From heart attacks to melanoma: Do common sense models of somatization influence symptom interpretation for female victims?

Common sense models regarding gender and stress influenced how laypeople responded to information about symptoms in 3 experiments. In Study 1, medical intervention was perceived to be less important for female targets reporting chest pain and stressful events than for male targets experiencing identical symptoms and stressors. In addition, chest pain was less likely to be attributed to cardiac causes for female targets. This gender-based stress-discounting effect was replicated for symptoms of gallstones and melanoma in Study 2, where participants again were less likely to recommend medical care for female than for male targets. Recognition memory for information about a somatizing target was tested in Study 3; results suggested that laypeople hold stereotypes associating somatization with female gender. The authors' findings provide insight into the naive theories that shape symptom interpretation and self-referral behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care

OBJECTIVES: To examine the effect of patients' causal attributions of common somatic symptoms on recognition by general practitioners of cases of depression and anxiety and to test the hypothesis that normalising attributions make recognition less likely. DESIGN: Cross sectional survey. SETTING: One general practice of eight doctors in Bristol. SUBJECTS: 305 general practice attenders. MAIN OUTCOME MEASURE: The rate of detection by general practitioners of cases of depression and anxiety as defined by the general health questionnaire. RESULTS: Consecutive attenders completed the general health questionnaire and the symptom interpretation questionnaire, which scores style of symptom attribution along the dimensions of psychologising, somatising, and normalising. General practitioners detected depression or anxiety in 56 (36%; 95% confidence interval 28% to 44%) of the 157 patients who scored highly on the general health questionnaire. Subjects with a normalising attributional style were less likely to be detected as cases; doctors did not make any psychological diagnosis in 46 (85%; 73% to 93%) of 54 patients who had high questionnaire and high normalising scores. Those with a psychologising style were more likely to be detected; doctors did not detect 21 (38%; 25% to 52%) of 55 patients who had high questionnaire and high psychologising scores. The somatisation scale was not associated with low detection rates. This pattern of results persisted after adjustment for age, sex, general health questionnaire score, and general practitioner. CONCLUSIONS: Normalising attributions minimise symptoms and are non-pathological in character. The normalising attributional style is predominant in general practice attenders and is an important cause of low rates of detection of depression and anxiety.     

Autonomic nervous system activity in essential hypertension: a comparison between dippers and non-dippers

This study examines whether race is a significant determinant of the diagnoses of acute myocardial infarction or angina pectoris in patients with symptoms suggestive of acute cardiac ischemia. The study population was comprised of 3401 (34%) African-American and 6600 (66%) white patients who presented to emergency departments with symptoms suggestive of acute cardiac ischemia. The main outcome measure was a diagnosis of acute myocardial infarction or angina pectoris. African Americans were younger, predominantly female, and more often had hypertension, diabetes mellitus, or smoked. The diagnosis of acute myocardial infarction was confirmed in 6% of African-American and 12% of white men, and in 4% of African-American and 8% of white women. After adjusting for age, gender, medical history, signs and symptoms, and hospital, African Americans were half as likely to develop acute myocardial infarction and were 60% as likely to have acute cardiac ischemia. Despite having less acute cardiac ischemia, African Americans in this study had high risk levels for coronary artery disease.     

Gender disparities in the attribution of cardiac-related symptoms: Contribution of common sense models of illness.

The role of common sense models of heart disease in the attribution of cardiac-related symptoms was examined in a sample of healthy young adults (N?=?224). Participants were less likely to attribute symptoms to possible cardiac causes for female victims reporting stressful life events (M?=?5.14) than for female victims without such stressors (M?=?6.82) or for male victims with (M?=?6.23) or without (M?=?6.48) concurrent stressors. Cardiac attributions remained lowest for female/high-stress victims in additional samples of undergraduates (N?=?194), community-residing adults (N?=?48), and physicians (N?=?45), although this outcome sometimes appeared to reflect additive, rather than interactive, effects. Two final experiments with undergraduate samples (Ns?=?48 and 60, respectively) indicated that stereotypes associating heart disease with male gender may account for gender disparities in the attribution of cardiac-related symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors related to delayed treatment and posttreatment symptom severity in Taiwanese patients with benign prostatic hyperplasia

