Application of the high risk model of threat perception to a primary care patient population

This study was designed to test the hypothesis that patients with a tendenc y to somatize psychological distress into physical symptoms could be differ entiated from patients who do not somatize on the basis of specific predisp osing factors defined by the High Risk Model of Threat Perception. Patients in a family practice were assessed for the tendency to somatize by the Dia gnostic Interview Schedule (DIS) and by physician rating. Twenty-seven perc ent of the patients were positive for tendency to somatize by physician rat ing. These patients had relatively high negative affect, absorption, catast rophizing, self-reported pain and stress, and greater utilization of servic es. None of the patients assessed by the DIS met criteria for somatization disorder, but 28% were positive for somatoforn pain disorder. These patient s also scored higher on the negative affect questionnaire, tended to have h igher absorption scores, reported greater pain and stress, and utilized mor e services. Results of this study are partially supportive of the High Risk Model of Threat Perception, because two of the predisposer factors were as sociated both with tendency to somatize by physician rating and with somato form pain disorder by interview. The higher utilization of services in the somatizing patients has cost and service ramifications. Treatment of patien ts with tendencies to somatize within a family practice setting are discuss ed.