儿童功能性躯体化症状的心理社会发生机制

发布时间：2018-02-10 06:29

本文关键词： 儿童躯体化症状多层线性模型生物—心理—社会模式　出处：《南开大学》2013年博士论文　论文类型：学位论文

【摘要】：儿童功能性躯体化症状(Functional Somatic Symptoms, FSS)又被称为“无医学解释的躯体症状”,是儿科临床上常见的主诉,常被诊断为功能性腹痛、慢性疲劳综合症等,严重的FSS有可能符合精神病学中躯体形式障碍的诊断。儿童FSS不仅高发于临床样本中,轻微的躯体化症状在非临床社区样本中也很常见。社区样本中的儿童FSS较为轻微,未达到临床诊断的标准,但是表现形式多样,对儿童的出勤率、学业成绩、家庭关系等方面都有负面影响。儿童FSS通常没有医学设备可检测出的生理病变,而是与心理、社会环境因素密切相关。本研究以非临床小学生和中学生为样本,采用纵向追踪和横断相结合的研究设计,使用问卷法对儿童功能性躯体化症状的发生率、发展趋势、心理发生机制和社会环境影响因素进行了探讨。研究共分为3个部分,由9个子研究组成。第一部分修订了测量儿童FSS的工具,并对本研究中使用到的研究工具的心理测量学属性进行了检验；第二部分探讨了儿童FSS的发展趋势,以及个体心理学属性,包括情绪、认知方式、行为等方面与儿童FSS之间的互动关系；第三部分探讨了家庭、班级以及负性生活事件等环境因素对儿童FSS的影响。综合本研究结果,得出了以下结论： 1.儿童FSS在非临床儿童和青少年群体中很常见。本研究中,仅有5.6%的被试儿童在过去3个月中没有感觉到任何躯体不适,有36.5%的被试在过去3个月中体验到“轻微”至“非常多”的躯体化症状。29.4%的被试在过去3个月中频繁体验到至少1种躯体化症状。本研究样本中发生率较高的躯体化症状依次是感觉乏力(65.3%)、肌肉酸痛(55.9%)、四肢疼痛(52.2%)、头疼(48.5%)。 2.儿童FSS随着年龄增长呈逐渐增多趋势。本研究发现儿童FSS随着年龄增长表现出逐渐增多的趋势,并且,增长趋势存在性别和焦虑水平上的个体差异。每隔九个月,女生的躯体化症状增长速度比男生高0.41分。初始状态焦虑得分较高的儿童,比低分组儿童的躯体化症状增长速度更快。每隔9个月,初始状态焦虑高分组比低分组增加值多0.44分。 3.儿童FSS与儿童的心理健康状况之间存在密切关系。儿童焦虑、抑郁、社交退缩、多动、攻击违纪行为、刻板行为等心理健康问题均可预测儿童FSS。躯体化症状中的“疼痛与乏力”因子与儿童心理健康之间的关系最为密切。 4.反刍思维是儿童FSS的认知易感性因素。症状反刍、沉思、反省维度以及反刍思维可正向预测儿童FSS水平。在控制了抑郁水平之后,反刍思维对儿童FSS的预测作用依然显著。儿童抑郁对反刍思维与儿童FSS之间的关系有调节作用,即儿童抑郁程度越高,反刍思维与儿童FSS之间的关系越密切。儿童抑郁在反刍思维与躯体化症状之间的部分中介作用亦显著,说明反刍思维对儿童FSS的影响有一部分是通过抑郁实现的。 5.儿童FSS不会导致日常功能的严重损伤。儿童FSS不能预测儿童的日常功能损伤,躯体化症状的出现对儿童和青少年正常生活的影响不大。 6.家庭环境对儿童FSS的发生发展有影响作用。功能性躯体症状存在着母系代际传递性,高躯体化症状水平儿童母亲不仅有较多的情绪问题,而且在敌对、偏执、恐惧等各维度及心理健康总体水平都比低躯体化症状水平儿童的母亲要差。在家庭教养方式方面,父母的过度保护行为和父亲的拒绝行为对儿童FSS有预测作用。母亲的过度保护可以中介母亲和子女之间FSS的传递,父亲家庭教养方式对母系FSS传递无调节作用。 7.班级环境因素对儿童FSS影响较为轻微。在诸多班级环境因素中,只有学业压力可以预测儿童FSS。 8.负性生活事件以及不良的应对方式可以预测儿童FSS。人际关系、学业压力以及受惩罚三类青少年负性生活事件中可以正向预测儿童FSS的发生；对应激事件采取“积极的合理化解释”的方式进行应对,可以减少儿童FSS的发生发展,而“忍耐”、“发泄情绪”的方式应对则会正向预测儿童FSS的发生
[Abstract]:Children with functional somatic symptoms (Functional Somatic, Symptoms, FSS) is also known as "no medical explanation of physical symptoms," is a common complaint in the pediatric clinic, often diagnosed with functional abdominal pain, chronic fatigue syndrome, the diagnosis of severe FSS has the potential to meet the mental illness of somatoform disorders in children. FSS is not only high in clinical samples, somatization symptoms are common in non clinical samples. The community in a community sample of children FSS are relatively minor, does not meet the clinical diagnosis standard, but the forms of children's academic achievement attendance, all have a negative impact on family relations. Physiological disease FSS children usually have no medical equipment can be detected, but with the psychological, social and environmental factors are closely related.
In this study, non clinical primary and secondary school students as samples, through the longitudinal and cross-sectional research design is combined with the use of questionnaire on incidence of children's functional somatic symptoms development trend, influencing factors of psychological mechanism and social environment are discussed. The research is divided into 3 parts, consisting of 9 sub the first part of the revision. To measure the children's FSS tool, and psychometric attributes of research tools used in this study were tested; the second part discusses the development trend of FSS in children, as well as individual psychological attributes, including emotional, cognitive, behavior and other aspects of interaction between children with FSS; the third part to investigate the influence of family, class and negative life events and other environmental factors of FSS in children.
Based on the results of this study, the following conclusions are drawn.
1. children, FSS, are common among non clinical and adolescent groups.