We evaluated the sociodemographic and clinical factors of delayed treatment and posttreatment symptom severity in outpatients with benign prostatic hyperplasia (BPH). The study included 146 BPH patients treated at the National Taiwan University Hospital in early 1997. All patients were treated with alpha-adrenergic antagonists or finasteride for at least 2 weeks. A questionnaire based on Andersen's Health Behavior Model was used to assess various sociodemographic features, while the pre- and posttreatment symptoms severity was rated according to the International Prostate Symptom Score (IPSS). Multiple logistic regression was used to assess the associations of these factors with delayed treatment and posttreatment symptom severity. Subjects who had recently quit smoking or were blue-collar workers tended to delay treatment, while those who chose a medical center as the care provider for chronic diseases tended to be less likely to delay treatment. However, none of these associations were statistically significant. No enabling factors (income, insurance) or need factors (symptom scores) evaluated were associated with delayed treatment. Predisposing factors associated with higher posttreatment symptom severity were delayed treatment (over 12 months) (adjusted odds ratio [OR]: 2.67, 95% confidence interval [CI]: 1.16-6.16), quitting smoking (adjusted OR: 4.47, 95% CI: 1.34-14.94), and having never smoked (adjusted OR: 3.73, 95% CI: 1.15-12.11). Subjects with severe pretreatment symptoms were far more likely than subjects with mild pretreatment symptoms to have severe symptoms after treatment (adjusted OR: 52.69, 95% CI: 54.46-621.90). Our findings, though based on a limited number of subjects, suggest sociodemographic factors rather than objective clinical attributes (prostate specific antigen level, prostate volume, and urodynamic results) are associated with delayed treatment in Taiwanese men with BPH. Both pretreatment symptom severity and sociodemographic factors are related to posttreatment symptom severity.     

Differential dependency of unmyelinated and A delta epidermal and upper dermal innervation on neurotrophins, trk receptors, and p75LNGFR

This study investigates discrepancy and congruence between doctors and patients in their beliefs about the need for medical treatment. One hundred seventy-six outpatients and 337 university students rated each of a set of 35 symptoms on the urgency with which they would seek medical advice were they experiencing that symptom. Sixty-six general practitioners rated the urgency with which a person experiencing that symptom should seek medical advice. These symptoms were classified as relatively serious or nonserious on the basis of ratings by a separate set of doctors. General practitioners perceived a greater overall need for treatment than did patients, but this difference was greater for nonserious than for serious symptoms. In fact patients perceived treatment to be more urgent for three serious symptoms, each potentially indicative of cancer. The observed pattern of doctor-patient discrepancies can be explained in terms of the availability heuristic. The role of this heuristic in the cognitive dynamics of doctor-patient relationships merits future attention.     

Comprehensive clinical assessment in community setting: applicability of the MDS-HC

A cohort of 759 coronary artery bypass grafting (CABG) patients (269 women and 490 men) was enrolled in the prospective POST CABG Biobehavioral Study at 5 clinical centers in the United States and Canada. Sociodemographic and medical data were obtained by interview and from medical charts. Health-related quality of life and psychosocial data were ascertained preoperatively by interview and questionnaire for those patients whose condition allowed preoperative assessment and was compared among patients from hospitals enrolling both male and female patients (143 women and 267 men). Women enrolled in the Biobehavioral Study were older than men (65.4 +/- 9.0 vs 61.8 +/- 9.7 years, p < 0.001) and more likely to have a preoperative medical condition which precluded biobehavioral evaluation (47% vs 34%, p < 0.001). Women were less likely to be high school graduates (59% vs 74%, p < 0.001), were less likely to be earning > or = $25,000 per year (39% vs 69%, p < 0.001), and were married less often at the time of surgery (59% vs 85%, p < 0.001). Fewer women than men were able to perform basic self-care activities (p < 0.001) and social activities (p < 0.001). Women were also less able to perform the more demanding activities required for independent living, recreation, and maintaining a household (p < 0.001). Women were also more anxious (p = 0.01) and reported more depressive symptoms (p < 0.001) than men. These data suggest that plans for perioperative and convalescent care for women undergoing CABG should take into account their less favorable medical and psychosocial status relative to men.     

Psychological sequelae of hate-crime victimization among lesbian, gay, and bisexual adults.

