Internal Picture of the Disease and Patterns of Attitude to Treatment in Women with Somatic Disorders



Relevance. The category of patients with somatization disorders (SD) poses a serious problem for primary health care, where their prevalence reaches 40%. There is an opinion that in modern society there is a phenomenon of stigma, and a stigmatizing attitude towards the mentally ill persists. Currently, the phenomenon of self–stigmatization is being studied to a greater extent in severe mental disorders: the connection of self–stigmatization with social identity, a sense of self–worth, internal stability, and the ability to cope with stressful situations. The issue of developing destigmatized forms of care for patients with non–psychotic disorders, primarily psychotherapeutic offices in the primary health care network, remains relevant. The purpose of the study is to study differences in the severity of self–stigmatization and indicators of attitude towards the disease and treatment in patients with SD who sought help from a psychiatrist or psychotherapist and in women who avoided contacting specialized specialists. Methods. Questionnaire for assessing self–stigma I.I. Mikhailova, V.S. Yastrebova, a questionnaire to study attitudes towards the disease and treatment of B.D. Karvasarsky, correlation and regression analysis. The article presents the results of an empirical study of the relationships and parameters of motivation for treatment and the level of self–stigmatization in women suffering from somatization disorders with manifestations of «psychiatrist–avoiding behavior», on the basis of which the authors describe models of attitude towards treatment. Conclusions. Based on the identified relationships between the parameters of patients’ motivation to seek help from a psychiatrist and the level of self–stigmatization, it was possible to describe models of attitude towards treatment in patients with somatization disorders who have not sought specialized psychiatric help for a long time: «model of denial», «model of fixation», «model of ignoring» , confirmed by the presence of regressive connections and the «dubious benefit» model, justified by the presence of a positive linear correlation. The data obtained will form the basis for the development of a program of psychotherapeutic assistance and clinical and psychological support for patients with CP not only at the inpatient, but also at the outpatient stages of treatment.

General Information

Keywords: somatized disorders, models of somatognosia, level of self–stigmatization, attitude towards the disease, motivation for treatment

Journal rubric: Empirical Researches

Article type: scientific article


Received: 12.04.2023


For citation: Bogushevskaya J.V., Vasileva A.V., Ivchenko A.I. Internal Picture of the Disease and Patterns of Attitude to Treatment in Women with Somatic Disorders. Konsul'tativnaya psikhologiya i psikhoterapiya = Counseling Psychology and Psychotherapy, 2023. Vol. 31, no. 4, pp. 105–124. DOI: 10.17759/cpp.2023310406. (In Russ., аbstr. in Engl.)


