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RORSCHACH ANATOMY RESPONSES AND

SOMATIC COMPLAINTS

BY

ROBERT J. COHEN

A THESIS
Submitted to the College of Science and Arts
Michigan State University of Agriculture and
Applied Science in partial fulfillmnt of
the requirements for the degree of

MASTER OF ARTS

Department of Psychology

1959

i:

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ACKNOWLEDGMENT

I wish to express my gratitude to Dr. Gerald F. King for his
active participation and assistance in the different phases of
this study. In this manner, he contributed toward making this a
meaningful experience for me. I would like to thank Drs. Albert
I. Rabin and Joseph Reyher for serving on my oral examination
committee. I appreciate the help given by the following psychol-
ogy graduate students by way of offering critical suggestions
and/or classifying data: Messrs. Paul Berg, Harold Davis, Jacques

Levy; and.Melvin Weinberg.

Robert J. Cohen

RORSCHACH ANATOMY RESPONSES AND

SOMATIC COMPLAINTS

BY

ROBERT J. COHEN

AN ABSTRACT
submitted to the College of Science and Arts
Michigan State University of Agriculture and
Applied Science in partial fulfillment of
the requirements for the degree of

MASTER OF ARTS

Department of Psychology

1959

RORSCHACH ANATOMY RESPONSES AND SOMATIC CORPLAINTS

Robert J. Cohen

(Gerald F. King, Ph.D., Major Professor)

ABSTRACT

Designed as a study of the concurrent validity of Rorschach
anatomy (Ag) responses, this study investigated the commonly
posited relationship between An responses and hypochondriacal
symptoms (somatic complaints).

A controlled interview, the Rorschach, and the wechsler-
Bellevue Verbal Scale (Form I) were administered to 100 recently
hospitalized neuropsychiatric patients, all of whom were males.
The Rorschach protocols were scored for number of general Ag re-
sponses, skeletal anatomy (ngég , and visceral anatomy (23:59)
responses. Responses to the interview were classified for somatic
complaints in accordance with the following schema: presence or
absence of somatic complaints, multiple somatic complaints, focal
somatic complaints, and diffuse somatic complaints, plus central-
ity of the somatic component in the patient's over-all problemo
Acceptable levels of reliability were obtained for Ag responses
(inter-rater) and somatic complaints (inter-rater and interview-
reinterview).

High general _A_n_, M, and M groups were formed and each
compared with a control Noﬁég group on the classifications used for
somatic complaints. With age, IQ, and number of Rorschach responses

controlled, tests of significance with chi square revealed no

iv

reliable differences in any of the comparisons. Consistent trends
in favor of the high anatomy groups were not even obtained.

The results were viewed as adding to the large number of Ror-
schach studies reporting negative findings for standard interpreta-
tions, a situation which seems to call for explorations with new
Rorschach interpretations. In regard to the relationship between
A_n_ responses and hypochondriacal symptoms, some recent conceptual
and empirical contributions suggest that future research in this
area should take into consideration an additional variable, level

of hostile drive strength.

’2
Approved ,SanQ/a

Major Pro essor

THO/Jug Mb“?

Date

 

Table of Contents
Page
I. Introduction... ..... .... ......... ........ ..... 1
II. Methodology.................... .......... ..... 4
Analysis of Somatic Complaints............ 5
Analysis of An ReSponses.................. 7
Reliability............................... 7
III. Results....................................... 10
High-An Group vs. No-Ag Group............. 10
High-ggfgn Group vs. No—An Group.......... 13
High-Elﬁgn Group vs. Noﬁgn Group.......... 13
Statistical Summary....... ..... ..... ..... . 13
IV. Discussion.................................... 19
V. Summary....................................... 22

VI. References.................................... 24

Appendices........................................ 25

Appendix A (Analysis of Somatic Complaints:
Instructions to Raters)

Appendix B (Classification of Somatic
Complaints: Reliability)

