully/victims, direct victims, and year 2 children were most likely to have high psychosomatic health problems (e.g. poor appetite, worries about going to school). Pure bullies (who never got victimised) had the least physical or psychosomatic health problems. No association between relational bullying and health problems was found.
CONCLUSIONS—Direct bullying (e.g. hitting) has only low to moderate associations with common health problems in primary school children. Nevertheless, health professionals seeing children with repeated sore throat, colds, breathing problems, nausea, poor appetite, or school worries should consider bullying as contributory factor.

PMCID: PMC1718894  PMID: 11517098
12.  Functional near-infrared spectroscopy studies in children 
Psychosomatic and developmental behavioral medicine in pediatrics has been the subject of significant recent attention, with infants, school-age children, and adolescents frequently presenting with psychosomatic, behavioral, and psychiatric symptoms. These may be a consequence of insecurity of attachment, reduced self-confidence, and peer -relationship conflicts during their developmental stages. Developmental cognitive neuroscience has revealed significant associations between specific brain lesions and particular cognitive dysfunctions. Thus, identifying the biological deficits underlying such cognitive dysfunction may provide new insights into therapeutic prospects for the management of those symptoms in children. Recent advances in noninvasive neuroimaging techniques, and especially functional near-infrared spectroscopy (NIRS), have contributed significant findings to the field of developmental cognitive neuroscience in pediatrics. We present here a comprehensive review of functional NIRS studies of children who have developed normally and of children with psychosomatic and behavioral disorders.
PMCID: PMC3337812  PMID: 22433235
Development; Children; Cognitive neuroscience; Near-infrared spectroscopy
13.  Validity issues in the assessment of alexithymia related to the developmental stages of emotional cognition and language 
We examined developmental aspects of the emotional awareness of adolescents by evaluating their responses to a self-reported questionnaire based on the Toronto Alexithymia Scale-20 (TAS-20).
The items of the TAS-20 were modified to make them more understandable by adolescents, and nine new items related to a limited capacity for imagination were added. The Japanese Linguistic Ability Test and the multi-dimensional empathy scale for adolescents were administered to examine concurrent validity. Two hundred and two normative young adolescents and thirty-two adolescent patients with psychosomatic and/or behavioral problems participated in the study. Eighty junior high school students also participated in a separate examination of test-retest reliability.
Thirteen items were extracted after exploratory and confirmatory factor analyses, and four core factors were identified in the resulting scale: Difficulty Identifying Feelings (DIF), Difficulty Describing Feelings (DDF), Externally-Oriented Thinking (EOT) and Constricted Imaginal Capacities (CIC). Interestingly, scores on the multi-dimensional empathy scale correlated positively with DIF and DDF, but negatively with EOT and CIC. Higher DDF scores were associated with higher Japanese linguistic abilities. DIF/DDF scores were higher for females than males, irrespective of linguistic ability. Test-retest reliability coefficients were significant. The patient group showed significantly higher DIF scores than the normative students.
The present findings indicated that subjective difficulties in identifying and describing feelings are associated with empathetic and linguistic abilities. The developmental aspect to emotional awareness herein described suggests that self-reported questionnaires for alexithymia must be carefully constructed and examined, even for adults.
PMCID: PMC2777913  PMID: 19886981
California Medicine  1956;85(5):302-305.
Valid data on the effectiveness of preventive programs in psychiatry are badly needed but cannot be obtained until reliable statistics on incidence and frequency of emotional disorders are available.
There is a suggestion that clear cut neuroses are less frequent but an equally strong suggestion that psychosomatic disorders are increasing in frequency. There is a tendency to look upon the increasing freedom of some aspects of our culture as a great advance over Victorian rigidity and restraint—but to what extent is this related to seeming increases in delinquency?
Parents seem to have become increasingly fearful of disciplining, training or frustrating children as a result of what is considered psychiatric teaching. Psychiatry has the responsibility for correcting such a misunderstanding. Psychotherapists who have not resolved their own dependency needs are in no position to help others with the dependency problems which underlie their neurotic difficulties. Psychotherapy involves more than just arranging the world to accommodate itself to the patient (which occasionally needs to be done). The patient too, has a responsibility for his illness and its treatment and must learn that life is characterized by the need to take some chances, by dangers, difficulties, frustrations and unknowns, as well as pleasures, safety, comfort and the familiar. The responsibility for meeting the need for psychiatric services belongs to all of medicine and not just to psychiatry.
