【作者】 张斌；

【导师】 汪新建；

【作者基本信息】 南开大学 ， 社会心理学， 2013， 博士

【摘要】 儿童功能性躯体化症状(Functional Somatic Symptoms, FSS)又被称为“无医学解释的躯体症状”,是儿科临床上常见的主诉,常被诊断为功能性腹痛、慢性疲劳综合症等,严重的FSS有可能符合精神病学中躯体形式障碍的诊断。儿童FSS不仅高发于临床样本中,轻微的躯体化症状在非临床社区样本中也很常见。社区样本中的儿童FSS较为轻微,未达到临床诊断的标准,但是表现形式多样,对儿童的出勤率、学业成绩、家庭关系等方面都有负面影响。儿童FSS通常没有医学设备可检测出的生理病变,而是与心理、社会环境因素密切相关。本研究以非临床小学生和中学生为样本,采用纵向追踪和横断相结合的研究设计,使用问卷法对儿童功能性躯体化症状的发生率、发展趋势、心理发生机制和社会环境影响因素进行了探讨。研究共分为3个部分,由9个子研究组成。第一部分修订了测量儿童FSS的工具,并对本研究中使用到的研究工具的心理测量学属性进行了检验；第二部分探讨了儿童FSS的发展趋势,以及个体心理学属性,包括情绪、认知方式、行为等方面与儿童FSS之间的互动关系；第三部分探讨了家庭、班级以及负性生活事件等环境因素对儿童FSS的影响。综合本研究结果,得出了以下结论：1.儿童FSS在非临床儿童和青少年群体中很常见。本研究中,仅有5.6%的被试儿童在过去3个月中没有感觉到任何躯体不适,有36.5%的被试在过去3个月中体验到“轻微”至“非常多”的躯体化症状。29.4%的被试在过去3个月中频繁体验到至少1种躯体化症状。本研究样本中发生率较高的躯体化症状依次是感觉乏力(65.3%)、肌肉酸痛(55.9%)、四肢疼痛(52.2%)、头疼(48.5%)。2.儿童FSS随着年龄增长呈逐渐增多趋势。本研究发现儿童FSS随着年龄增长表现出逐渐增多的趋势,并且,增长趋势存在性别和焦虑水平上的个体差异。每隔九个月,女生的躯体化症状增长速度比男生高0.41分。初始状态焦虑得分较高的儿童,比低分组儿童的躯体化症状增长速度更快。每隔9个月,初始状态焦虑高分组比低分组增加值多0.44分。3.儿童FSS与儿童的心理健康状况之间存在密切关系。儿童焦虑、抑郁、社交退缩、多动、攻击违纪行为、刻板行为等心理健康问题均可预测儿童FSS。躯体化症状中的“疼痛与乏力”因子与儿童心理健康之间的关系最为密切。4.反刍思维是儿童FSS的认知易感性因素。症状反刍、沉思、反省维度以及反刍思维可正向预测儿童FSS水平。在控制了抑郁水平之后,反刍思维对儿童FSS的预测作用依然显著。儿童抑郁对反刍思维与儿童FSS之间的关系有调节作用,即儿童抑郁程度越高,反刍思维与儿童FSS之间的关系越密切。儿童抑郁在反刍思维与躯体化症状之间的部分中介作用亦显著,说明反刍思维对儿童FSS的影响有一部分是通过抑郁实现的。5.儿童FSS不会导致日常功能的严重损伤。儿童FSS不能预测儿童的日常功能损伤,躯体化症状的出现对儿童和青少年正常生活的影响不大。6.家庭环境对儿童FSS的发生发展有影响作用。功能性躯体症状存在着母系代际传递性,高躯体化症状水平儿童母亲不仅有较多的情绪问题,而且在敌对、偏执、恐惧等各维度及心理健康总体水平都比低躯体化症状水平儿童的母亲要差。在家庭教养方式方面,父母的过度保护行为和父亲的拒绝行为对儿童FSS有预测作用。母亲的过度保护可以中介母亲和子女之间FSS的传递,父亲家庭教养方式对母系FSS传递无调节作用。7.班级环境因素对儿童FSS影响较为轻微。在诸多班级环境因素中,只有学业压力可以预测儿童FSS。8.负性生活事件以及不良的应对方式可以预测儿童FSS。人际关系、学业压力以及受惩罚三类青少年负性生活事件中可以正向预测儿童FSS的发生；对应激事件采取“积极的合理化解释”的方式进行应对,可以减少儿童FSS的发生发展,而“忍耐”、“发泄情绪”的方式应对则会正向预测儿童FSS的发生更多还原

