Somatic symptom disorder and the role of epistemic trust, personality functioning and child abuse: Results from a population-based representative German sample

Hanna Kampling; David Riedl; Astrid Lampe; Tobias Nolte; Elmar Brähler; Mareike Ernst; Jörg M Fegert; Tobias Geisel; Nora Hettich-Damm; Andreas Jud; Sandra Zara; Johannes Kruse

doi:10.1016/j.jad.2024.12.096

Somatic symptom disorder and the role of epistemic trust, personality functioning and child abuse: Results from a population-based representative German sample

J Affect Disord. 2024 Dec 28:S0165-0327(24)02084-6. doi: 10.1016/j.jad.2024.12.096. Online ahead of print.

Authors

Hanna Kampling¹, David Riedl², Astrid Lampe³, Tobias Nolte⁴, Elmar Brähler⁵, Mareike Ernst⁶, Jörg M Fegert⁷, Tobias Geisel⁸, Nora Hettich-Damm⁹, Andreas Jud¹⁰, Sandra Zara¹¹, Johannes Kruse¹²

Affiliations

¹ Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany. Electronic address: hanna.kampling@psycho.med.uni-giessen.de.
² Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria; Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria.
³ Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria; VAMED Rehabilitation Center, Schruns, Austria.
⁴ Anna Freud National Centre for Children and Families, London, United Kingdom; Research Department of Clinical, Educational and Health Psychology, UCL, London, United Kingdom.
⁵ Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Integrated Research and Treatment Center for Adiposity Diseases, Behavioral Medicine Research Unit, University Medical Center Leipzig, Leipzig, Germany.
⁶ Department of Clinical Psychology, Psychotherapy and Psychoanalysis, Department of Psychology, University of Klagenfurt, Klagenfurt am Wörthersee, Austria.
⁷ Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany; German Center for Mental Health (DZPG), partner site Ulm, Germany.
⁸ Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany.
⁹ Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
¹⁰ Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany.
¹¹ Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany.
¹² Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany; Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany.

PMID: 39736403
DOI: 10.1016/j.jad.2024.12.096

Abstract

Background: A growing body of evidence explored symptom burden of somatic symptom disorder (SSD) and its complex etiology involving psychosocial aspects. Child abuse has been linked to numerous psychopathologies including somatic symptoms as well as impaired personality functioning and disruptions in epistemic trust. This work aims to investigate personality functioning and epistemic trust in the association between child abuse and somatic symptom burden.

Methods: We conducted structural equation modelling (SEM) using representative data of the German population (N = 2436). Personality functioning (OPD-SQS) was applied as a mediator between retrospectively recalled child abuse (ICAST-R) and somatic symptom burden (SSS-8, SSD-12, 6 month time criterion), while epistemic trust was added as a predictor of personality functioning.

Results: 6.8 % (n = 166) of participants self-reported SSD. Prevalence of child abuse (53.6 % vs. 31.7 %; χ² = 33.44, p < .001) was significantly higher among those with SSD. Child abuse was significantly associated with somatic symptom burden (criterion A: β = 0.23, 95 %-CI: 0.19-0.27, p < .001; criterion B (β = 0.24, 95 %-CI: 0.20-0.28, p < .001) and explained 6 % and 5 % of its variance respectively. Adding personality functioning as a mediator increased the explained variance to 28 % for both somatic symptom burden criterion A and B. Including epistemic trust further increased the explained variance of personality functioning (from 15 to 36 %).

Limitations: All assessments and results are based on self-report and cross-sectional data.

Conclusions: Impairments in personality functioning and disruptions in epistemic trust might play an important role in experiencing symptoms of SSD. Both domains thus present new avenues for treatment improvement and further research in patients with SSD.

Keywords: Child abuse; Epistemic trust; Personality functioning; Population-based representative data; Somatic symptom disorder; Structural equation modelling.