Table

Table

Table

Table

Table

Table

Table

List of Tables

Page
Comparison of the Rorschach Anatomy (Ag)
Groups on Age, IQ, and Number of Rorschach
Responses (3) ................................ 8
Comparison of the High-An and No-An Groups
on Somatic Complaints ........................ 11
Comparison of the Highﬁgg and No-An Groups
on Centrality of the Somatic Component in
Overall Problem .............................. 12
Comparison of the High—nggn and No-gg
Groups on Somatic Complaints ................. 14

Comparison of the Higheggjgn and Noﬁgn
Groups on Centrality of the Somatic Component
in Overall Problem ........................... 15

Comparison of the Highjyijgn and Noﬁgn Groups
on Somatic Complaints....... ........ . ........ 16

Comparison of the High-ylrgn and Nojgn
Groups on Centrality of the Somatic Component
in Overall Problem ........................... 17

ii

I. Introduction

In Psychodiagnostics, Rorschach indicates that "in
subjects who are not physicians" anatomy (An) responses
represent ”either a complex impelling the subject to try
to give the impression of intelligence or a tendency to
hypochondriacal rumination, or to both" (9, pp. 198-199).
Along with Klopfer (4), Beck (1) shares the belief that
anatomy associations indicate an excessive concern with
health. Rapaport (7), while accepting feelings of
intellectual adequacy and bodily preoccupations as
meanings of An, suggests that responses stem from two
additional sources, namely, generalized anxiety and
extreme blocking.

In making interpretations of Ag responses, most
clinicians take into consideration certain qualitative
differences. Rapaport (7) distinguishes between skeletal
(§k) and visceral (2;) Ag, ascribing different meanings to
each type. Phillips and Smith (6) include the following
‘under Ag reSponses: general anatomy, x—ray, bony anatomy,
‘Visceral anatomy, and gums and teeth. They say that
'“persons with psychosomatic disorders....produce bony

anatomy contents beyond expectancy" (6, p. 127).

It has been generally acknowledged that inferring
hypochondriacal traits from a Rorschach protocol is more
complex than merely noting the presence of An_(4, 5, 6).
Mons outlines the problem in the following manner:

The response must therefore be examined and
assessed in relationship to (several) factors.
Their relative number, their special character -
e.g., whether scientific or merely morbid - and
their relation to colour will help decide in each
instance whether one is dealing with a justifiable
association or with a hypochondriacal tendency.

The anatomy responses must therefore always
be viewed with some suspicion, and only be dis-
carded as ‘normal' when their number and quality
can be logically accounted for by a 'normal'
thought content (5, p. 81, 82).

The current investigator is aware of only one
empirical study of the relationship between A3 and
Zhypochondriasis. Rav (8) obtained, by group adminis-
'tration, Rorschach protocols from a large sample of
linselected normal males. Instead of using an outside
<2riterion of hypochondriasis, he hypothesized that the
rnxmber of Ag responses should be correlated with other
Eiigns on the Rorschach indicative of hypochondriasis,
(e.g., high 2Q, high 5, etc. The results failed to
snipport any of the predictions. While one might disagree
‘With.some of his predictions, the study can be viewed as

a test of the Rorschach's internal interpretative con-

sistency.

Although a review of Rorschach literature reveals
differences of opinion regarding the interpretations
of Ag responses, there is general agreement concerning
one interpretation, i.e., investigators believe that it
taps something called hypochondriasis, somatic pre-
occupation, or concern with health. It is surprising
that this basic interpretation has received so little
controlled empirical attention. The present research
represents an attempt to test the concurrent validity
of An responses, using reported somatic complaints as
an outside criterion. While a quantitative analysis is
employed, the study takes into consideration the type

of Ag responses and the nature of the somatic complaints.

II. Methodology

A study done by King (3) contributed the raw data
employed in the present investigation. Thus, it is
desirable that a brief summary of the methodology he used
be presented here. For a more detailed account of this
research design, the reader is referred to the original
source.

