Types of psychosomatic reactions in adolescence

Smyslova Kristina Vladimirovna student; Institute of Education; I. Kant Baltic Federal University 11 Generala Galitskogo str., Kaliningrad, Kaliningrad region, 236006, Russia kristinasmyslova@yandex.ru Bolotina Anastasiya Alekseevna student; Institute of Education; I. Kant Baltic Federal University 238542, Russia, Kaliningrad region, Zelenograd district, Pereslavskoye settlement, Sunny Lane, 4 anastasijabolotina@gmail.com Vorsina Yaroslava Andreevna Graduate student; Institute of Education; I. Kant Baltic Federal University 5, Shady Lane, Guryevsk, Kaliningrad region, 238300, Russia YAVorsina@stud.kantiana.ru

Glavatskih Marianna Mihailovna PhD in Psychology Associate Professor; Higher School of Education and Psychology; I. Kant Baltic Federal University 23 Generala Galitskogo str., Kaliningrad region, Kaliningrad, 236006, Russia ni-hao@mail.ru

Methodological and theoretical justification

The methodological basis of the study is the transactional concept of stress proposed by Richard Lazarus and Susan Folkman ^[13], in which stress is considered as the result of a cognitive assessment of the situation and available coping resources. In this logic, coping strategies act as a psychological mechanism mediating the relationship between stress, emotional state, psychological distress and subjective bodily complaints.

The theoretical understanding of psychosomatic symptoms in the article is based on the integration of several complementary foundations. The psychosomatic level includes the approaches of F. Alexander ^[1] and Z. Lipowski ^[11], in which bodily complaints are considered in connection with the experience and processing of psychological stress. The clinical and psychological level is represented by the works of A. B. Smulevich ^[7] and E. R. Isaeva ^[4], which emphasize the connection of bodily complaints with affective stress, personal vulnerability and features of emotional regulation. The cognitive-affective level allows us to consider psychosomatic manifestations as a result of the interaction of assessment of a stressful situation, ways of coping and processing bodily sensations. Such integration does not involve making clinical diagnoses, but is used for psychological analysis of subjective psychosomatic symptoms.

Based on these theoretical provisions, it is assumed that there is a statistically significant relationship between the features of coping strategies and the level of psychosomatic symptoms in adolescents and adolescents, which is confirmed by modern studies demonstrating the relationship between psychological distress, coping strategies and the severity of functional somatic symptoms (Nyengaard et al., 2022) ^[12].

Given that the empirical design of this study does not include physiological indicators, physiological stress models are not used as an independent basis for interpreting the results. The main focus is on psychological indicators of distress, coping behavior, and subjective bodily complaints.

In the framework of this study, coping behavior is defined as a system of conscious cognitive and behavioral strategies for responding to stressful situations, while a dichotomy of adaptive and maladaptive strategies is highlighted, where the latter can increase psychological distress or hinder effective coping with a stressor. Maladaptive coping strategies are understood as reactions such as avoidance, passivity, deliberate ignoring of the problem or denial, which are associated with an increased level of psychological dysfunction and psychosomatic manifestations of stress reactions ^[3].

In the framework of this study, the types of psychosomatic response are empirically identified groups of subjects formed on the basis of a cluster analysis of a set of indicators of coping behavior, the severity of psychosomatic symptoms and the level of psychological distress. Thus, these types are not considered as clinical diagnoses or stable personality types, but are interpreted as statistically isolated profiles of psychosomatic functioning, reflecting differences in the nature of the relationship between strategies for coping with stress, the level of psychological distress and the severity of somatic complaints.

Empirical previous studies of children and adolescents have shown that maladaptive strategies for regulating emotions (for example, rumination, difficulties with verbalizing feelings) positively correlate with the severity of functional somatic symptoms (FSS), while adaptive strategies negatively correlate. This confirms that the features of emotional reaction and its processing in adolescence are associated with the severity of psychosomatic manifestations ^[15].

Thus, the study is implemented within the framework of a cognitive-transactional and psychosomatic methodological paradigm involving clinical and psychological tools, which provides a comprehensive analysis of the relationship between coping behavior and psychosomatic manifestations. In the Russian psychological and pedagogical literature, coping behavior is considered as a resource for the subject's adaptation in a difficult life situation ^{[6; 5]}. Modern research emphasizes the importance of flexibility of coping behavior, individual resources, and social support in different age periods ^[10], and the materials of the 2025 conference capture the relevance of resource-based and ontogenetic approaches to the study of stress and coping ^[8]. Empirical evidence shows that a variety of coping strategies is associated with adaptive trajectories and the level of psychological well-being in different educational environments ^[7], whereas maladaptive strategies such as escape-avoidance correlate with increased depressive symptoms in older adolescents ^[2].