PMCID: PMC1532003  PMID: 13364677
15.  Work-related stress and psychosomatic medicine 
This article introduces key concepts of work-related stress relevant to the clinical and research fields of psychosomatic medicine. Stress is a term used to describe the body's physiological and/or psychological reaction to circumstances that require behavioral adjustment. According to the Japanese National Survey of Health, the most frequent stressors are work-related problems, followed by health-related and then financial problems. Conceptually, work-related stress includes a variety of conditions, such as overwork, unemployment or job insecurity, and lack of work-family balance. Job stress has been linked to a range of adverse physical and mental health outcomes, such as cardiovascular disease, insomnia, depression, and anxiety. Stressful working conditions can also impact employee well-being indirectly by directly contributing to negative health behaviors or by limiting an individual's ability to make positive changes to lifestyle behaviors, such as smoking and sedentary behavior. Over the past two decades, two major job stress models have dominated the occupational health literature: the job demand-control-support model and the effort-reward imbalance model. In both models, standardized questionnaires have been developed and frequently used to assess job stress. Unemployment has also been reported to be associated with increased mortality and morbidity, such as by cardiovascular disease, stroke, and suicide. During the past two decades, a trend toward more flexible labor markets has emerged in the private and public sectors of developed countries, and temporary employment arrangements have increased. Temporary workers often complain that they are more productive but receive less compensation than permanent workers. A significant body of research reveals that temporary workers have reported chronic work-related stress for years. The Japanese government has urged all employers to implement four approaches to comprehensive mind/body health care for stress management in the workplace: focusing on individuals, utilizing supervisory lines, enlisting company health care staff, and referring to medical resources outside the company. Good communications between occupational health practitioners and physicians in charge in hospitals/clinics help employees with psychosomatic distress to return to work, and it is critical for psychosomatic practitioners and researchers to understand the basic ideas of work-related stress from the viewpoint of occupational health.
PMCID: PMC2882896  PMID: 20504368
16.  Age and gender differences of psychogenic fever: a review of the Japanese literature 
Psychogenic fever is one of the most common psychosomatic diseases. Patients with psychogenic fever have acute or persistent body temperature above normal range in psychologically stressful situations. In spite of numerous case reports on psychogenic fever, there are few epidemiological studies. Therefore, our goal was to investigate the age distribution and gender differences of psychogenic fever in Japan.
To achieve this goal, we searched Medline and Ichushi WEB, a Japanese medical database, and added other publications that were not included in these databases. Thus, we reviewed 195 Japanese cases of psychogenic fever published in 62 papers.
Psychogenic fever patients ranged from 3 to 56 years old, with the highest number of cases occurring in 13 year-olds in both sexes. The male: female ratio of 1: 1.19 suggested a slight predominance of female cases. Psychogenic fever accounted for 18% of fever cases of unknown origin in children and 2–6% of the psychosomatic diseases of pediatric patients. Patients with psychogenic fever were not only found in pediatrics departments, but also in psychosomatic medicine, psychiatry, internal medicine, anesthesiology, dentistry, and obstetrics/gynecology departments.
The age of psychogenic fever patients ranged from 3 to 56 years old and the male: female ratio was 1:1.19. Psychogenic fever is seen especially in adolescence in Japan.
PMCID: PMC1888691  PMID: 17511878
17.  ‘Girls need to strengthen each other as a group’: experiences from a gender-sensitive stress management intervention by youth-friendly Swedish health services – a qualitative study 
BMC Public Health  2013;13:907.
Mental health problems among young people, and girls and young women in particular, are a well-known health problem. Such gendered mental health patterns are also seen in conjunction with stress-related problems, such as anxiety and depression and psychosomatic complaints. Thus, intervention models tailored to the health care situation experienced by young women within a gendered and sociocultural context are needed. This qualitative study aims to illuminate young women’s experiences of participating in a body-based, gender-sensitive stress management group intervention by youth-friendly health services in northern Sweden.
A physiotherapeutic body-based, health-promoting, gender-sensitive stress management intervention was created by youth-friendly Swedish health services. The stress management courses (n = 7) consisted of eight sessions, each lasting about two hours, and were led by the physiotherapist at the youth centre. The content in the intervention had a gender-sensitive approach, combining reflective discussions; short general lectures on, for example, stress and pressures related to body ideals; and physiotherapeutic methods, including body awareness and relaxation. Follow-up interviews were carried out with 32 young women (17–25 years of age) after they had completed the intervention. The data were analysed with qualitative content analysis.
