{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:55:12Z","timestamp":1787313312154,"version":"build-2736575974"},"reference-count":33,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2018,5,10]],"date-time":"2018-05-10T00:00:00Z","timestamp":1525910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Psychosomatic patients often complain of a variety of somatic symptoms. We sought to clarify the role of clinical predictors of complaints of somatic symptoms. Methods: We enrolled 604 patients visiting a psychosomatic outpatient clinic. The outcome was the total number of somatic symptoms, and the candidate clinical predictors were perceived psychosocial stress, alexithymia, somatosensory amplification, adaptation, anxiety, and depression. All participants completed questionnaires assessing the outcome and the predictors. Results: The average number of reported somatic symptoms was 4.8; the most frequent was fatigue (75.3%), followed by insomnia (56.1%), low-back pain (49.5%), headache (44.7%), and palpitations (43.1%). Multiple regression analysis showed that the total number of somatic symptoms was significantly associated with the degree of perceived psychosocial stress, alexithymia, somatosensory amplification, and depression. Also, structural equation models indicated links between excessive adaptation (via perceived psychosocial stress, alexithymia, and somatosensory amplification) and the total number of somatic symptoms. Conclusion: The results suggested that the association between psychosocial stress and reported somatic symptoms is mediated by alexithymia and somatosensory amplification in psychosomatic patients.<\/jats:p>","DOI":"10.3390\/jcm7050112","type":"journal-article","created":{"date-parts":[[2018,5,11]],"date-time":"2018-05-11T03:42:48Z","timestamp":1526010168000},"page":"112","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Alexithymia and Somatosensory Amplification Link Perceived Psychosocial Stress and Somatic Symptoms in Outpatients with Psychosomatic Illness"],"prefix":"10.3390","volume":"7","author":[{"given":"Mutsuhiro","family":"Nakao","sequence":"first","affiliation":[{"name":"Department of Psychosomatic Medicine, School of Medicine, International University of Health and Welfare, Narita, Chiba 286-8686, Japan"},{"name":"Department of Psychosomatic Medicine, Teikyo University Hospital, Tokyo 173-8605, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeaki","family":"Takeuchi","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine, Teikyo University Hospital, Tokyo 173-8605, Japan"},{"name":"Department of Psychosomatic Medicine, School of Medicine, Toho University Hospital, Tokyo 143-8541, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,5,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13030-017-0088-6","article-title":"Current state and future prospects for psychosomatic medicine in Japan","volume":"11","author":"Murakami","year":"2017","journal-title":"Biopsychosoc. Med."},{"key":"ref_2","unstructured":"The Committee on Education and Training of the Japanese Society of Psychosomatic Medicine (1991). An updated treatment guideline for psychosomatic medicine. Jpn. J. Psychosom. Med., 31, 537\u2013576. (In Japanese)."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1159\/000286529","article-title":"The prevalence of alexithymia characteristics in psychosomatic patients","volume":"22","author":"Sifneos","year":"1973","journal-title":"Psychother. Psychosom."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/0022-3999(94)90006-X","article-title":"The twenty-item Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure","volume":"38","author":"Bagby","year":"1994","journal-title":"J. Psychosom. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/S0022-3999(02)00467-1","article-title":"Alexithymia and somatisation: Quantitative review of the literature","volume":"54","author":"Heiser","year":"2003","journal-title":"Psychosom. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"261","DOI":"10.3389\/fpsyt.2017.00261","article-title":"Moderating effects of alexithymia on associations between the therapeutic alliance and the outcome of brief psychodynamic\u2013interpersonal psychotherapy for multisomatoform disorder","volume":"8","author":"Probst","year":"2017","journal-title":"Front. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"910","DOI":"10.7326\/0003-4819-130-11-199906010-00016","article-title":"Functional somatic syndromes","volume":"130","author":"Barsky","year":"1999","journal-title":"Ann. Intern. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/0022-3956(90)90004-A","article-title":"The somatosensory amplification scale and its relationship to hypochondriasis","volume":"24","author":"Barsky","year":"1990","journal-title":"J. Psychiatr. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1176\/appi.psy.43.1.55","article-title":"Relationship between somatosensory amplification and alexithymia in a Japanese psychosomatic clinic","volume":"43","author":"Nakao","year":"2002","journal-title":"Psychosomatics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1007\/s40279-017-0855-3","article-title":"The general adaptation syndrome: A foundation for the concept of periodization","volume":"48","author":"Cunanan","year":"2018","journal-title":"Sports Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1891\/1061-3749.24.3.477","article-title":"Predict moral distress using workplace stress, stress of conscience mediated by coping using Roy adaptation model: A path analysis","volume":"24","author":"Alkrisat","year":"2016","journal-title":"J. Nurs. Meas."