At the same time, existing research on young people tends to focus either on psychosomatic manifestations or coping strategies, and less often integrates these areas based on gender and age. Typological studies in which coping profiles are compared with the level of psychological distress and subjective bodily complaints in a Russian sample of adolescents and adolescents are insufficiently presented. This significantly limits the possibilities of developing effective preventive and corrective programs aimed at reducing psychosomatic symptoms and developing adaptive models of coping with stress in young people.

The purpose of this study was to identify the features of the relationship between coping strategies and the severity of psychosomatic symptoms in adolescents and adolescents, as well as to determine the types of psychosomatic response based on indicators of coping behavior and psychological distress.

The study tested the hypothesis that there are types of psychosomatic reactions in the sample under study, which differ in the profile of coping strategies used and the severity of psychological symptoms.

Research base: Immanuel Kant Baltic Federal University.

Research methods:

1. The symptomatic questionnaire SCL-90-R (Symptom Check List-90-Revised), adapted by N. V. Tarabrina (2001), designed to assess the severity of psychological symptoms, symptomatic complaints and the general level of psychological distress.

2. The questionnaire of coping attitudes of adolescents ACOPE (Adolescent Coping Orientation for Problem Experiences), authors J. Patterson, H. McCubbin (1981), adapted by N. A. Polskaya (2014), aimed at identifying dominant coping strategies.

3. Questionnaire of somatic symptoms in children CSSI (Children's Somatic Symptoms Inventory), adapted by A. A. Zolotareva and A. S. Hegai (2024), designed for quantitative and qualitative assessment of somatic complaints in childhood and adolescence.

4. The Giessen Questionnaire of somatic complaints (Der Giessener Beschwerdebogen, GBB), adapted by the V. M. Bekhterev National Research Medical Institute (1993), used for differentiated registration of subjective somatic complaints and assessment of their intensity.

The use of the diagnostic battery is due to the interdisciplinary logic of research based on the biopsychosocial model, which makes it possible to conduct research in a system of various factors, from medical aspects to social response to stress situations: the SCL-90-R questionnaire was used to identify the psychopathological symptoms of students of different types of psychosomatic response based on medical psychology, the psychological aspect in the form of subjective Somatic complaints were determined by the CSSI and Giessen questionnaires, and the issue of responding to stressful life situations was studied by the ACOPE questionnaire. This approach is widely used in modern clinical and medical psychology, as it allows us to study psychosomatic manifestations not in isolation, but in a system of interrelated indicators ^[9].

Sample characteristics: The sample consisted of 136 respondents aged 14-18 years. Of these: female respondents (101 students, 74.3%) and male respondents (35 students,25.7%). During the statistical analysis, there were no significant differences in the main studied indicators depending on gender, which allows us to consider the sample as relatively homogeneous and conduct further analysis in the general group.

Statistical processing included correlation analysis, K-means clustering, and intergroup comparisons using the Mann-Whitney U-test for independent samples. Cluster analysis was performed using standardized indicators of coping behavior, psychological distress, and psychosomatic complaints; the decision to identify three clusters was made taking into account the meaningful interpretability of the profiles and consistency with the purpose of the study. The differences were interpreted as statistically significant at p < 0.05; at p > 0.05, conclusions about significant intergroup differences were not formulated.

Types of psychosomatic reactions in adolescence

At this stage of the study, a cluster analysis using the K-means method was performed, during which the entire sample of respondents was divided into three empirical groups of psychosomatic response.

The percentage of students in each group out of the total number of respondents was as follows:

l Group No. 1: 51 people = 38%, of which 41 are girls (81%) and 10 are boys (19%).

l Group No. 2: 46 people = 34%, of which 37 are girls (82%) and 9 are boys (18%).

l Group No. 3: 39 people = 29%, of which 24 are girls (61%) and 15 are boys (39%).

Let's take a closer look at the age ratios in each of the selected groups.