In this study, only 5.6% of the children were in the past 3 months did not feel any physical discomfort, there are 36.5% subjects in the past 3 months to experience the "minor" to "very much" somatic symptoms of.29.4% subjects in the past 3 months if traditional to experience at least 1 body the symptoms of somatization symptoms. The occurrence rate is higher in this study are the feeling of weakness (65.3%), (55.9%), muscle soreness and pain in the limbs (52.2%), headache (48.5%).
2. children's FSS increased with age.
The study found that children with age FSS showed a gradually increasing trend, and there are individual differences in gender and anxiety level on the growth trend. Every nine months, the growth rate of female somatic symptoms is higher than boys 0.41. Initial state anxiety scores higher than the growth of children, children's somatization symptoms group faster. Every 9 months, the initial state anxiety of high scoring groups to increase the value of more than 0.44 points.
There is a close relationship between 3. children's FSS and the mental health of children.
Children's mental health problems such as anxiety, depression, social withdrawal, hyperactivity, aggressive behavior and stereotyped behavior can all predict that the relationship between "FSS." and "mental fatigue" is most closely related to children's somatization symptoms.
4. ruminant thinking is a cognitive susceptibility factor for children's FSS.
Symptom ruminating, meditation, introspection and ruminating can positively predict children's FSS level. After controlling the level of depression, ruminant plays a significant role in predicting FSS in children.
The children's depression has moderating effect on the relationship between rumination in children with FSS, the degree of depression in children is higher, the relationship between rumination and child FSS more closely. The part of the intermediary role between rumination and depression in children's somatization symptoms significantly, explain the effect of rumination on children FSS partly by depression to achieve.
5. children with FSS do not cause serious injury to daily function.
Children's FSS can not predict children's daily functional impairment, and the presence of somatization symptoms has little effect on normal life in children and adolescents.
6. the family environment has an impact on the development of FSS in children.
There are maternal intergenerational transmission and high somatization symptoms in functional somatic symptoms. Mothers of children not only have more emotional problems, but also have dimensions of hostility, paranoia, fear and mental health.
In terms of family rearing styles, parental overprotective behavior and father's refusal behavior have a predictive effect on children's FSS. Mothers' excessive protection can mediate the transmission of FSS between mothers and children, and the way of family rearing has no moderating effect on maternal FSS transmission.
The influence of 7. class environmental factors on children's FSS was slight.
Among the many class environmental factors, only academic pressure can predict children's FSS.
8. negative life events and bad coping styles can predict children's FSS.
The interpersonal relationship, the occurrence of FSS in children can positively predict academic pressure and punished three teenagers in negative life events; take "reasonable positive interpretation" way to deal with the stress events, can reduce the occurrence and development of FSS in children, and "patience", "to vent emotions" approach will be positively predict children FSS

【学位授予单位】：南开大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R749.94

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