Questionnaire data about criminal victimization experiences were collected from 2,259 Sacramento-area lesbians, gay men, and bisexuals (N?=?1,170 women and 1,089 men). Approximately 1/5 of the women and 1/4 of the men had experienced victimization because of their adult sexual orientation. Hate crimes were less likely than nonbias crimes to have been reported to police. Compared with other recent crime victims, lesbian and gay hate-crime survivors manifested significantly more symptoms of depression, anger, anxiety, and posttraumatic stress. They also displayed significantly more crime-related fears and beliefs, lower sense of mastery, and more attributions of their personal setbacks to sexual prejudice than did nonbias crime victims and nonvictims. Comparable differences were not observed among bisexuals. The findings highlight the importance of recognizing hate-crime survivors' special needs in clinical settings and in public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributions for positive life events predict recovery from depression among psychiatric inpatients: An investigation of the Needles and Abramson model of recovery from depression.

The authors investigated whether attributions for positive life events predict decreases in hopelessness and depressive symptoms among clinically depressed adults. Measures of attributional style, attributions for recent events, depressive symptoms, dysfunctional attitudes, hopelessness, and life events were administered to 52 depressed psychiatric inpatients treated with antidepressant medication; the measures were readministered 12 and 24 days later. Results indicated that (a) internal, stable, global attributions for recent positive events mediated a significant association between attributional style for positive life events and decreased hopelessness; (b) decreases in hopelessness mediated a significant association between internal, stable, global attributions for recent positive events and decreases in depressive symptom levels; and (c) depressotypic cognitions were not associated with decreases in either hopelessness or depressive symptom levels. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical students' and residents' gender bias in the diagnosis, treatment, and interpretation of coronary heart disease symptoms.

Two competing hypotheses explaining gender bias in cardiac care were tested. The first posits that women's coronary heart disease (CHD) symptoms are simply misinterpreted or discounted. The second posits that women's CHD symptoms are misinterpreted when presented in the context of stress. In two studies, medical students and residents randomized to 2 (male vs. female) × 2 (stress vs. nostress) experiments read vignettes of patients with CHD symptoms and indicated their diagnosis, treatment, and symptom origin interpretation. Both studies disconfirmed the first hypothesis and strongly supported the second. Only when stress was added did women receive significantly lower CHD diagnoses and cardiologist referrals than men and did the origin interpretation of women's CHD symptoms (e.g., chest pain) shift from organic to psychogenic. Neither participants' gender nor their attitude toward women influenced assessments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributing negative intent to wife behavior: The attributions of maritally violent versus nonviolent men.

Compared attributions for negative wife behavior offered by 3 groups of husbands: 22 maritally violent and distressed, 17 nonviolent but maritally distressed, and 17 nonviolent and nondistressed. Husbands rated wife behaviors presented in 9 hypothetical problematic marital situation vignettes. On a measure of responsibility attributions, violent husbands were more likely than nondistressed husbands to attribute negative intentions, selfish motivation, and blame to the wife. On a measure of possible negative wife intentions, violent husbands were more likely than either distressed or nondistressed men to attribute negative intentions to the wife. Exploratory analyses suggested that certain types of marital situations (e.g., jealousy and rejection from wife) were particularly likely to elicit attributions of negative intent from violent husbands. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In situ hybridization with riboprobes: an overview for veterinary pathologists

Although preliminary reports indicate that fatigue is a common symptom of human immunodeficiency virus (HIV) disease, little empirical research has focused on its prevalence or characteristics among patients with acquired immunodeficiency syndrome (AIDS). We assessed the frequency of fatigue and its medical and psychological correlates, in a cross-sectional survey of ambulatory AIDS patients. Ambulatory patients with AIDS who participated in a study of quality life (N = 427) were classified into fatigue/no fatigue groups based on their responses to fatigue items on the Memorial Symptom Assessment Scale (MSAS) and the AIDS physical symptom checklist. Self-report inventories were also administered to assess psychological distress, depressive symptoms, and overall quality of life. Medical information was elicited through clinical interview and review of medical chart. Fifty-four percent of the patients endorsed both of the fatigue items from the MSAS and the AIDS physical symptom checklists, and were classified as having fatigue. Women were significantly more likely to report fatigue than men (chi square = 5.28, df = 1, P < 0.03), and patients reporting homosexual contact as their transmission risk factor were significantly less likely to report fatigue than were patients reporting injection drug use or heterosexual contact (chi square = 5.13, df = 2, P < 0.03). The presence of fatigue was significantly associated with the number of current AIDS-related physical symptoms [t(425) = 8.00, P < 0.0001], current treatment for HIV-related medical disorders (chi square = 12.51, df = 1, P < 0.0001), anemia [t(174) = -2.35, P < 0.02], and pain (chi square = 36.36, df = 1 P < 0.0001). Patients with fatigue also had significantly poorer physical functioning ability [Karnofsky: t(422) = -6.27, P < 0.0001], as well as greater degree of overall psychological distress and lower quality of life [F(5,418) = 23.79, P < 0.0001], as measured by the Brief Symptom Inventory, Beck Depression Inventory, Beck Hopelessness Scale, Functional Living Inventory for Cancer (modified for AIDS), and the MSAS Psychological Distress Subscale. Fatigue is a common symptom in ambulatory AIDS patients and is associated with significant physical and psychological morbidity.     

