Symptom expectations as a clinical target in somatic symptom disorder

Hahn, Stefanie; Pauls, Franz; Wittenbecher, Henrike; Maehder, Kerstin; Löwe, Bernd; Blankenburg, Kristina; Toussaint, Anne; Nestoriuc, Yvonne

doi:10.1016/j.jpsychores.2026.112546

Symptom expectations as a clinical target in somatic symptom disorder

Cross-sectional evidence from the SOMA.SSD study

Publication date

2026-01-16

Document type

Forschungsartikel

Author

Hahn, Stefanie

Pauls, Franz

Wittenbecher, Henrike

Maehder, Kerstin

Löwe, Bernd

Blankenburg, Kristina

Toussaint, Anne

Nestoriuc, Yvonne

Organisational unit

Klinische Psychologie und Psychotherapie

DOI

10.1016/j.jpsychores.2026.112546

URI

https://openhsu.ub.hsu-hh.de/handle/10.24405/23777

Scopus ID

2-s2.0-105028170669

Project

SOMA.SSD

Publisher

Elsevier BV

Series or journal

Journal of Psychosomatic Research

ISSN

0022-3999

Periodical volume

203

Article ID

112546

Is part of

https://openhsu.ub.hsu-hh.de/handle/10.24405/23768

Peer-reviewed

✅

Part of the university bibliography

✅

Language

English

Keyword

Persistent somatic symptoms

Psychological burden

Psychological factors

Somatic symptom disorder

Symptom expectations

Abstract

Background Symptom expectations influence symptom severity in patients with pain disorders through nocebo and placebo mechanisms. Similar associations have been suggested for patients with somatic symptom disorder (SSD). While evidence underlines the significance of expectations for symptom experience, yet little is known about the nature of these expectations in SSD or about the psychological and biological factors that shape them. Methods Patients diagnosed with SSD participated in a structured on-site assessment at the psychosomatic outpatient clinic of the University Medical Center Hamburg-Eppendorf. The assessment included standardized questionnaires, a physical examination, and a clinical interview. Descriptive statistics and multiple regression analyses were conducted on symptom impairment expectation and symptom-specific expectation measures. Results A total of N = 241 patients participated in this study. The majority of patients (66.8% female, mean age = 44.5 years) reported negative short-term symptom expectations (54%). Patients with more negative expectations also reported greater somatic symptom severity, higher depression and anxiety severity, increased symptom-related distress, and higher symptom-related disability. Symptom-related disability was found to have the largest association with symptom impairment expectations (short-term: β = 0.46, p ' 0.001, long-term: β = 0.26, p ' 0.001), whereas symptom severity was associated with symptom-specific expectations the most (β = 0.66, p ' 0.001). Conclusion Negative symptom expectations are associated with elevated psychological burden in patients with SSD, indicating a clinically relevant subgroup that may benefit from expectation-focused interventions.

Description

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

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Published version

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