In his experiment, a controlled interview, the
Rorschach Test, and the Wechsler-Bellevue Verbal Scale
(Form I) were administered to 100 carefully screened,
recently admitted male neuropsychiatric patients at the
Fort Custer Veterans Administration Hospital, Battle Creek,
Michigan. The controlled interview was used to obtain data
to test certain hypotheses concerning the neuropsychiatric
patient's orientation toward his illness. The first section
of the interview focused on the patient's conception of his
problem. A copy of the outline of this section follows:

Introduction. As a patient here in the hospital,
the hospital staff is interested in you and your
problem. If we are to help you, we must get certain
information about you. I am going to ask you some
questions. I would like you to listen carefully and
answer the questions the best you can. Think each
question over before answering. I would appreciate

your talking slowly because I want to write down as
much as I can of what you say.

1. (Nature of the Problem) Like every person
who comes to this hospital, there is a reason. We
will call this your problem. Now, first of all, I
'would like you to tell me in your own words what
your problem is.

(If hesitant, the subject should be encouraged.

The question can be repeated and paraphrased. If
paraphrasing is necessary, only minor variations
should be used. If the subject's account of his
problem is brief and confined to such general
descriptive terms as tense, nervous, emotionally
upset, etc., more information should be obtained
by asking the general question: "What are you
tense (nervous, etc.) about?" At the end of the
subject's account, he should be asked: "Anything
else?")

Every other subject of the first 50 was reinterviewed
six to eight days later by another person. The reinterview
teas essentially a repetition of the interview except for

the introduction.

Ihnalysis g; Somatic Complaints

The 100 interview protocols were scored for the
prresence or absence of a) somatic complaints, b) multi-
ple somatic complaints, c) focal somatic complaints, d)
cij.ffuse somatic complaints, as well as e) centrality of
Somatic component in the patient's overall problem. The
fOllowing is a copy of the definitions of these categories
that were included in the instructions1 to the judges:

Presence 9; somatic complaints. Somatic complaints

are defined as any verbalization, spontaneous or
otherwise, indicating some degree of discomfort and/or

*

lTTue complete instructions are available in Appendix A.

malfunctioning in any bodily organ or locus

(e.g., stomach trouble, headaches, backaches) as
well as any overall disturbance in bodily status
(e.g., fatigue, malnutrition, loss of weight).
Various responses symptomatic of anxiety (e.g.,
nerves, jumpiness, tension) are not to be classi—
fied as somatic complaints unless they are in some
way explicitly connected with bodily disturbances.
Examples of the latter would be the following.

(I worry so much that my head aches. I become
very jumpy, even my muscles twitch. This tension
and restlessness gets so bad that I get a sinking
feeling in my stomach.) With this frame of refer-
ence, it is still difficult to make decisions about
certain symptoms as to whether they are somatic or
not, e.g., sleeplessness (insomnia) and loss of
appetite. Symptoms of this nature are to be
classified as somatic since they represent dis-
turbances in cyclical bodily activities.

Multiple somatic complaints. The criteria for
multiple somatic complaints is two or more somatic
complaints.

Focal somatic complaints. Focal somatic complaints
are ones in which the disturbances are localized in
Specific organs or regions of the body (e.g., stomach
aches, pain in arm muscles).

Diffuse somatic complaints. The disturbances tend
to encompass the entire body in diffuse somatic
complaints, with no particular focus or localization
(e.g., run-down, tired). '

Classifications for centrality 9f somatic component
_ig overall problem. Central: The patient gives the
major emphasis to somatic factors (regardless of type)
in his account of his problem. Peripheral: The
patient includes somatic complaints in his account of
his problem, but they are secondary in importance to
other factors non-somatic in nature. Absent: The
patient does not report somatic complaints in his
account of his problem.