Predictors and outcome of discharge against medical advice from the psychiatric units of a general hospital

OBJECTIVE: The study examined predictors of discharge against medical advice (AMA) and outcomes of psychiatric patients with AMA discharges, as measured by poorer symptom ratings at discharge and higher rates of rehospitalization. METHODS: A total of 195 patients discharged AMA from general hospital psychiatric units were compared retrospectively with 2,230 regularly discharged patients. AMA status was defined as signing out against medical advice, being absent without leave, or being administratively discharged. All patients received standardized assessments within 24 hours of admission and at discharge. Demographic characteristics, psychiatric history, DSA-IV psychiatric and substance use diagnoses, and scores on an expanded 32-item version of the Psychiatric Symptom Assessment Scale were compared. RESULTS: The groups did not differ in primary psychiatric diagnoses. Patients discharged AMA were significantly less likely to be Caucasian or to be functionally impaired due to physical illness. They were more likely to live alone, have a substance use diagnosis, use more psychoactive substances, and have more previous hospitalizations. Patients discharged AMA had significantly shorter lengths of stay, higher rehospitalization rates, and more severe symptoms at discharge, even when length of stay was taken into account. The differences between the groups in male gender and young age were better accounted for by a greater likelihood of substance abuse in these groups. CONCLUSIONS: The results suggest a profile of patients who may be discharged AMA. Such patients have worse outcomes and are more likely to be high utilizers of inpatient resources. Aggressive identification of patients likely to be discharged AMA and early discharge planning for appropriate outpatient treatment are recommended.     

Tumor type and vascularity: important variables in infusional brachytherapy with colloidal 32P

PURPOSE: We determined the occurrence of and risk factors for acute urinary retention in the community setting. MATERIALS AND METHODS: A cohort of 2,115 men 40 to 79 years old was randomly selected from an enumeration of the Olmsted County, Minnesota population (55% response rate). Participants completed a previously validated baseline questionnaire that assessed symptom severity, and voided into a portable urometer to measure peak urinary flow rates. A 25% random subsample underwent transrectal sonographic imaging of the prostate to determine prostate volume. Followup was performed through a retrospective review of community medical records to determine the occurrence of acute urinary retention in the subsequent 4 years. RESULTS: During the 8,344 person-years of followup 57 men had a first episode of acute urinary retention (incidence 6.8/1,000 person-years, 95% confidence interval [CI] 5.2, 8.9). Among men with no to mild symptoms (American Urological Association symptom index score 7 or less) the incidence of acute urinary retention increased from 2.6/1,000 person-years among men 40 to 49 years old to 9.3/1,000 person-years among men 70 to 79 years old. By contrast, rates increased from 3.0/1,000 person-years for men 40 to 49 years old to 34.7/1,000 person-years among men 70 to 79 years old among men with moderate to severe symptoms (American Urological Association symptom index score greater than 7). Men with depressed peak urinary flow rate (less than 12 ml. per second) were at 4 times the risk of acute urinary retention compared with men with urinary flow rates greater than 12 ml. per second (95% CI 2.3, 6.6). Men with an enlarged prostate (greater than 30 ml.) experienced a 3-fold increase in risk (95% CI 1.0, 9.0, p = 0.04). CONCLUSIONS: Lower urinary tract symptoms, depressed peak urinary flow rates, enlarged prostates and older age are associated with an increased risk of acute urinary retention in community dwelling men. These findings may help to identify men at increased risk of acute urinary retention in whom closer evaluation may be warranted.     

