Personality Trait Worsens Rheumatoid Arthritis Symptoms

TUCSON, ARIZ. — A psychological trait associated with heightened awareness of bodily distress may help to explain why some rheumatoid arthritis patients suffer more from achiness, malaise, and fatigue than do others with similar disease severity, Dr. Ilana M. Braun reported at the annual meeting of the Academy of Psychosomatic Medicine.

The trait, somatic absorption, was closely associated with generalized symptoms of rheumatoid arthritis in 87 patients studied by Dr. Braun, a psychiatrist at Harvard Medical School and Massachusetts General Hospital in Boston. It had no relationship to specific symptoms, such as joint pain, swelling, stiffness, and deformity, or to disease severity.

The magnitude of effect was modest, accounting for just 4% of variability in nonspecific symptoms, but Dr. Braun noted that it was significant statistically—and possibly clinically.

People who score high on measures of absorption have a capacity for deep involvement in sensory events, she said. They have a heightened sense of reality that makes them more sensitive not only to bodily distress, but also to hypnosis and to biofeedback.

“There might be a role for psychiatry in the treatment of rheumatoid arthritis,” she said, questioning whether some patients might respond to these kinds of interventions for nonspecific symptoms.

“It is a personality style that you can target,” Dr. Braun added in an interview. “This is not a disorder. These are perfectly healthy people [mentally]. They just have a certain way of responding to the world.”

While she called for more research into the clinical utility of her finding, Dr. Braun suggested that ultimately it may present rheumatologists with an alternative to increasing medication when patients complain they feel poorly in the absence of specific symptoms. “What I am saying is, for the malaise and the fatigue don't double the dose,” she said. “Send them to the hypnotist.”

The study was supported by a Webb Fellowship from the academy. Dr. Braun enrolled patients from a larger, longitudinal study of rheumatoid arthritis. The largely female population had a median age of 55.5 years. A majority, 85%, had been to college, more than half were employed, and about half were married.

Patients completed the 14-item Rheumatoid Arthritis Symptoms Questionnaire. Dr. Braun and her coinvestigators also used erythrocyte sedimentation rate and a standard 28-joint physical examination by a rheumatologist to measure disease severity. They calculated the total number of medications prescribed for pain and other “disease-modifying agents.”

Assessment of somatic absorption was based on the 29-item Somatic Absorption Scale, a measure derived from the Tellegen Absorption Scale. Dr. Braun said the Somatic Absorption Scale focuses on “absorption as it pertains to somatic or visceral experience.” For example, a subject might be asked whether she could imagine her arm being so heavy she could not move it, or if she notices how her clothes feel against her skin. The Rand Mental Health Inventory was used as well to identify common symptoms that are neither physical nor psychosomatic of prevalent mental disorders.

Dr. Braun reported somatic absorption was significantly more pronounced in younger subjects, people with more severe psychiatric symptoms, African Americans, and Hispanics. Rheumatoid arthritis symptoms with statistically significant ties to somatic absorption were pain in limbs, pain in back, fatigue, generalized aching, and “feeling sick all over.”

In a discussion of the findings, Dr. Stephen J. Ferrando said he found himself looking up the literature on absorption, a personality construct developed in the 1970s to assess which patients might respond to hypnosis and biofeedback.

Dr. Ferrando, a professor of clinical psychiatry and clinical public health at Cornell University in New York, called the findings very interesting and said he looks forward to an analysis of how the subjects fare in the longitudinal study from which the population was drawn.

TUCSON, ARIZ. — A psychological trait associated with heightened awareness of bodily distress may help to explain why some rheumatoid arthritis patients suffer more from achiness, malaise, and fatigue than do others with similar disease severity, Dr. Ilana M. Braun reported at the annual meeting of the Academy of Psychosomatic Medicine.

The trait, somatic absorption, was closely associated with generalized symptoms of rheumatoid arthritis in 87 patients studied by Dr. Braun, a psychiatrist at Harvard Medical School and Massachusetts General Hospital in Boston. It had no relationship to specific symptoms, such as joint pain, swelling, stiffness, and deformity, or to disease severity.

The magnitude of effect was modest, accounting for just 4% of variability in nonspecific symptoms, but Dr. Braun noted that it was significant statistically—and possibly clinically.

People who score high on measures of absorption have a capacity for deep involvement in sensory events, she said. They have a heightened sense of reality that makes them more sensitive not only to bodily distress, but also to hypnosis and to biofeedback.

“There might be a role for psychiatry in the treatment of rheumatoid arthritis,” she said, questioning whether some patients might respond to these kinds of interventions for nonspecific symptoms.

“It is a personality style that you can target,” Dr. Braun added in an interview. “This is not a disorder. These are perfectly healthy people [mentally]. They just have a certain way of responding to the world.”

While she called for more research into the clinical utility of her finding, Dr. Braun suggested that ultimately it may present rheumatologists with an alternative to increasing medication when patients complain they feel poorly in the absence of specific symptoms. “What I am saying is, for the malaise and the fatigue don't double the dose,” she said. “Send them to the hypnotist.”