 

 

Analysis pf Ag Responses

 

In this study, the 100 Rorschach protocols were
scored for the number of general_§p, Skfgp, and_y;5Ap
responses. The criteria for forming the Rorschach anatomy
groups were two or more Ag responses for the High-5p group,
two or more §krgp responses for the High-gkfgp group, one
or more Viegp responses for the Highﬁyiﬁgp group, and no
“Ag responses for the Nojgp group, which yielded prelimi-
nary groups of 34, 26, 23 and 42 Se, respectively. The
distribution of these groups in terms of age, Verbal IQ,
and number of Rorschach responses (3) were examined for
the purpose of equating the groups on these variables. Table
1 gives the results of equating the groups on age, IQ, and

.3, along with the final N for each group.2

Reliability

 

The author scored all of the Rorschach protocols for
the number of Ag, Skfﬁp, and_yijgp responses, according
to Beck's (1) definition of Ag and dictionary (10) defi-
nitions of visceral and skeletal. Using the same criteria,
another judge independently scored every other protocol.
There was 94 per cent agreement for Ag, 90 per cent agree—

ment for §Eféﬂo and 88 per cent agreement for ygsgp.

 

2The groups were equated by discarding gs with extreme

scores .

 

 

 

 

 

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The interview protocols were equally divided into
two samples of 50, and each sample was rated in accordance
with the definitions of the categories of somatic com-
plaints by three independent judges. The only common
judge in the two samples was the author. The mean inter-
rater reliability for the five judges on the interview
categories was as follows: 97 per cent for somatic com-
plaints, 95 per cent for multiple somatic complaints, 95
per cent for focal somatic complaints, 86 per cent for
diffuse somatic complaints, and 87 per cent for centrality
of somatic component in overall problem. More details
concerning the obtained reliabilities can be found in
Appendix B.

One of the judges scored the 25 reinterview pro-
tocols for the five categories of somatic complaints.

The following interview-reinterview agreement was obtained:
96 per cent agreement for somatic complaints, 96 per cent
agreement for multiple somatic complaints, 100 per cent
agreement for focal somatic complaints, 84 per cent agree-
ment for diffuse somatic complaints, and 80 per cent
agreement for centrality of somatic component in overall

problem.

10

III. Results

A preliminary analysis revealed that 59 of the 100
.Ss were judged to have somatic complaints. Of these, 38
had multiple somatic complaints, 42 had focal somatic
complaints, and 42 had diffuse somatic complaints. Twenty-
four §s reported somatic complaints of central importance
in the overall problem, while the somatic complaints of
the remaining 35 Se were classified as peripheral.

In analyzing the data, each of the Rorschach anatomy
groups was compared with the Noagp group for the five
classifications of somatic complaints. Contingency
tables were constructed, and significance was tested by

chi square.

ﬂighsgp Group Mg. Npﬁgp Group

Tables 2 and 3 provide a comparison of the High-Ag
and No—Ap groups for the categories of somatic complaints.
As can be seen, none of the differences were statistically
significant. The data in Table 2 indicate that more Se
in the Highsgp group reported the presence of somatic
complaints, multiple somatic complaints, and diffuse
somatic complaints than did SS in the No-Ap group. In
Table 3, it is seen that the Highféﬂ group gave more cen-

‘trality to somatic components in the overall problem than

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muchHmEou mucamadsou mpcamadEOU mpcamamEoo
UHumEom UHmeOm oHumEOm UHumEom
mmsmmao swoon washbass

 

 

mucamadeoo oaumﬁom co

masonw mmroz cam mﬂrnmam esp mo GOmHndeoo

N dance

12

Tﬁﬂe3

Comparison of the High-Ag and No-Ap Groups
on Centrality of the Somatic Component in
Overall Problem

 

 

 

Groups Central Peripheral Absent
Highﬁgp 9 12 ll
Noﬁgp 6 10 16

 

Chi square = 1.704

13

the No-Ap group. However, all of the trends are minor in

nature.

mgr-area ___Gro_u2 ye- Ale-Ar; seam

Tables 4 and 5 provide a comparison of the High-Skagp
and Noagp groups for the categories of somatic complaints.
It can be readily seen that none of the chi squares were
statistically significant. An examination of Table 4
reveals that there are not even consistent trends in favor
of the High-Skrgp group. Table 5 shows that the High-Skjgp
group placed slightly more emphasis on the centrality of

the somatic component than did the No-Ap group.

giqggyiegp Group ys. Ngﬁgp Group

A comparison of the Highsygagp and No-Ap_groups, on
somatic complaints is seen in Tables 6 and 7. Again, the
pattern of cell frequencies reveals little difference or
consistent trends between the groups. All chi squares

were low and not significant.