  1. Bogushevskaya J.V. Klinicheskiye faktory, prepyatstvuyushchiye svoyevremennomu obrashcheniyu bol'nykh somatizirovannymi rasstroystvami za psikhiatricheskoy pomoshch'yu [Clinical factors preventing the timely treatment of patients with somatic disorders for psychiatric care]. Kremlevskaya meditsina. Klinicheskiy vestnik, 2022, no. 1, pp. 36¾41 (In Russ.).
  2. Vasileva A.V. Problemy zhenskogo psikhicheskogo zdorov'ya – mezhdistsiplinarnyy rakurs [Problems of women's mental health – an interdisciplinary perspective]. ​​Russian Medical Journal, 2018, no. 10, pp. 51¾54. (In Russ.).
  3. Vasileva A.V.  Razrabotka konstrukta vnutrenney kartiny bolezni dlya optimizatsii mediko–psikhologicheskoy reabilitatsii [Development of the construct of the internal picture of the disease for optimizing medical and psychological rehabilitation]. Human Ecology, 2019, no. 12, pp. 32¾40. (In Russ.).
  4. Karavaeva T.A. Somatoformnyye rasstroystva [Somatoform disorders] / T.A. Karavaeva, A.V. Vasilyeva / In the book: Psychotherapy. Textbook. Moscow, 2022, pp. 516¾543. (In Russ.).
  5. Karyagina T.D. Lichnost' i perezhivaniye v kontekste eksperimental'noy psikhoterapii [Personality and experience in the context of experimental psychotherapy]. Counseling psychology and psychotherapy, 2017, vol. 25, no. 3, pp. 11¾32. (In Russ.).
  6. Lutova N.B. Compliance in psychiatry and approaches to its improvement [Electronic resource]. Russian Psychiatric Journal, 2012, no. 2. URL:–v–psihiatrii–i–podhody–k–ego–uluchsheniyu (accessed: 03.05.2023).
  7. Lutova N.B., Makarevich O.V., Sorokin M.Yu., Novikova K.E., Abramchik S.S., Vid V.D. Psychiatric stigma: clinical–demographic or cultural factors [Electronic resource] // Social and clinical psychiatry, 2019, no. 4. URL:–stigma–kliniko–demograficheskie–ili–kulturalnye–faktory (accessed: 03.05.2023).
  8. Martynikhin I.A. The use of ICD–10 for the diagnosis of mental disorders in Russia: according to government statistics and the results of a survey of doctors. Consortium Psychiatricum, 2021, vol. 2, no. 2, pp. 35¾44. DOI: 10.17816/CP69
  9. Martynikhin I.A. Epidemiology, features and specific risk factors for disorders of the depressive and anxiety spectrum in women. Women's mental health from hysteria to a gender–sensitive approach / Ed. N. G. Neznanova. St. Petersburg: LLC Publishing House Alef–Press, 2018, pp. 276¾296.
  10. Nedurueva T.V., Pavlova L.E. Peculiarities of communicative attitudes and coping behavior of pediatricians in a situation of therapeutic interaction [Electronic resource]. Collection of humanitarian research, 2019, no. 1 (16). URL:–kommunikativnyh–ustanovok–i–sovladayuschego–povedeniya–vrachey–pediatrov–v–situatsii–lechebnogo–vzaimodeystviya (accessed: 04.10.2023).
  11. Neznanov N.G., Vasileva A.V., Salagai O.O. The role of psychotherapy as a medical specialty in public health. Public health, 2022, vol.2, no. 2, pp. 40¾57. DOI: 10.21045/2782 1676 2022 2 2–40–57.
  12. Smirnov N.V., Selin A.V. Adaptation resources of the individual in situations of chronic somatic disease [Electronic resource]. Tauride Journal of Psychiatry, 2018, no. 3 (83). URL:–resursy–lichnosti–v–situatsiyah–hronicheskogo–somaticheskogo–zabolevaniya (accessed: 03.05.2023).
  13. Sorokin M.Yu., Lutova N.B., Vid V.D. Typology of patients with mental disorders depending on the structure of motivation for treatment and adherence to therapy [Electronic resource]. Social and Clinical Psychiatry, 2018, № 2. URL:–bolnyh–psihicheskimi–rasstroystvami–v–zavisimosti–ot–struktury–motivatsii–k–lecheniyu–i–priverzhennosti–terapii (accessed: 03.05.2023).
  14. Kholmogorova A.B. Clinical psychology: in 4 volumes: a textbook for institutions of higher education. prof. Education / Ed. A.B. Kholmogorova. T. 2. Private pathopsychology / A. B. Kholmogorova, N. G. Garanyan, M. S. Rodionova, N. V. Tarabrina, Moscow: Academy Publishing Center, 2012. 432 p.
  15. Kholmogorova A.B., Garanyan N.G., Shayb P., Wirsching M. Emotions and mental health in the social and family context (on the model of somatoform disorders) [Electronic resource]. Medical psychology in Russia: electron. scientific magazine, 2011, no. 1. URL:  (accessed: 13.05.2023)
  16. Kholmogorova A.B., Moskovskaya M.S., Sheryagina E.V. Alexithymia and the ability to provide various types of social support [Electronic resource]. Counseling psychology and psychotherapy, 2014, vol. 22, no. 4, pp. 115¾129. 
  17. Butean J., Mone I.S., Visu–Petra L., Opre A. Predictors of individual differences in lie acceptability in adolescence: exploring the influence of social desirability, callous unemotional traits and somatization. Journal of Evidence–Based Psychotherapies, 2020, vol. 20, № 2, pp. 51—66. DOI:10.24193/jebp.2020.2.11
  18. Lehmann M., Jonas C., Pohontsch N.J., Zimmermann T., Scherer M., L we B. General practitioners’ views on the diagnostic innovations in DSM–5 somatic symptom disorder–A focus group study. Journal of Psychosomatic Research, 2019, vol. 123, e109734. DOI:10.1016/j.jpsychores.2019.109734
  19. Lipowski Z.J. Somatization: a borderland between medicine and psychiatry. Canadian Medical Association Journal, 1986, vol. 135, no. 6. pp. 609—614.
  20. Mewes R. Recent developments on psychological factors in medically unexplained symptoms and somatoform disorders. Front Public Health, 2022, vol. 4, no.10, e1033203. DOI: 10.3389/fpubh.2022.1033203

Information About the Authors

Julia V. Bogushevskaya, PhD in Medicine, Associate Professor of the Department of Psychiatry and Psychosomatics, Kursk State Medical University (FGBOU VO KSMU of the Ministry of Health of Russia), Kursk, Russia, ORCID:, e-mail:

Anna V. Vasileva, Doctor of Medicine, Chief Researcher, Department for Non-psychotic Mental Disorders Treatment and Psychotherapy, V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology, Associate Professor, Chair of Psychotherapy, Medical Psychology and Sexology, North-Western State Medical Universitynamed after I.I. Mechnikov, St.Petersburg, Russia, ORCID:, e-mail:

Anastasia I. Ivchenko, Student, Kursk State Medical University (FGBOU VO KSMU of the Ministry of Health of Russia), Kursk, Russia, e-mail:



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