【Abstract】 Functional somatic symptoms (FSS) is defined as medically unexplained symptoms, are commonly experience by children and adolescents in clinical sample. FSS are often diagnosed as functional abdominal pain, chronic fatigue syndromes etc. by pediatrician; severe FSS could be diagnosed as somatoform disorder by psychiatrist. FSS are also common in community sample which is less severe and do not meet the clinical diagnostic criteria. However, community sample report a variety of complaints, associated with attendance rate, academic achievement and family disfunctioning. FSS usualy could not be explained medically, may induced by psychological and social factors.The research uses sample of students from primary and secondary school; and emply crosssectional and longitudinal research design. Questionnaires are used to explore the occurrence rate, developmental tendency, psychological mechanism and related social factors of FSS. The research composed of3parts. The first part revised the questionnaire used to evaluation FSS in children and adolescents, and verified all the other tools used in this research; the second part explore the developmental trendency, and how the psychological variable affect FSS in children including emotion, cognitive style, behavior; the third part discussed how the environmental factor affect FSS in children.Based on the results, the following conclusions could be drawn.1. FSS in children is common in community sample.In this research, only5.6%children did not experience any somatic symptom at all in the past3-month.36.5%experienced "slightly" or "a lot" somatic symptom in the past3months.29.4%experienced at least1symptom frequently in the past3months. The most prevalent functional somatic symptoms are fatigue (65.3%), sore muscle (55.9%), pain of limbs (52.2%) and headache (48.5%).2. FSS in children grow along with the increase of age.The research find growth tendency of FSS in children. Furthermore, there are gender and differences in the growth tendency. Every nine-month, FSS in girls grow faster than FSS in boys by0.41point. FSS in children with high initial anxiety grow faster than children with low initial anxiety by0.44every9month.3. FSS in children have close relationship with mental health status.Children’s anxiety, depression, social withdrawal, hyperactivity, maladaptive behavior can predict FSS in children."pain and fatigue" FSS have closer relationship with mental health.4. Rumination is cognitive vulnerability factor of FSS in children.Symptom rumination, ponder, reflection and ruminant thinking dimensions could positively predict FSS in children. Controlling depression, the relationship between rumination and FSS are still significant. Depression moderated the relationship between rumination and FSS, the relationship is stronger while the depression is more severe. Children’s depression partly mediated the relationship between rumination and FSS in children.5. FSS in children would not result in severe functional disability.FSS in children could not predict children’s functional disability, FSS have slightly effect on children’s daily life.6. FSS in children were affected by family environment.FSS maternal intergenerational transmission, mothers with more somatization symptoms not only suffered from more emotional distress, but also have more paranoid, phobia and worse overall mental health status.Parenting style also related to FSS in children, especially parental over-protection and paternal rejection. Maternal over-protection mediated the maternal intergenerational transmission, paternal parenting style has no effect on the maternal intergenerational transmission.7. FSS in children have slightly relationship with classroom enviromentAmong classroom environment dimensions, only academic pression could significantly predict FSS in children.8. Life event and coping style can predict FSS in children.Life event, specifically, Interpersonal relationship, academic pressure and punishment could positively predict the occurrence of FSS. Positive reasonable explaination of streesors can predict less FSS in children, wihle tolerance and venting emotions can predict more FSS in children.更多还原