Spatistical Summary

The results offer a fairly simple summary: none of
the RorSChaCh Ag groups reported significantly more somatic
complaints of any type or gave more emphasis to somatic

complaints than the control No—Ap group. Consistent trends

l4

 

 

 

 

 

 

 

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UHumEOm oaumeom UHumEOm UHumEOm
mmsmmao Hmoom meanness

 

 

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mdsoaw mwroz Ucm mﬂLMWIanm mnu mo cowenmmEoo

ﬂ mHQME

15

Table 5

Comparison of the High-Skrgp and Noeﬁp Groups
on Centrality of the Somatic Component in
Overall Problem

 

 

 

Groups Central _Peripheral Absent
Highﬁgkagp 7 7 8
No-An 6 10 16

 

Chi square 2 1.572

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mucamamEou muchHQEOU muCHMHQEOU mucamameoo
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17

Table 7

Comparison of the Highﬁylegp and No—Ap Groups
on Centrality of the Somatic Component in
Overall Problem

 

 

 

Groups Central Peripheral Absent
Highayiﬁgp 7 7 6
No-An 6 10 16

 

Chi square I 2.498

18

in favor of the Ag groups were not even obtained. It

should be pointed out, however, that the statistical tests
with the three Ap_groups (High-Ag, High-Skrgp, and High—
.yiﬁép) were not independent, as the three groups showed
considerable overlap in terms of common gs. Derived from
chi squares computed from median tests3, the phi coefficients

among the three types of Ag reSponses were as follows: Ap

vs. ghféﬂ, .89; Ag vs. Zifﬂﬂ, .50; and Skrgp vs. yiﬁgﬂ, .36.

w

Chi squares: Ag vs. §Eﬂéﬂ, 79.6; Ag vs. yiﬁéﬂ, 25.7;
and §Eﬁﬂ£ vs. ylfﬂﬂ, 13.2 (all significant beyond the
.01 level of confidence).

19

IV. Discussion

In considering negative results, the immediate
question usually arises as to what is the most adequate
interpretation. Should the conclusion be that the results
do g2; lend support to the notion that number of Rorschach
Ag responses is related to hypochondriacal complaints? Or,
would it be more appropriate to say that the results are
inconclusive due to certain methodological deficiencies?

Let us turn to the methodology employed in this research.
The results cannot be attributed to differences in age, IQ,
or number of Rorschach responses as the groups were equated
for these variables. There is the matter of the controlled
interview, a crucial aspect of the methodology. This instru-
ment yielded fairly good inter—rater and interview-reinterview
reliability. It should also be pointed out that the same
controlled interview yielded positive results in another
Rorschach study (3). What remains are the gs and the setting
of the study, "functional" neuropsychiatric patients in a
neuropsychiatric hospital. It is granted that it would be
desirable to try a variation of this study with another
population (e.g., general hospital patients); but if the

EXDsited relationship between Ag responses and hypochondriasis

20

is a general one, it should have held up in the present
study. The most appropriate interpretation then seems to
be that the results do not support a relationship between
number of Ag responses and hypochondriacal complaints.

This study contributes to the growing reservoir of
negative research results for standard Rorschach inter-
pretations. It would appear that the situation calls for
explorations with new interpretations for some of the
Rorschach variables. King's (3) study of human movement
(g) indicates that new conceptual schemas can lead to
fruitful results.

In regard to Ag responses, Phillips and Smith have
recently offered the following different interpretation
of this variable: ”Anatomy content reflects a sensitivity
to, and concern with, the expression of destructive
impulses. Paradoxically, those individuals who act out
their destructive impulses do not develop anatomy content...”
(6, p. 123). Using this frame of reference, Wolf (11) com-
pared a group of patients who had histories of hostile acting
out with a group classified as "non-actors," finding that
Ag reSponses were a significant factor only when hostile
drive level, as derived from Rorschach content, was taken

into consideration. He offers the interpretation that Ag

responses in the presence of high hostile drive operate as

21

a control factor which channels these impulses into somatiza-
tion and other substitutive activities. Further, Ag responses
produced in individuals with low hostile drive probably have
some other meaning.

