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Aggression and Somatic Symptoms: the Role of Emotion Regulation and Distress Tolerance

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Abstract

Background

The current study used a longitudinal design (via three biweekly assessments) to assess the association of state aggression and somatic symptoms and the potential role of trait emotion regulation and distress tolerance in these associations in a sample of 186 college students.

Method

Multilevel modeling was used to examine the influence of state psychological aggression and state physical aggression on somatic symptoms (i.e., within-person variables) and the moderation of emotion regulation and distress tolerance (i.e., between-person variables) on the relation between aggression and somatic symptoms.

Results

The results indicated that state psychological aggression was positively associated with somatic symptoms. Emotion regulation moderated the influence of psychological aggression on somatic symptoms, in which psychological aggression was associated with somatic symptoms among those who reported medium and high levels of difficulties in emotion regulation, but not those with low levels of difficulties in emotion regulation. Distress tolerance did not moderate the association between aggression and somatic symptoms.

Conclusion

The current findings speak to the importance of including the assessment of psychological aggression in health promotion programs and medical visits and identifying emotion regulation as a treatment marker for those with somatic symptoms.

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References

  1. Wyckoff JP. Aggression and emotion: anger, not general negative affect, predicts desire to aggress. Pers Individ Dif. 2016;101:220–6. https://doi.org/10.1016/j.paid.2016.06.001.

    Article  Google Scholar 

  2. Anderson CA, Deuser WE, DeNeve KM. Hot temperatures, hostile affect, hostile cognition, and arousal: tests of a general model of affective aggression. Personal Soc Psychol Bull. 1995;21:434–48. https://doi.org/10.1177/0146167295215002.

    Article  Google Scholar 

  3. Kruk MR, Halász J, Meelis W, Haller J. Fast positive feedback between the adrenocortical stress response and a brain mechanism involved in aggressive behavior. Behav Neurosci. 2004;118:1062–70.

    Article  CAS  Google Scholar 

  4. Christie IC, Friedman BH. Autonomic specificity of discrete emotion and dimensions of affective space: a multivariate approach. Int J Psychophysiol. 2004;51:143–53. https://doi.org/10.1016/j.ijpsycho.2003.08.002.

    Article  PubMed  Google Scholar 

  5. Mendes WB, Major B, McCoy S, Blascovich J. How attributional ambiguity shapes physiological and emotional responses to social rejection and acceptance. J Pers Soc Psychol. 2008;94:278–91. https://doi.org/10.1037/0022-3514.94.2.278.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Garralda ME. Unexplained physical complaints. Child Adolesc Psychiatr Clin N Am. 2010;19:199–209. https://doi.org/10.1016/j.chc.2010.01.002.

    Article  PubMed  Google Scholar 

  7. Clarke DD. Diagnosis and treatment of medically unexplained symptoms and chronic functional syndromes. Fam Syst Health. 2016;34:309–16. https://doi.org/10.1037/fsh0000228.

    Article  PubMed  Google Scholar 

  8. Henningsen P, Zimmermann T, Sattel H. Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review. Psychosom Med. 2003;65:528–33. https://doi.org/10.1097/01.PSY.0000075977.90337.E7.

    Article  PubMed  Google Scholar 

  9. Shorey RC, Temple JR, Febres J, Brasfield H, Sherman AE, Stuart GL. The consequences of perpetrating psychological aggression in dating relationships: a descriptive investigation. J Interpers Violence. 2012;27:2980–98. https://doi.org/10.1177/0886260512441079.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Smith TW, Glazer K, Ruiz JM, Gallo LC. Hostility, anger, aggressiveness, and coronary heart disease: an interpersonal perspective on personality, emotion, and health. J Pers. 2004;72:1217–70. https://doi.org/10.1111/j.1467-6494.2004.00296.x.

    Article  PubMed  Google Scholar 

  11. Taggart P, Boyett MR, Logantha S, Lambiase PD. Anger, emotion, and arrhythmias: from brain to heart. Front Physiol. 2011;2:67. https://doi.org/10.3389/fphys.2011.00067.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Yan LL, Liu K, Matthews KA, Daviglus ML, Ferguson TF, Kiefe CI. Psychosocial factors and risk of hypertension: the coronary artery risk development in young adults (CARDIA) study. JAMA. 2003;290:2138–48. https://doi.org/10.1001/jama.290.16.2138.

    Article  CAS  PubMed  Google Scholar 

  13. Rutledge T, Hogan BE. A quantitative review of prospective evidence linking psychological factors with hypertension development. Psychosom Med. 2002;64:758–66.

    PubMed  Google Scholar 

  14. Tilov B, Semerdzhieva M, Bakova D, Tornyova B, Stoyanov D. Study of the relationship between aggression and chronic diseases (diabetes and hypertension). J Eval Clin Pract. 2016;22:421–4. https://doi.org/10.1111/jep.12502.