The overall results of our interview analysis suggest that the stress management course we evaluated facilitated ‘a space for gendered and embodied empowerment in a hectic life’, implying that it both contributed to a sense of individual growth and allowed participants to unburden themselves of stress problems within a trustful and supportive context. Participants’ narrated experiences of ‘finding a social oasis to challenge gendered expectations’, ‘being bodily empowered’, and ‘altering gendered positions and stance to life’ point to empowering processes of change that allowed them to cope with distress, despite sometimes continuously stressful life situations. This intervention also decreased stress-related symptoms such as anxiousness, restlessness, muscle tension, aches and pains, fatigue, and impaired sleep.
The participants’ experiences of the intervention as a safe and exploratory space for gendered collective understanding and embodied empowerment further indicates the need to develop gender-sensitive interventions to reduce individualisation of health problems and instead encourage spaces for collective support, action, and change.
PMCID: PMC3850732  PMID: 24083344
Sweden; Young women; Adolescents; Youth mental health; Stress management; Intervention; Gender; Embodiment; Qualitative interviews; Physiotherapy
18.  The role of the pediatrician in youth violence prevention 
School bullying has become a major social problem in Korea after the emergence of media reports on children who committed suicide after being victimized by bullies. In this article, we review the characteristics of bullying, and investigate the role of the pediatrician in the prevention of and intervention against bullying and school violence. Bullying can take on many forms such as physical threat, verbal humiliation, malicious rumors, and social ostracism. The prevalence of bullying in various countries is approximately 10% to 20%. In Korea, the prevalence of school violence is similar but seems to be more intense because of the highly competitive environment. From our review of literature, we found that children who were bullied had a significantly higher risk of developing psychosomatic and psychosocial problems such as headache, abdominal pain, anxiety, and depression than those who were not bullied. Hence, it is important for health practitioners to detect these signs in a child who was bullied by questioning and examining the child, and to determine whether bullying plays a contributing role when a child exhibits such signs. Pediatricians can play an important role in the prevention of or intervention against school violence along with school authorities, parents, and community leaders. Moreover, guidelines to prevent school violence, such as the Olweus Bullying Prevention Program, KiVa of the Finish Ministry of Education, and Connected Kids: Safe, Strong, Secure of the American Academy Pediatrics, should be implemented.
PMCID: PMC3564024  PMID: 23390438
Bullying; Violence; Pediatrician; Child; Adolescent; Korea
19.  Stress causing psychosomatic illness among nurses 
Stress in nurses is an endemic problem. It contributes to health problems in nurses and decreases their efficiency. Documenting the causes and extent of stress in any healthcare unit is essential for successful interventions
Establishing the existence and extent of work stress in nurses in a hospital setting, identifying the major sources of stress, and finding the incidence of psychosomatic illness related to stress.
Materials and Methods:
This study used a questionnaire relating to stressors and a list of psychosomatic ailments. One hundred and six nurses responded and they were all included in the study. Stressors were based on four main factors: work related, work interactions, job satisfaction, and home stress. The factors relating to stress were given weights according to the severity. The total score of 50 was divided into mild, moderate, severe, and burnout.
Most important causes of stress were jobs not finishing in time because of shortage of staff, conflict with patient relatives, overtime, and insufficient pay. Psychosomatic disorders like acidity, back pain, stiffness in neck and shoulders, forgetfulness, anger, and worry significantly increased in nurses having higher stress scores. Increase in age or seniority did not significantly decrease stress.
Moderate levels of stress are seen in a majority of the nurses. Incidence of psychosomatic illness increases with the level of stress. Healthcare organizations need to urgently take preemptive steps to counter this problem.
PMCID: PMC2822165  PMID: 20165610
Burnout; nursing shortage; nursing stress; psychosomatic illness; shift work
20.  Mental health of immigrants from the former Soviet Bloc: a future problem for primary health care in the enlarged European Union? A cross-sectional study 
BMC Public Health  2007;7:27.
Enlargement of the European Union has caused worries about the possibility of increased migration from its new members, the former Soviet countries, and consequently increased demands on the health care systems of the host countries. This study investigated whether or not earlier immigrants from the former Soviet Bloc have poorer self-reported mental health, measured as self-reported psychiatric illness and psychosomatic complaints, than the host population in Sweden. It also examined the particular factors which might determine the self-reported mental health of these immigrants.
The cross-sectional national sample included 25–84-year-old Swedish-born persons (n = 35,459) and immigrants from Poland (n = 161), other East European countries (n = 164), and the former Soviet Union (n = 60) who arrived in Sweden after 1944 and were interviewed during 1994–2001. Unconditional multivariate logistic regression was used in the analyses.