Patients' awareness of stroke signs, symptoms, and risk factors

BACKGROUND AND PURPOSE: We sought to determine knowledge at the time of symptom onset regarding the signs, symptoms, and risk factors of stroke in patients presenting to the emergency department with potential stroke. METHODS: Patients admitted from the emergency department with possible stroke were identified prospectively. A standardized, structured interview with open-ended questions was performed within 48 hours of symptom onset to assess patients' knowledge base concerning stroke signs, symptoms, and risk factors. RESULTS: Of the 174 eligible patients, 163 patients were able to respond to the interview questions. Of these 163 patients, 39% (63) did not know a single sign or symptom of stroke. Unilateral weakness (26%) and numbness (22%) were the most frequently noted symptoms. Patients aged > or = 65 years were less likely to know a sign or symptom of stroke than those aged < 65 years (percentage not knowing a single sign or symptom, 47% versus 28%, P = .016). Similarly, 43% of patients did not know a single risk factor for stroke. The elderly were less likely to know a risk factor than their younger counterparts. CONCLUSIONS: Almost 40% of patients admitted with a possible stroke did not know the signs, symptoms, or risk factor of a stroke. Further public education is needed to increase awareness of the warning signs and risk factors of stroke.     

Causal attribution, perceived benefits, and morbidity after a heart attack: An 8-year study.

In a sample of 287 heart attack victims who were interviewed 7 weeks and 8 years after their attack or who were known to have died during follow-up, interrelations among causal attributions for the attack, perceived benefits of the attack, survivor morbidity, and heart attack recurrence were explored. Analyses focused on early cognitive predictors of heart attack recurrence and 8-year morbidity and on the effects of surviving another heart attack on cognitive appraisals. Independently of sociodemographic characteristics and physicians' ratings of initial prognosis, patients who cited benefits from their misfortune 7 weeks after the first attack were less likely to have another attack and had lower levels of morbidity 8 years later. Attributing the initial attack to stress responses (e.g., worrying, nervousness) was also predictive of greater morbidity in 8-year survivors and blaming the initial attack on other people was predictive of reinfarctions. Men who survived a subsequent heart attack were more likely than men who did not have additional attacks to cite benefits and made more attributions 8 years after the initial attack. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Natural history of prostatism: impaired health states in men with lower urinary tract symptoms

PURPOSE: Lower urinary tract symptoms are reported to have a significant impact on quality of life. However, the impact on specific aspects of health status is not clear. We evaluated the association between lower urinary tract symptoms, and physical and mental aspects of health using community based data from a cross-sectional component of a prospective cohort study. MATERIALS AND METHODS: A total of 2,133 men 41 to 84 years old who were randomly selected from the Olmsted County, Minnesota population completed the 36-item health status questionnaire and a previously validated questionnaire assessing urinary symptoms. Eight domains, measured on a scale of 0 to 100, were used to assess general health status. Men were classified as having an impaired health status if they scored less than 75 points on the scale. Symptom severity (none, mild, moderate or severe) was measured from responses to the urinary symptom questionnaire. RESULTS: The results demonstrated a cross-sectional decrease in mean health status scores for all 8 domains across levels of increasing urinary symptom severity. The strongest associations between health status scores and urinary symptoms (severe versus none) were observed for role limitation due to physical problems (odds ratio 15.7, 95% confidence interval 6.6 to 37.0), energy/fatigue (odds ratio 9.2, 95% confidence interval 4.7 to 18.1), role limitation due to emotional problems (odds ratio 8.7, 95% confidence interval 4.1 to 18.2) and general perception of health (odds ratio 7.2, 95% confidence interval 3.8 to 13.4). For these 4 dimensions men with mild urinary symptoms were also significantly more likely to have an impaired health status. Adjustment for age and co-morbidity did not alter the results. CONCLUSIONS: These findings suggest that urinary symptoms have a multidimensional association with physical and mental aspects of health. Although lower urinary tract symptoms may be the cause of an impaired health status, men with impaired health conditions may be more sensitive to prevalent urinary symptoms and more likely to report them. While the casual nature of this association has not been ascertained, these results may help to identify appropriate health dimensions to assess in patients with lower urinary tract symptoms.     