    Article  PubMed  Google Scholar 

  15. Fekkes M, Pijpers FIM, Verloove-Vanhorick SP. Bullying behavior and associations with psychosomatic complaints and depression in victims. J Pediatr. 2004;144:17–22. https://doi.org/10.1016/j.jpeds.2003.09.025.

    Article  PubMed  Google Scholar 

  16. Kellner R, Hernandez J, Pathak D. Self-rated inhibited anger, somatization and depression. Psychother Psychosom. 1992;57:102–7. https://doi.org/10.1159/000288582.

    Article  CAS  PubMed  Google Scholar 

  17. Hogan BE, Linden W. Curvilinear relationships of expressed anger and blood pressure in women but not in men: evidence from two samples. J Psychosom Res. 2005;59:97–102. https://doi.org/10.1016/j.jpsychores.2005.02.014.

    Article  PubMed  Google Scholar 

  18. Sheppes G, Suri G, Gross JJ. Emotion regulation and psychopathology. Annu Rev Clin Psychol. 2015;11:379–405. https://doi.org/10.1146/annurev-clinpsy-032814-112739.

    Article  PubMed  Google Scholar 

  19. De Gucht V, Heiser W. Alexithymia and somatisation: a quantitative review of the literature. J Psychosom Res. 2003;54:425–34. https://doi.org/10.1016/S0022-3999(02)00467-1.

    Article  PubMed  Google Scholar 

  20. Lumley MA, Smith JA, Longo DJ. The relationship of alexithymia to pain severity and impairment among patients with chronic myofascial pain: comparisons with self-efficacy, catastrophizing, and depression. J Psychosom Res. 2002;53:823–30. https://doi.org/10.1016/S0022-3999(02)00337-9.

    Article  PubMed  Google Scholar 

  21. Ballespí S, Vives J, Alonso N, et al. To know or not to know? Mentalization as protection from somatic complaints. PLoS One. 2019;14. https://doi.org/10.1371/journal.pone.0215308.

  22. Pennebaker JW. Writing about emotional experiences as a therapeutic process. Psychol Sci. 1997;8:162–6. https://doi.org/10.1111/j.1467-9280.1997.tb00403.x.

    Article  Google Scholar 

  23. Travagin G, Margola D, Revenson TA. How effective are expressive writing interventions for adolescents? A meta-analytic review. Clin Psychol Rev. 2015;36:42–55. https://doi.org/10.1016/j.cpr.2015.01.003.

    Article  PubMed  Google Scholar 

  24. Subic-Wrana C, Beutel ME, Knebel A, Lane RD. Theory of mind and emotional awareness deficits in patients with somatoform disorders. Psychosom Med. 2010;72. https://doi.org/10.1097/PSY.0b013e3181d35e83.

  25. Leyro TM, Zvolensky MJ, Bernstein A. Distress tolerance and psychopathological symptoms and disorders: a review of the empirical literature among adults. Psychol Bull. 2010;136:576–600. https://doi.org/10.1037/a0019712.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hambrook D, Oldershaw A, Rimes K, Schmidt U, Tchanturia K, Treasure J, et al. Emotional expression, self-silencing, and distress tolerance in anorexia nervosa and chronic fatigue syndrome. Br J Clin Psychol. 2011;50:310–25.

    Article  Google Scholar 

  27. Rogers AH, Bakhshaie J, Mayorga NA, et al. Distress tolerance and pain experience among young adults. Psychol Health Med. 2018;23:1231–8.

    Article  Google Scholar 

  28. Reitzel LR, Smith NG, Obasi EM, Forney M, Leventhal AM. Perceived distress tolerance accounts for the covariance between discrimination experiences and anxiety symptoms among sexual minority adults. J Anxiety Disord. 2017;48:22–7. https://doi.org/10.1016/j.janxdis.2016.07.006.

    Article  PubMed  Google Scholar 

  29. Simons JS, Gaher RM. The distress tolerance scale: development and validation of a self-report measure. Motiv Emot. 2005;29:83–102.

    Article  Google Scholar 

  30. Nock MK, Mendes WB. Physiological arousal, distress tolerance, and social problem-solving deficits among adolescent self-injurers. J Consult Clin Psychol. 2008;76:28–38.

    Article  Google Scholar 

  31. Cowan HR. Can a good life be unsatisfying? Within-person dynamics of life satisfaction and psychological well-being in late midlife. Psychol Sci. 2019;30:697–710. https://doi.org/10.1177/0956797619831981.

    Article  PubMed  Google Scholar 

  32. Follingstad DR, Coyne S, Gambone L. A representative measure of psychological aggression and its severity. Violence Vict. 2005;20:25–38.