Wolf's findings and interpretations indicate that level
of hostile drive should be taken into consideration in any
future study of the relationship between Ag responses and
hypochondriacal complaints. A possible procedure for the
present data would be to divide the As, on the basis of
Rorschach content, into two groups, one with high and one with
low hostile drive strength. The suggestion is that Ag responses
would be related to hypochondriacal symptoms in the high

group but not in the low one.

22

V. Summary

Designed as a study of the concurrent validity of
Rorschach anatomy (Ag) responses, this study investigated
the commonly posited relationship between Ag responses and
hypochondriacal symptoms.

A controlled interview, the Rorschach, and the Wechsler-
Bellevue Verbal Scale (Form I) were administered to 100
recently hospitalized neuropsychiatric patients (all males).
The Rorschach protocols were scored for number of general
‘Ag responses, skeletal anatomy (ggﬁAg), and visceral
anatomy (ylfAﬂ) responses. Responses to the interview were
classified for somatic complaints in accordance with the
following achema: presence or absence of somatic complaints,
multiple somatic complaints, focal somatic complaints, and
diffuse somatic complaints, plus centrality of the somatic
component in the patient's overall problem. Acceptable
levels of reliability were obtained for Ag responses (inter—
rater) and somatic complaints (inter-rater and interview-
reinterview).

High general Ag, ﬁg-Ag, and ygﬁAg groups were formed
and each compared with a control NoﬁAg group on the

classifications used for somatic complaints. With age, IQ,

23

and number of Rorschach responses controlled, tests of
significance with chi square revealed no reliable differences
in any of the comparisons. Consistent trends in favor of
the high anatomy groups were not even obtained.

The results were viewed as adding to the large number
of Rorschach studies reporting negative results for standard
interpretations, a situation which seems to call for explora-
tions with new Rorschach interpretations. In regard to the
relationship between Ag responses and hypochondriacal symptoms,
some recent conceptual and empirical contributions suggest
that future research in this area should take into con-
sideration an additional variable, level of hostile drive

strength.

10.

ll.

24

VI. References

Beck, S. J. Rorschach's Test. Vol. II. .5 variety
.9: personality pictures. New York: Grune and
Stratton, 1946.

Beck, S. J. Rorschach's Test. Vol. III. Advances
Ag interpretation. New York: Grune and Stratton,
1952.

 

King, G. F. A theoretical and experimental considera-
tion of the Rorschach human movement response.
Psychol. Monogr., 1958, 72, No. 5 (Whole No. 458).

Klopfer, B., Ainsworth, Mary D., Klopfer, W. G., and
Holt, R. R. Developments Ag the Rorschach Technique.
Yonkers: World Book Co., 1954.

 

Mons, W. Principles and practice pg the Rorschach
Personality Test. London: Faber and Faber, 1947.

 

 

Phillips, L., and Smith, J. G. Rorschach interpretation:
Advanced technique. New York: Grune and Stratton,
1953.

 

 

Rapaport, D. Diagnostic psychological testing. Vol. II.
The theory, statistical evaluation, and diagnostic
application p§_g.batte§y p§_tests. Chicago: Year
Book Publishers, 1946.

Rav, J. Anatomy responses in the Rorschach Test. .g.
proj. Tech., 1951, 15, 433—443.

Rorschach, H. Psychodiagnostics: A diagnostic test
based pg perception. (Trans, by P. Lemkau and B.
Kronenberg) New York: Grune and Stratton, 1942.

 

 

webster's New Collegiate Dictionary. Springfield:
G. and C. Merriam, 1951.

Wolf, I. Hostile acting out and Rorschach Test content.
_g.gproj. Tech., 1957, 21, 414-419.

