Somatosensory amplification

Somatosensory amplification (SSA) is a tendency to perceive normal somatic and visceral sensations as being relatively intense, disturbing and noxious. It is a common feature of hypochondriasis and is commonly found with fibromyalgia, major depressive disorder, some anxiety disorders, Asperger syndrome, and alexithymia.[1][2][3][4] One common clinical measure of SSA is the Somatosensory Amplification Scale (SSAS).

The term “amplification of bodily sensations”[5] was coined by Dr. Arthur J. Barsky in 1979[5] to explain why patients suffering from the same medical disease experienced symptoms differently.[6] He described it as “a temporally stable, generalised feature”[6] of hypochondriasis. In the 1980s, the term “somatosensory amplification” (SSA) was first used.[5][6]

It is unclear whether persons with SSA have a truly increased physiological sensitivity to bodily sensations. One study paradoxically found lower levels of SSA in hypochondriacs who reported being constantly aware of their own heartbeats.[3] Tentative electroencephalography results tend to indicate SSA is more likely due to differences in long-latency cognitive processing, rather than objective physiological differences in sensitivity.[7]

It is not currently known whether SSA causes or is caused by any of these conditions, only that they are comorbid conditions. One small study found that, in patients with depression, SSA may be part of the depression (i.e., treating the depression reduced the SSA).[1]

Characteristics

SSA has three main components which are both sensory (“lower-level”) and cognitive-emotional (“higher-level”)[6]: being overly attentive to bodily sensations,[6][8][9][10][11] “focusing on rare and weak body sensations”[6], and "the tendency to appraise ambiguous or vague visceral and somatic sensations as abnormal, pathological, and symptomatic of disease, rather than considering them to be normal.”[8]

The cognitive-emotional process may be the outcome of the sensory process, leading to many criticisms towards this conceptualisation of SSA[6]. According to a study, the first component of SSA may be more accurately described as body awareness, i.e. the tendency to focus on one’s body[5]. SSA leads to bodily sensations being felt as symptoms of disease and to symptoms being felt more intensely[6].

A review conceptualises SSA as an amplification of internal and external stimuli which are perceived as threatening to the body’s integrity. It states that SSA involves an emotional and automatic response to stimuli which leads them to be perceived as threatening, giving rise to worries and anxiety. This process may remain subconscious, making the individual unable to detect and describe it, linking SSA to alexithymia[6].

According to Barsky, sensations which may be amplified are[9]:

“1) normal physiological sensations such as intestinal peristalsis, postural hypotension. and changes in heart rate; 2) benign dysfunctions and trivial, self-limited infirmities such as transient tinnitis, a twitching eyelid, or dry skin; 3) the visceral and somatic concomitants of intense affect, such as the sympathetic arousal accompanying anxiety; and 4) the symptoms of serious nonpsychiatric medical disease and end-organ pathology.”

SSA has features of an enduring trait,[6][8][9][10] but it is also state-like.[8][9]

See also

References

  1. 1 2 Sayar, Kemal; Barsky, Arthur J.; Gulec, Huseyin (2005). "Does Somatosensory Amplification Decrease with Antidepressant Treatment?". Psychosomatics. 46 (4): 340–4. doi:10.1176/appi.psy.46.4.340. PMID 16000677.
  2. ↑ Nakao, Mutsuhiro; Barsky, Arthur J.; Kumano, Hiroaki; Kuboki, Tomifusa (2002). "Relationship Between Somatosensory Amplification and Alexithymia in a Japanese Psychosomatic Clinic". Psychosomatics. 43 (1): 55–60. doi:10.1176/appi.psy.43.1.55. PMID 11927759. INIST:13566951.
  3. 1 2 Mailloux, Jennifer; Brener, Jasper (2002). "Somatosensory amplification and its relationship to heartbeat detection ability". Psychosomatic Medicine. 64 (2): 353–7. doi:10.1097/00006842-200203000-00020. PMID 11914453. S2CID 20107812.
  4. ↑ Muramatsu, Kumiko; Miyaoka, Hitoshi; Muramatsu, Yoshiyuki; Fuse, Katsuya; Yoshimine, Fumitoshi; Kamijima, Kunitoshi; Gejyo, Fumitake; Sakurai, Koji (2002). "The amplification of somatic symptoms in upper respiratory tract infections". General Hospital Psychiatry. 24 (3): 172–5. doi:10.1016/S0163-8343(02)00177-9. PMID 12062142.
  5. 1 2 3 4 Köteles, Ferenc; Doering, Bettina K (2016-07-10). "The many faces of somatosensory amplification: The relative contribution of body awareness, symptom labeling, and anxiety". Journal of Health Psychology. 21 (12): 2903–2911. doi:10.1177/1359105315588216. ISSN 1359-1053.
  6. 1 2 3 4 5 6 7 8 9 10 Köteles, Ferenc; Witthöft, Michael (2017-10-01). "Somatosensory amplification – An old construct from a new perspective". Journal of Psychosomatic Research. 101: 1–9. doi:10.1016/j.jpsychores.2017.07.011. ISSN 0022-3999.
  7. ↑ Nakao, Mutsuhiro; Barsky, Arthur J.; Nishikitani, Mariko; Yano, Eiji; Murata, Katsuyuki (2007). "Somatosensory amplification and its relationship to somatosensory, auditory, and visual evoked and event-related potentials (P300)". Neuroscience Letters. 415 (2): 185–9. doi:10.1016/j.neulet.2007.01.021. PMID 17267120. S2CID 42803595.
  8. 1 2 3 4 Nakao, Mutsuhiro; Barsky, Arthur J. (2007-10-09). "Clinical application of somatosensory amplification in psychosomatic medicine". BioPsychoSocial Medicine. 1 (1): 17. doi:10.1186/1751-0759-1-17. ISSN 1751-0759. PMC 2089063. PMID 17925010.
  9. 1 2 3 4 Barsky, Arthur J. (1992-02-01). "Amplification, Somatization, and the Somatoform Disorders". Psychosomatics. 33 (1): 28–34. doi:10.1016/S0033-3182(92)72018-0. ISSN 0033-3182.
  10. 1 2 Duddu, Venugopal; Isaac, Mohan K.; Chaturvedi, Santosh K. (2006-01-01). "Somatization, somatosensory amplification, attribution styles and illness behaviour: A review". International Review of Psychiatry. 18 (1): 25–33. doi:10.1080/09540260500466790. ISSN 0954-0261. PMID 16451877.
  11. ↑ Martínez, M. Pilar; Belloch, Amparo; Botella, Cristina (1999). "Somatosensory amplification in hypochondriasis and panic disorder". Clinical Psychology & Psychotherapy. 6 (1): 46–53. doi:10.1002/(SICI)1099-0879(199902)6:1<46::AID-CPP183>3.0.CO;2-H. ISSN 1099-0879.
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