The study was supported by a Webb Fellowship from the academy. Dr. Braun enrolled patients from a larger, longitudinal study of rheumatoid arthritis. The largely female population had a median age of 55.5 years. A majority, 85%, had been to college, more than half were employed, and about half were married.

Patients completed the 14-item Rheumatoid Arthritis Symptoms Questionnaire. Dr. Braun and her coinvestigators also used erythrocyte sedimentation rate and a standard 28-joint physical examination by a rheumatologist to measure disease severity. They calculated the total number of medications prescribed for pain and other “disease-modifying agents.”

Assessment of somatic absorption was based on the 29-item Somatic Absorption Scale, a measure derived from the Tellegen Absorption Scale. Dr. Braun said the Somatic Absorption Scale focuses on “absorption as it pertains to somatic or visceral experience.” For example, a subject might be asked whether she could imagine her arm being so heavy she could not move it, or if she notices how her clothes feel against her skin. The Rand Mental Health Inventory was used as well to identify common symptoms that are neither physical nor psychosomatic of prevalent mental disorders.

Dr. Braun reported somatic absorption was significantly more pronounced in younger subjects, people with more severe psychiatric symptoms, African Americans, and Hispanics. Rheumatoid arthritis symptoms with statistically significant ties to somatic absorption were pain in limbs, pain in back, fatigue, generalized aching, and “feeling sick all over.”

In a discussion of the findings, Dr. Stephen J. Ferrando said he found himself looking up the literature on absorption, a personality construct developed in the 1970s to assess which patients might respond to hypnosis and biofeedback.

Dr. Ferrando, a professor of clinical psychiatry and clinical public health at Cornell University in New York, called the findings very interesting and said he looks forward to an analysis of how the subjects fare in the longitudinal study from which the population was drawn.

TUCSON, ARIZ. — A psychological trait associated with heightened awareness of bodily distress may help to explain why some rheumatoid arthritis patients suffer more from achiness, malaise, and fatigue than do others with similar disease severity, Dr. Ilana M. Braun reported at the annual meeting of the Academy of Psychosomatic Medicine.

The trait, somatic absorption, was closely associated with generalized symptoms of rheumatoid arthritis in 87 patients studied by Dr. Braun, a psychiatrist at Harvard Medical School and Massachusetts General Hospital in Boston. It had no relationship to specific symptoms, such as joint pain, swelling, stiffness, and deformity, or to disease severity.

The magnitude of effect was modest, accounting for just 4% of variability in nonspecific symptoms, but Dr. Braun noted that it was significant statistically—and possibly clinically.

People who score high on measures of absorption have a capacity for deep involvement in sensory events, she said. They have a heightened sense of reality that makes them more sensitive not only to bodily distress, but also to hypnosis and to biofeedback.

“There might be a role for psychiatry in the treatment of rheumatoid arthritis,” she said, questioning whether some patients might respond to these kinds of interventions for nonspecific symptoms.

“It is a personality style that you can target,” Dr. Braun added in an interview. “This is not a disorder. These are perfectly healthy people [mentally]. They just have a certain way of responding to the world.”

While she called for more research into the clinical utility of her finding, Dr. Braun suggested that ultimately it may present rheumatologists with an alternative to increasing medication when patients complain they feel poorly in the absence of specific symptoms. “What I am saying is, for the malaise and the fatigue don't double the dose,” she said. “Send them to the hypnotist.”

The study was supported by a Webb Fellowship from the academy. Dr. Braun enrolled patients from a larger, longitudinal study of rheumatoid arthritis. The largely female population had a median age of 55.5 years. A majority, 85%, had been to college, more than half were employed, and about half were married.

Patients completed the 14-item Rheumatoid Arthritis Symptoms Questionnaire. Dr. Braun and her coinvestigators also used erythrocyte sedimentation rate and a standard 28-joint physical examination by a rheumatologist to measure disease severity. They calculated the total number of medications prescribed for pain and other “disease-modifying agents.”

Assessment of somatic absorption was based on the 29-item Somatic Absorption Scale, a measure derived from the Tellegen Absorption Scale. Dr. Braun said the Somatic Absorption Scale focuses on “absorption as it pertains to somatic or visceral experience.” For example, a subject might be asked whether she could imagine her arm being so heavy she could not move it, or if she notices how her clothes feel against her skin. The Rand Mental Health Inventory was used as well to identify common symptoms that are neither physical nor psychosomatic of prevalent mental disorders.

Dr. Braun reported somatic absorption was significantly more pronounced in younger subjects, people with more severe psychiatric symptoms, African Americans, and Hispanics. Rheumatoid arthritis symptoms with statistically significant ties to somatic absorption were pain in limbs, pain in back, fatigue, generalized aching, and “feeling sick all over.”

In a discussion of the findings, Dr. Stephen J. Ferrando said he found himself looking up the literature on absorption, a personality construct developed in the 1970s to assess which patients might respond to hypnosis and biofeedback.

Dr. Ferrando, a professor of clinical psychiatry and clinical public health at Cornell University in New York, called the findings very interesting and said he looks forward to an analysis of how the subjects fare in the longitudinal study from which the population was drawn.