Causal attributions for somatic symptom disorder

OBJECTIVES: Two research questions will be addressed: (1) What does the German public think about possible causes of somatic symptom disorder (SSD) and are there differences in causal attributions according to symptom and course of SSD? (2) Are causal attributions associated with beliefs about treatment and stigmatizing attitudes?

METHODS: Two vignettes with symptoms of SSD were used in a national telephone survey in Germany (N = 1004). Vignettes differed regarding main type of symptom (pain vs. fatigue) and existence of an earlier somatic disease (yes vs. no). Respondents were asked about their agreement with five causal beliefs (broken home, heredity, lack of willpower, work stress, and misinterpretation of body signals).

RESULTS: About 90% of the respondents agreed that work stress is a possible cause of the SSD symptoms. Agreement was significantly more pronounced in case of a person with fatigue and an earlier severe somatic disease. A quarter endorsed lack of willpower as a possible cause. Lack of willpower was associated with a significant increase of desire for social distance in both vignettes. Work stress was associated with a significantly increased likelihood of positively evaluating the effectiveness of psychotherapy in both cases of SSD.

CONCLUSIONS: Public beliefs about causes of SSD are associated with stigma and treatment beliefs. Emphasising work stress as a cause may promote the belief that psychotherapy is effective for treatment of SSD.