The findings indicated that the country of birth had a profound influence on self-reported mental health. Polish and other East European immigrants in general had a twofold higher odds ratio of reporting psychiatric illness and psychosomatic complaints, which fact could not be explained by adjustments for the demographic and socioeconomic variables. However, immigrants from the former Soviet Union had odds similar to those of the Swedish-born reference group. Adjustments for migration-related variables (language spoken at home and years in Sweden) changed the association between the country of birth and the outcomes only to a limited extent.
Since poor mental health may hinder acculturation, the mental health of immigrants from Poland and other East European countries should be acknowledged, particularly with the expansion of the European Union and inclusion of nine former Soviet Bloc countries by 2007.
PMCID: PMC1828724  PMID: 17328817
21.  The alexithymic brain: the neural pathways linking alexithymia to physical disorders 
Alexithymia is a personality trait characterized by difficulties in identifying and describing feelings and is associated with psychiatric and psychosomatic disorders. The mechanisms underlying the link between emotional dysregulation and psychosomatic disorders are unclear. Recent progress in neuroimaging has provided important information regarding emotional experience in alexithymia. We have conducted three brain imaging studies on alexithymia, which we describe herein. This article considers the role of emotion in the development of physical symptoms and discusses a possible pathway that we have identified in our neuroimaging studies linking alexithymia with psychosomatic disorders. In terms of socio-affective processing, alexithymics demonstrate lower reactivity in brain regions associated with emotion. Many studies have reported reduced activation in limbic areas (e.g., cingulate cortex, anterior insula, amygdala) and the prefrontal cortex when alexithymics attempt to feel other people’s feelings or retrieve their own emotional episodes, compared to nonalexithymics. With respect to primitive emotional reactions such as the response to pain, alexithymics show amplified activity in areas considered to be involved in physical sensation. In addition to greater hormonal arousal responses in alexithymics during visceral pain, increased activity has been reported in the insula, anterior cingulate cortex, and midbrain. Moreover, in complex social situations, alexithymics may not be able to use feelings to guide their behavior appropriately. The Iowa gambling task (IGT) was developed to assess decision-making processes based on emotion-guided evaluation. When alexithymics perform the IGT, they fail to learn an advantageous decision-making strategy and show reduced activity in the medial prefrontal cortex, a key area for successful performance of the IGT, and increased activity in the caudate, a region associated with impulsive choice. The neural machinery in alexithymia is therefore activated more on the physiologic, motor-expressive level and less in the cognitive-experiential domains of the emotional response system. Affects may play an important role in alleviating intrinsic physiologic reactions and adapting to the environment. Deficient development of emotional neural structures may lead to hypersensitivity to bodily sensations and unhealthy behaviors, a possible mechanism linking alexithymia to psychosomatic disorders.
PMCID: PMC3563604  PMID: 23302233
Affect; Alexithymia; Emotional dysregulation; Neuroimaging; Psychosomatic disorders
22.  The siblings of childhood cancer patients need early support: a follow up study over the first year 
Archives of Disease in Childhood  2004;89(11):1008-1013.
Background and methods: In a 1 year follow up study, we assessed the life situation of 33 siblings of childhood cancer patients and 357 healthy controls. The hypothesis was that siblings have more behavioural and health related problems just after the cancer diagnosis. Validated assessment methods were used.
Results: Siblings below school age tended to have conduct problems, psychosomatic problems, and a mixed group of other behavioural problems, when assessed 3 months after the cancer diagnosis. These symptoms became less evident during follow up. Among the school aged siblings, however, conduct problems, learning problems, psychosomatic problems, impulsive-hyperactive symptoms, and other behavioural symptoms remained unchanged during follow up. In their self assessments, the school aged siblings showed both state and trait anxiety more often than controls at the first assessment, but later these symptoms settled to the same level as the controls. The overall Children's Depression Inventory (CDI) depression scores did not show differences between the study groups.
Conclusions: The ratings of the parents were in keeping with the self assessment of the school aged siblings only in a few aspects; the emphasis of findings can be changed when proxies are used. The siblings have symptoms and adverse feelings which probably could be relieved by targeted, early information about the illness, and possibly by group discussions or activities, soon after the cancer diagnosis. In order to obtain necessary support for the siblings with educational problems, school personnel need to be informed about the sibling distress.
