The implicit health-related self-concept in somatoform disorders

Background and objective: Dual-process theories stress the importance of explicit as well as implicit cognitive processes for the development of somatoform disorders (SFDs).(1) In particular, the self-concept has been demonstrated to be a key factor in SFD. Yet, the self-concept in SFDs has been studied only on an explicit but not on an implicit level. Methods: The present study empirically examined the implicit health-related self-concept in SFDs by using the Implicit Association Test (AT). Twenty-two patients with SFDs (according to DSM-IV) and 27 healthy control participants (CG) completed an IAT to assess associations of the self with illness- versus health-related words. Results: (a) Patients with an SFD associated themselves more with illness-related words than patients in the CG, (b) this implicit self-concept was connected to self-reported bodily weakness in the SFD group, and (c) both the explicit and implicit health-related self-concepts were significantly related to the number and severity of bodily symptoms. However, the implicit measure had no incremental predictive value for symptom reports over the explicit self-concept measure. Limitations: Due to the small sample size and the failure to match the SFD group and CG on education, further confirming evidence including other clinical control groups is needed. Conclusion: These findings are consistent with existing dual-process models of SFDs and could be of clinical relevance as they bring into focus implicit cognitive processes that may be targeted more directly for an effective treatment of SFDs. (C) 2013 Elsevier Ltd. All rights reserved.