臺灣博碩士論文加值系統

本研究以實徵方法探究「身體化(somatization)」傾向的可能成因。不少研究指出華人傾向於透過身體化反應，來表達內心憂鬱與焦慮情緒。經文獻探討發現，華人身體化傾向可能的影響因素有：(1)情緒語彙與情緒表達/壓抑特性；(2)個體對精神問題的社會污名(social stigma)；(3)中西文化傳統中的身心觀點；(4)生病行為之就醫特性。本研究之主要目的乃在：以心理社會因素(psycho-social factor)，解釋台灣民眾至精神科就醫時的身體化現象。本研究共探究四項重要議題，包括：(1)開場白假說之驗證；(2)表達型及再認型之身、心不適與污名感受間之關聯性探討；(3)情緒字彙、情緒感受/壓抑與身、心不適之關聯性探討；(4)生病行為與身心不適之關聯性探討。本研究以自行發展及編製的漸進式訪談問卷、污名感受量表與就醫態度量表，以及過去研究探討身心症狀常用的SCL-90-R、身體症狀檢測等量表為工具，並取38名精神科門診輕型精神病患為受試者，得到結果顯示：(1)約58%患者有先說身體問題再說心理問題的開場白傾向，但開場白傾向未與污名感受達顯著相關，而是與心理諮商需求達顯著負相關。(2)表達型身體不適與精神醫療污名感受二者間達顯著相關，而再認型身體症狀在去除心理症狀嚴重度之影響後，與污名感受二者間未達顯著相關。顯示污名感受愈強，有愈多身體抱怨，但身體症狀嚴重度不受影響。(3)情緒字彙極限詞數愈少者，心理症狀嚴重度愈低，而身體訴說字數比例愈高。情緒感受強度較情緒壓抑程度更能預測身心症狀。(4)一年內身體症狀總數愈多者，愈傾向對自己的問題做超自然歸因。此外，身體訴說比例較高的患者，對精神醫療效果的預期愈高。本研究進一步探討自行編製使用之污名量表、漸進式病情訪談法及身心訴說內容分析法等研究工具的價值與本研究的限制，並說明未來可以開展的研究方向及臨床應用的意義。

This study investigated the possible causes of somatization through empirical method. Some studies pointed out that Chinese people tended to express depression and anxiety through somatization, and the proposed factors accounted for this phenomena including 1) the amounts of emotional vocabularies and characteristics of emotional suppression, 2) the perceived psychiatric stigma, 3) the different conception of body and mind in Chinese and Western cultures, and 4) the characteristics of help-seeking behaviors. The main purpose of this study was to understand the somatization phenomenon in a psycho-social model, and four hypotheses were examined, i.e., 1) the hypothesis of “prologue theory;” 2) the correlation of the expression mode and recognition mode of illness with perceived stigma, 3) the correlation of emotional vocabularies, emotional suppression, and illness, and 4) the correlation of help-seeking behaviors and illness complaints. This study administered Stepwise Semi-structured Interview Questionnaire, Perceived Psychiatric Stigma Scale, and Help-seeking Attitude Scale that were developed for this study along with Symptom CheckList-90-R and Somatic Symptom Index to 38 neurotic outpatients individually.
The results showed that:
1)58% patients had the tendency to complain somatic problems before psychological problems. This tendency did not correlate with perceived stigma, but the need of psychological counseling.
2)Somatic complaints correlated with perceived stigma positively. However, after statistically controlling the effect of psychological symptom seriousness, somatic symptoms would not correlate with perceived stigma. It means that the stronger stigma one perceived, the more somatic complaints would be expressed, but neither one affected the actual somatic seriousness.
3)The fewer emotional vocabularies one owned, the less psychological symptoms would be expressed. The extents of perceived emotions predicted symptoms better than the degree emotions suppressed.
4)The more somatic symptoms one experienced in one year, the stronger tendency s/he utilized super-nature attribution. Besides, those who spend much more time in somatic complaints had lower expectation to psychiatric help.
Finally, the instruments developed in this study were discussed and further investigations were suggested.

目 次
第一章 緒論……………………………………………………………1
第一節 研究動機………………………………………………......1
第二節 「身體化」議題及相關現象之探究.….……...………...2
第三節 「身體化」過去之解釋理論……………...……………...8
第四節 研究目的及架構……………….………………………....24
第二章 研究方法…………………………………………………….27
第一節 研究對象及研究程序…………….……………………....27
第二節 研究工具………………………….……………………....31
第三章 研究結果…………………………………………………….49
第一節 開場白假說之驗證…………………...………………....49
第二節 表達型與再認型身心不適與污名感受之關聯性….…....51
第三節 情緒字彙、情緒感受/壓抑與身體症狀之關聯性……....54
第四節 生病行為與身心不適之關聯性……………………….....57
第四章 討論…………………………………………….…………..60
第一節 開場白假說之驗證…..…………………………………...60
第二節 表達型與再認型身心不適與污名感受之關聯性…….....65
第三節 情緒字彙、情緒感受/壓抑與身體症狀之關聯性……....67
第四節 生病行為與身心不適之關連性……………………….....68
第五章 研究貢獻、限制、未來方向及應用………………….…..71
第一節 研究貢獻與限制……………………………………….....71
第二節 未來研究方向………………………………………….....72
第三節 研究結果之應用……………………………………….....72
參考文獻………………………………………………………………75
附錄一 研究對象同意書……………………………………………80
附錄二 病情訪談漸進式半結構化問卷……………………………81
附錄三 病人基本資料………………………………………………82
附錄四 SCL-90-R……………………………………………………84
附錄五 身體症狀檢測………………………………………………87
附錄六 精神醫療及心理諮商態度調查……………………………88
附錄七 醫療預期與疾病態度調查…………………………………90
附錄八 壓力與情緒測量……………………………………………91
附錄九 身心訴說內容分析法………………………………………95
表目次
表1、身體化傾向相關研究文獻整理………...………………………7
表2、污名分類整理表………………………………………………….14
表3、建立工具用之255名受試者人口學變項特性……………………28
表4、正式研究38位患者人口學變項特性……….……………………30
表5、精神污名量表的因素結構……………………………………….46
表6、心理污名量表的因素結構……………………………………….47
表7、患者第一抱怨內容的分布情形………………………………….49
表8、患者主訴內容的人數與百分比分布情形……………………….50
表9、開場白傾向的人數與百分比分布情形..………………….....51
表10、表達型身心不適與污名感受二者間的相.…………………….52
表11、再認型身心不適與污名感受二者間之相關……………………52
表12、以統計方法控制心理症狀嚴重度下，污名感受與表達型
身心抱怨之相關………..……...……………………….……………53
表13、表達型身心不適與再認型身心不適之相關……………………54
表14、情緒字彙詞數與各種再認型身心不適之相關…………………55
表15、情緒字彙與表達型身、心抱怨之相關…………………………55
表16、再認型身、心症狀及情緒感受、情緒壓抑二群變項間之相關.….56
表17、再認型身心不適與生病行為各變項之相關….….…………..57
表18、表達型身心不適與生病行為各變項之相關…………………..58
圖目次
圖1、本研究架構模式圖………………………………………………..26
圖2、精神污名量表的分配情形………………………………………..61
圖3、心理污名量表的分配情形………………………………………..61
圖4、開場白傾向與精神污名的散佈圖………………………………..62
圖5、開場白傾向與心理污名的散佈圖………………………………..62

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