Objective
Patients with somatoform disorders could be vulnerable to stressors and have difficulties coping with stress. The aim was to explore what the patients experience as stressful and how they resolve stress in everyday life.
Methods
A cross-sectional retrospective design using 24 semi-structured individual life history interviews. Data-analysis was based on grounded theory.
Results
A major concern in patients was a longing for existential recognition. This influenced the patients' self-confidence, stress appraisals, symptom perceptions, and coping attitudes. Generally, patients had difficulties with self-confidence and self-recognition of bodily sensations, feelings, vulnerability, and needs, which negatively framed their attempts to obtain recognition in social interactions. Experiences of recognition appeared in three different modalities: 1) “existential misrecognition” covered the experience of being met with distrust and disrespect, 2) “uncertain existential recognition” covered experiences of unclear communication and a perception of not being totally recognized, and 3) “successful existential recognition” covered experiences of total respect and understanding. “Misrecognition” and “uncertain recognition” related to decreased self-confidence, avoidant coping behaviours, increased stress, and symptom appraisal; whereas “successful recognition” related to higher self-confidence, active coping behaviours, decreased stress, and symptom appraisal.
Conclusion
Different modalities of existential recognition influenced self-identity and social identity affecting patients' daily stress and symptom appraisals, self-confidence, self-recognition, and coping attitudes. Clinically it seems crucial to improve the patients' ability to communicate concerns, feelings, and needs in social interactions. Better communicative skills and more active coping could reduce the harm the patients experienced by not being recognized and increase the healing potential of successful recognition.
Physical complaints not attributable to conventionally defined diseases are prevalent in all medical settings [1]. When the symptoms become chronic they are diagnosed as somatoform disorders (SD). Patients with SD are often vulnerable to stressors and may find it difficult to cope with stress. However, little is known about the nature, mechanisms, and effects of stress and the exact interaction with coping [2], [3], [4], [5] and [6]. Much research shows how the stress experience could be aggravated by the often troublesome nature of the patients' encounters with the health care system, which are marked by diagnostic confusion, lacking etiology, uncertain illness perceptions, troublesome doctor–patient relationships, and insufficient treatment [7], [8], [9], [10], [11], [12], [13], [14], [15] and [16]. Less is known of stress triggers and management in non-clinical social spheres. Although patients seem to fight to overcome their illnesses and to interact with relatives, friends, colleagues, and health care professionals in order to create meaningful relations and manage a life in distress [17], they experience role constraints, social isolation and de-legitimization processes [18] and [19]. The struggle these patients experience fighting for being recognized as “legitimately ill” makes it especially relevant to bring in Honneth's concept of recognition. Honneth emphasises how the individual's need for social recognition is crucial to identity-formation and development of self-confidence, self-esteem, self-respect, and social- and physical integrity. Human identity depends on mutual recognition involving cognitive respect, social esteem and emotional support in social interactions [20].
Emotions are found to play a central role within the physiological stress response, emphasising the importance of subjective experience [21] and [22]. Further stress is considered to be dependent on the meaning the stimulus holds to the perceiver and the perceiver's coping behaviour [23], [24], [25] and [26]. The cognitive-activation theory of stress points out that when sustained cognitive stress is activated and met by a negative expectancy of coping, the stress-response is maintained [27]. Thus, the experience of stress is highly subjective and dependent on people's experiences of stressors, how they resolve stress, and how they had resolved stress earlier in their lives, which all affect their expected coping possibilities and behaviours. Therefore, the aim of this paper is to explore what patients with SD experience as stressful in their daily life and how they react when confronted with stressful challenges like e.g. misrecognition or lack of recognition in social interactions with significant others.