 

Appendix A

25

26

Analysis p§_Somatic Complaints

 

Instructions 39 Raters

You are asked to read carefully the following proto—
cols and make certain judgments or ratings. The protocols
represent close to verbatim recordings of the responses of
hospitalized neuropsychiatric patients when they were asked
to describe their problems (reasons for being in the hospi-
tal). Thus, each patient has given his version of his
illness.

Presence of somatic complaints. Score each protocol

 

for the presence or absence of somatic complaints. If a
somatic complaint (or complaints) is included as part of
the problem by the patient, record A for present in the
appropriate column of the Rating Sheet. If somatic com-
plaints are absent, record an A. Use the following-
definition of somatic complaints as a frame of reference
in making the judgments:

Somatic complaints are defined as any verbalization,
spontaneous or otherwise, indicating some degree of dis-
comfort and/or malfunctioning in any bodily organ or locus
(e.g., stomach trouble, headaches, backaches) as well as

any overall disturbance in bodily status (e.g., fatigue,
malnutrition, loss of weight). Various responses symptomatic
of anxiety (e.g., nerves, jumpiness, tension) are not to be
classified as somatic complaints unless they are in some way
explicitly connected with bodily disturbances. Examples of the
latter would be the following. (I worry so much that my head
aches. I become very jumpy, even my muscles twitch. This
tension and restlessness gets so bad that I get a sinking

27

feeling in my stomach.) With this frame of reference,

it is still difficult to make decisions about certain
symptoms as to whether they are somatic or not, e.g.,
sleeplessness (insomnia) and loss of appetite. Symptoms
of this nature are to be classified as somatic since they
represent disturbances in cyclical bodily activities.

Multiple somatic complaints. The criterion for multiple

 

somatic complaints is two or more somatic complaints. Score
each protocol for the presence (2) or absence (A) of multi—
ple somatic complaints in the appropriate column of the
Rating Sheet.

Focal somatic complaints. Focal somatic complaints are

 

ones in which the disturbances are localized in specific
organs or regions of the body (e.g., stomach aches, pain in
arm muscles). Consider only focal somatic complaints and
score each protocol either gior A.

Diffuse somatic complaints. The disturbances tend to

 

encompass the entire body in diffuse somatic complaints,
with no particular focus or localization (e.g., run-down,
tired). Consider only diffuse somatic complaints and
record either A or‘A for each protocol.

Centrality p; somatic component Ag overall problem.
Now evaluate the importance of any somatic component in the
patient's overall version of his problem. You are to judge
how much emphasis is given somatic factors by the patient in

relation to other non—somatic factors. Use the following

28

categories in rating each protocol.
Central (g): The patient gives the major
emphasis to somatic factors (regardless
of type) in his account of his problem.

Peripheral (g): The patient includes somatic

 

complaints in his account of his problem,
but they are secondary in importance to
other factors non-Somatic in nature.

Absent (A): The patient does g2; report somatic

complaints in his account of his problem.

Appendix B

29

30

Classification of Somatic Complaints: Reliability

First 50 Interview Protocols

Somatic Complaints

 

Judges Percentage of Agreement
A vs. B 94
A vs. C 98
B vs. C 96

Multiple Somatic Complaints

A vs. B 90
A vs. C 96
B vs. C 94

Focal Somatic Complaints

A vs. B 98
A vs. C 96
B vs. C 96

Diffuse Somatic Complaints

A vs. B 80
A vs. C 84
B vs. C 84

Centrality of Somatic Component

A vs. B 80
A vs. C 92
B vs. C 84

Second 50 Interview Protocols

Somatic Complaints

D vs. E 98
D vs. F 98
E vs. F 100

Multiple Somatic Complaints

D vs. E 98
D vs. F 98
E vs. F 96

Focal Somatic Complaints

D vs. E 90
D vs. F 92
E vs. F 98

Diffuse Somatic Complaints

D vs. E 86
D vs. F 94
E vs. F 88

Centrality of Somatic Component

D vs. E 84
D vs. F 88
E vs. F 96

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