Access and outcomes of elderly patients enrolled in managed care

OBJECTIVE: To determine differences in access to care and medical outcomes for Medicare patients with an acute or a chronic symptom who were enrolled in health maintenance organizations (HMOs) compared with similar fee-for-service (FFS) nonenrollees. DESIGN: A 1990 household telephone survey of Medicare beneficiaries who reported joint pain or chest pain during the previous 12 months. SAMPLE: Stratified random sample of HMO enrollees (n = 6476) and comparable sample of FFS Medicare beneficiaries (n = 6381). ACCESS AND OUTCOME MEASURES: Care-seeking behavior, physician visits, diagnostic procedures performed, therapeutic interventions prescribed, follow-up recommended by a physician, and symptom response to treatment. RESULTS: After controlling for demographic factors, health and functional status, and health behavior characteristics, HMO enrollees with joint pain (n = 2243) were more likely than nonenrollees (n = 2009) to have a physician visit (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.03 to 1.38) and medication prescribed (OR, 1.35; 95% CI, 1.14 to 1.60). Patients with chest pain who were enrolled in HMOs (n = 556) were less likely than nonenrollees (n = 524) to have a physician visit (OR, 0.50; 95% CI, 0.30 to 0.82). For both joint and chest pain, HMO enrollees were less likely to see a specialist for care, have follow-up recommended, or have their progress monitored. There were no differences in complete elimination of symptoms, but HMO enrollees with continued joint pain reported less symptomatic improvement than nonenrollees (OR, 0.72; 95% CI, 0.59 to 0.86). CONCLUSIONS: Reduced utilization of services for patients with specific ambulatory conditions was observed in HMOs with Medicare risk contracts, with less symptomatic improvement in one of the four outcomes studied.     

Neuroepithelial progenitor cells explanted from human fetal brain proliferate and differentiate in vitro

Analyses tested the following contrasting hypotheses: a) The occurrence of a new symptom in the presence of ongoing life stress increases the attribution of symptoms to illness and increases the use of health care; b) new symptoms occurring in the presence of ongoing life stress are attributed to stressors if they are ambiguous indicators of illness, and they are unlikely to motivate care-seeking if the stressor, i.e., the perceived cause, is of recent onset. The 43-to-92-year old subjects in this longitudinal study were less likely to seek care for the ambiguous symptoms they experienced during the previous week if there was a concurrent life stressor that began during the previous 3 weeks; these symptoms were attributed to stress rather than to illness, and subjects tolerated the emotional distress caused by the combination of a stressor and an ambiguous symptom. Subjects were less willing to tolerate the combined distress of an ambiguous symptom and a concurrent life stressor if the stressor onset was not recent; under such conditions, subjects were more likely to seek health care. Current life stressors did not affect care-seeking for symptoms that were clear signs of disease; these symptoms were readily identified as health threats in need of medical attention. The findings contribute to a better theoretical understanding of how individuals perceive their physical states and how they cope with stress. Practical implications of these findings for increasing efficient use of health care services are also discussed.     

Patients who somatize in primary care: a longitudinal study of cognitive and social characteristics

We examined the cognitive and sociodemographic characteristics of patients making somatic presentations of depression and anxiety in primary care. Only 15% of patients with depressive symptomatology on self-report, and only 21% of patients with current major depression or anxiety disorders on diagnostic interview, presented psychosocial symptoms to their GP. The remainder of patients with psychiatric distress presented exclusively somatic symptoms and were divided into three groups-initial, facultative and true somatizers-based on their willingness to offer or endorse a psychosocial cause for their symptoms. Somatizers did not differ markedly from psychologizers in sociodemographic characteristics except for a greater proportion of men among the true somatizers. Compared to psychologizers, somatizers reported lower levels of psychological distress, less introspectiveness and less worry about having an emotional problem. Somatizers were also less likely to attribute common somatic symptoms to psychological causes and more likely to endorse normalizing causes. In the 12 months following their initial visit, somatizers made less use of speciality mental health care and were less likely to present emotional problems to their GP. Somatizers were markedly less likely to talk about personal problems to their GP and reported themselves less likely to seek help for anxiety or sadness. Somatization represents a persistent pattern of illness behaviour in which mental health care is not sought despite easily elicited evidence of emotional distress. Somatization is not, however, associated with higher levels of medical health care utilization than that found among patients with frank depression or anxiety.