PMCID: PMC1719713  PMID: 15499052
23.  The Perspective of Psychosomatic Medicine on the Effect of Religion on the Mind–Body Relationship in Japan 
Shintoism, Buddhism, and Qi, which advocate the unity of mind and body, have contributed to the Japanese philosophy of life. The practice of psychosomatic medicine emphasizes the connection between mind and body and combines the psychotherapies (directed at the mind) and relaxation techniques (directed at the body), to achieve stress management. Participation in religious activities such as preaching, praying, meditating, and practicing Zen can also elicit relaxation responses. Thus, it is time for traditional religions to play an active role in helping those seeking psychological stability after the Great East Japan Earthquake and the ongoing crisis related to the nuclear accident in Fukushima, Japan, to maintain a healthy mind–body relationship.
PMCID: PMC3929030  PMID: 22434576
Buddhism; Japan; Psychosomatic medicine; Religion; Shintoism
24.  Recurrent abdominal pain in children and adolescents – a survey among paediatricians 
Objective: Little is known about prevalence and usual treatment of childhood and adolescent recurrent abdominal pain (RAP) in outpatient paediatricians’ practice. This study’s primary objective was to acquire insights into the usual paediatricians’ treatment and their estimation of prevalence, age and gender of RAP patients. Further objectives were to assess to which extent family members of patients report similar symptoms, how paediatricians rate the strain of parents of affected children and adolescents and how paediatricians estimate the demand for psychological support.
Methods: Provided by a medical register, 437 outpatient paediatricians received a questionnaire to assess their perception of several psychosomatic problems and disorders including recurrent abdominal pain.
Results: According to paediatricians’ estimation, 15% of all visits are caused by patients with RAP. In 22% of these cases of RAP, at least one family member has similar problems. In about 15% of all RAP cases, parents ask for professional psychological support concerning their children’s issues, whereas 40% of paediatricians wish for psychological support considering this group of patients.
Conclusions: Estimated frequencies and paediatricians’ demands show the need for evidence-based psychological interventions in RAP to support usual medical treatment.
PMCID: PMC3070435  PMID: 21468324
recurrent abdominal pain; RAP; functional abdominal pain; paediatricians; standard medical care; outpatient practice
25.  Results of a psychosomatic training program in China, Vietnam and Laos: successful cross-cultural transfer of a postgraduate training program for medical doctors 
With the “ASIA-LINK” program, the European Community has supported the development and implementation of a curriculum of postgraduate psychosomatic training for medical doctors in China, Vietnam and Laos. Currently, these three countries are undergoing great social, economic and cultural changes. The associated psychosocial stress has led to increases in psychological and psychosomatic problems, as well as disorders for which no adequate medical or psychological care is available, even in cities. Health care in these three countries is characterized by the coexistence of Western medicine and traditional medicine. Psychological and psychosomatic disorders and problems are insufficiently recognized and treated, and there is a need for biopsychosocially orientated medical care. Little is known about the transferability of Western-oriented psychosomatic training programs in the Southeast Asian cultural context.
The curriculum was developed and implemented in three steps: 1) an experimental phase to build a future teacher group; 2) a joint training program for future teachers and German teachers; and 3) training by Asian trainers that was supervised by German teachers. The didactic elements included live patient interviews, lectures, communication skills training and Balint groups. The training was evaluated using questionnaires for the participants and interviews of the German teachers and the future teachers.
Regional training centers were formed in China (Shanghai), Vietnam (Ho Chi Minh City and Hue) and Laos (Vientiane). A total of 200 physicians completed the training, and 30 physicians acquired the status of future teacher. The acceptance of the training was high, and feelings of competence increased during the courses. The interactive training methods were greatly appreciated, with the skills training and self-experience ranked as the most important topics. Adaptations to the cultural background of the participants were necessary for the topics of “breaking bad news,” the handling of negative emotions, discontinuities in participation, the hierarchical doctor-patient relationship, culture-specific syndromes and language barriers. In addition to practical skills for daily clinical practice, the participants wanted to learn more about didactic teaching methods. Half a year after the completion of the training program, the participants stated that the program had a great impact on their daily medical practice.
The training in psychosomatic medicine for postgraduate medical doctors resulted in a positive response and is an important step in addressing the barriers in providing psychosomatic primary care. The transferability of western concepts should be tested locally, and adaptations should be undertaken where necessary. The revised curriculum forms the basis of training in psychosomatic medicine and psychotherapy for medical students and postgraduate doctors in China, Vietnam and Laos.
PMCID: PMC3546304  PMID: 22929520
Psychosomatic medicine; Curriculum; Teaching of teachers; China; Vietnam; Laos

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