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1159\/000354182","article-title":"Definition of psychosomatic medicine and the applicability of DSM-IV-TR to outpatients visiting a Japanese psychosomatic clinic","volume":"83","author":"Nakao","year":"2014","journal-title":"Psychother. Psychosom."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"30","DOI":"10.5414\/CPP45030","article-title":"Prescription of benzodiazepine in comparison with SSRI and SNRI for outpatients attending a Japanese university hospital","volume":"45","author":"Nakao","year":"2007","journal-title":"Int. J. Clin. Pharmacol. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1007\/s12529-015-9520-0","article-title":"Clinical characteristics and referral patterns of outpatients visiting a Japanese psychosomatic medicine clinic","volume":"23","author":"Nakao","year":"2016","journal-title":"Int. J. Behav. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1159\/000012258","article-title":"Assessment of patients by DSM-III-R and DSM-IV in a Japanese psychosomatic clinic","volume":"67","author":"Nakao","year":"1998","journal-title":"Psychother. Psychosom."},{"key":"ref_16","unstructured":"American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Press. [4th ed.]. Text Revision."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1001\/archfami.3.9.774","article-title":"Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment","volume":"3","author":"Kroenke","year":"1994","journal-title":"Arch. Fam. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1097\/00006842-199803000-00006","article-title":"Gender differences in the reporting of physical and somatoform symptoms","volume":"60","author":"Kroenke","year":"1998","journal-title":"Psychosom. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1159\/000056225","article-title":"Anxiety is a good indicator for somatic symptom reduction through a behavioral medicine intervention in a mind\/body medicine clinic","volume":"70","author":"Nakao","year":"2001","journal-title":"Psychother. Psychosom."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1080\/08964280109595764","article-title":"Somatization and symptom reduction through a behavioral medicine intervention in a mind\/body medicine clinic","volume":"26","author":"Nakao","year":"2001","journal-title":"Behav. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"787","DOI":"10.2466\/pr0.1997.80.3.787","article-title":"Is alexithymia a culture-bound construct? Validity and reliability of the Japanese versions of the 20-item Toronto Alexithymia Scale and modified Beth Israel Hospital Psychosomatic Questionnaire","volume":"80","author":"Fukunishi","year":"1997","journal-title":"Psychol. Rep."},{"key":"ref_22","first-page":"539","article-title":"Reliability and validity of the Japanese version of Somatosensory Amplification Scale: Clinical application to psychosomatic illness","volume":"41","author":"Nakao","year":"2001","journal-title":"Jpn. J. Psychosom. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1111\/j.1600-0447.1999.tb07245.x","article-title":"Assessment of ego state in anorexia nervosa and bulimia nervosa","volume":"99","author":"Nakao","year":"1999","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_24","first-page":"15","article-title":"Transactional analysis theory: The basics","volume":"33","author":"Solomon","year":"2003","journal-title":"Trans. Anal. J."},{"key":"ref_25","unstructured":"McNair, D.M., Lorr, M., and Droppleman, L.F. (1971). Profile of Mood States, Educational and Industrial Testing Service."},{"key":"ref_26","first-page":"913","article-title":"Production of the Japanese edition of Profile of Mood State (POMS): Assessment of reliability and validity","volume":"37","author":"Yokoyama","year":"1990","journal-title":"Jpn. J. Public Health"},{"key":"ref_27","first-page":"55","article-title":"Relationship between alexithymia and coping strategies in patients with somatoform disorder","volume":"10","author":"Tominaga","year":"2014","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"99","DOI":"10.5152\/npa.2016.12385","article-title":"Alexithymia and somatization in depressed patients: The role of the type of somatic symptom attribution","volume":"54","author":"Taycan","year":"2017","journal-title":"Arch. Neuropsychiatr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1111\/j.1600-0722.2004.00160.x","article-title":"Collinearity in linear regression is a serious problem in oral health research","volume":"112","author":"Tu","year":"2004","journal-title":"Eur. J. Oral. Sci."},{"key":"ref_30","first-page":"265","article-title":"The relaxation response: Your inborn capacity to counteract the harmful effects of stress","volume":"68","author":"Benson","year":"1981","journal-title":"J. Fla. Med. Assoc."},{"key":"ref_31","unstructured":"Kline, R. (2005). Principles and Practice of Structural Equation Modeling, The Guilford Press. [2nd ed.]."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s11920-010-0112-z","article-title":"Psychosomatic medicine is a comprehensive field, not a synonym for consultation liaison psychiatry","volume":"12","author":"Fava","year":"2010","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1751-0759-1-17","article-title":"Clinical application of somatosensory amplification in psychosomatic medicine","volume":"1","author":"Nakao","year":"2007","journal-title":"BioPsychoSoc. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/7\/5\/112\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:04:07Z","timestamp":1760195047000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/7\/5\/112"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5,10]]},"references-count":33,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2018,5]]}},"alternative-id":["jcm7050112"],"URL":"https:\/\/doi.org\/10.3390\/jcm7050112","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,5,10]]}}}