    Article  Google Scholar 

  33. Murphy CM, Hoover SA. Measuring emotional abuse in dating relationships as a multifactorial construct. Violence Vict. 1999;14:39–53.

    Article  CAS  Google Scholar 

  34. Campbell JC. Health consequences of intimate partner violence. Lancet (London, England). 2002;359:1331–6. https://doi.org/10.1016/S0140-6736(02)08336-8.

    Article  Google Scholar 

  35. van Dijke A, Ford JD. Adult attachment and emotion dysregulation in borderline personality and somatoform disorders. Borderline Personal Disord Emot dysregulation. 2015;2:6. https://doi.org/10.1186/s40479-015-0026-9.

    Article  Google Scholar 

  36. Fischer S, Gaab J, Ehlert U, Nater UM. Prevalence, overlap, and predictors of functional somatic syndromes in a student sample. Int J Behav Med. 2013;20:184–93. https://doi.org/10.1007/s12529-012-9266-x.

    Article  PubMed  Google Scholar 

  37. McNealy KR, Lombardero A. Somatic presentation of mental health concerns, stigma, and mental health treatment engagement among college students. J Am Coll Heal. 2019:1–8. https://doi.org/10.1080/07448481.2019.1590372.

  38. Spink GL, Jorgensen RS, Cristiano S. Cognitive and affective factors predicting daily somatic complaints in college students. J Couns Psychol. 2018;65:110–9. https://doi.org/10.1037/cou0000229.

    Article  PubMed  Google Scholar 

  39. Straus MA, Hamby SL, Boney-Mccoy SUE, Sugarman DB. The revised conflict tactics scales (CTS2): development and preliminary psychometric data. J Fam Issues. 1996;17:283–316. https://doi.org/10.1177/019251396017003001.

    Article  Google Scholar 

  40. Derogatis LR. BSI brief symptom inventory. Administration, scoring, and procedures manual. 4th ed. Minneapolis: National Computer Systems; 1993.

    Google Scholar 

  41. Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. 2004;26:41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94.

    Article  Google Scholar 

  42. Hyde JS. The gender similarities hypothesis. Am Psychol. 2005;60:581–92.

    Article  Google Scholar 

  43. Raudenbush SW, Bryk AS. Hierarchical linear models: applications and data analysis methods. 2nd ed. Thousand Oaks: Sage Publications; 2002.

    Google Scholar 

  44. Snijders T, Berkhof J. Diagnostic checks for multilevel models. In: Leeuw J, Meijer E, editors. Handbook of multilevel analysis. New York: Springer; 2008. p. 139–73.

    Google Scholar 

  45. Hyphantis T, Goulia P, Carvalho AF. Personality traits, defense mechanisms and hostility features associated with somatic symptom severity in both health and disease. J Psychosom Res. 2013;75:362–9. https://doi.org/10.1016/j.jpsychores.2013.08.014.

    Article  PubMed  Google Scholar 

  46. Shorey RC, McNulty JK, Moore TM, Stuart GL. Trait anger and partner-specific anger management moderate the temporal association between alcohol use and dating violence. J Stud Alcohol Drugs. 2017;78:313–8. https://doi.org/10.15288/jsad.2017.78.313.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Zvolensky MJ, Vujanovic AA, Bernstein A, Leyro T. Distress tolerance: theory, measurement, and relations to psychopathology. Curr Dir Psychol Sci. 2010;19:406–10. https://doi.org/10.1177/0963721410388642.

    Article  Google Scholar 

  48. Schmidt NB, Richey JA, Cromer KR, Buckner JD. Discomfort intolerance: evaluation of a potential risk factor for anxiety psychopathology. Behav Ther. 2007;38:247–55. https://doi.org/10.1016/j.beth.2006.08.004.

    Article  PubMed  Google Scholar 

  49. Fjorback LO, Arendt M, Ørnbøl E, et al. Mindfulness therapy for somatization disorder and functional somatic syndromes — randomized trial with one-year follow-up. J Psychosom Res. 2013;74:31–40. https://doi.org/10.1016/j.jpsychores.2012.09.006.

    Article  PubMed  Google Scholar 

  50. Goodman M, Carpenter D, Tang CY, Goldstein KE, Avedon J, Fernandez N, et al. Dialectical behavior therapy alters emotion regulation and amygdala activity in patients with borderline personality disorder. J Psychiatr Res. 2014;57:108–16. https://doi.org/10.1016/j.jpsychires.2014.06.020.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Yang Yang.

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Yang, Y. Aggression and Somatic Symptoms: the Role of Emotion Regulation and Distress Tolerance. Int.J. Behav. Med. 27, 466–474 (2020). https://doi.org/10.1007/s12529-020-09885-6

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