Table 1. Percentage of respondents of different age periods in the selected groups

Table 1 shows the percentage of individuals in the three selected groups by age period. In all three groups, representatives of the older adolescent age predominate: in group 1, their share is 56%, in group 2 — 76%, in group 3 — 61%. The largest proportion of respondents of the older adolescent age is noted in the 2nd group. The data obtained reflect the percentage distribution of participants within the selected groups and do not allow us to assert without additional statistical verification that the severity of the types of psychosomatic reactions increases naturally with age.

Due to the fact that age was not one of the clustering variables, the presented distribution is considered as a descriptive characteristic. At this stage, it does not allow us to conclude that the age period has a statistically significant effect on belonging to a particular type of psychosomatic response.

The description of the features of psychopathological symptoms, subjective somatic complaints and coping strategies was carried out on the basis of significant differences between the identified types; the data are presented in Table 2.

Table 2. Comparative analysis of psychopathological symptoms in different types of psychosomatic response in adolescence

Based on the data in Table 2, the selected groups differ in the severity profile of psychopathological symptoms. The most pronounced and persistent differences are observed between group 1 and group 2 (p < 0.001 on most scales). Group 3 occupies an intermediate position: according to a number of indicators, it does not statistically differ from group 1, but on separate scales it differs from group 2. The most significant for the differentiation of profiles are obsessions, psychoticism and depressive-anxiety symptoms.

Statistically significant differences were most consistently revealed when comparing group 1 and group 2 on the scales of obsession, depression, anxiety, somatization and other indicators of SCL-90-R. This may indicate increased emotional tension, a tendency to internal conflicts and general instability of the psycho-emotional state in group 2. When comparing group 2 and group 3, significant differences do not appear on all scales, which requires caution when interpreting the intermediate position of the asthenic type.

Group 3 shows intermediate values: its indicators of psychopathological symptoms are higher than those of group 1, but lower than those of group 2, which may reflect the presence of severe fatigue, decreased tone and emotional lability without signs of clinical diagnosis.

In group 1, values on all scales remain at a low level, which indicates a satisfactory level of mental and emotional well-being.

Figure 1. Average values on the scale of "somatization" of the symptomatic questionnaire in different types of psychosomatic response in adolescence

Figure 1 shows the average indicator of the SCL-90-R somatization scale as an additional visualization of one of the key indicators presented in Table 2. The highest level of psychosomatic manifestations is observed in the group with mental maladaptation. In the group with an asthenic profile, this indicator is also higher than in the normotypic group, but lower than in the maladapted respondents.

Features of psychosomatic manifestations

The analysis of somatic complaints showed that according to the "somatization" scale of the symptomatic questionnaire (SCL-90-R), the highest values are observed in group 2. The result is consistent with the idea of the relationship between psychological distress and subjective bodily complaints, but cannot be considered as clinical confirmation of somatic disorder. At the same time, the data obtained using the Giessen questionnaire of somatic Complaints did not reveal statistically significant differences in all the studied indicators (in all cases, p > 0.05). Thus, individual higher averages in the group with an asthenic profile can only be used as a descriptive characteristic and require verification on a more balanced sample.

In group 1, which uses more diverse coping strategies, there were no high average rates of psychosomatic symptoms. This is consistent with the assumption of a protective function of adaptive coping, but within the framework of correlational design, it does not allow us to conclude about causal relationships.

A comparative analysis using the Mann-Whitney U-test revealed statistically significant differences in a number of indicators of coping strategies, the data are presented in Table 3.

Table 3. Comparative analysis of coping strategies in different types of psychosomatic response in adolescence

Based on the data obtained, each of the three groups can be characterized, defining the first as a type with a conditional norm "Conditional norm", the second group "Mental maladaptation" and the third group "Asthenic type". The "Conditional Norm" is characterized by the widest, most diverse and proactive arsenal of coping strategies, which allows young people in this group to effectively manage stress at different levels of response. In this group, problem-oriented coping is more pronounced, including "developing self-confidence" and "intensive training", reflecting directed efforts to overcome the problem; emotionally oriented and cognitive strategies such as "treating the problem with a sense of humor" and "distraction"; socially oriented coping, including "seeking family support," "seeking professional help," and "support from close friends." Also, the respondents in this group are more likely to use spiritual coping — "seeking church support."

The group of "Mental maladaptation" is characterized by a narrower and less variable profile of coping strategies. The response to stressful situations in this group is more biased towards emotionally expressive coping methods, primarily the "aggression" strategy, which probably acts as a form of unconstructive release of internal tension. At the same time, strategies related to seeking social support are more pronounced, including "seeking social support" and "seeking support from close friends," but their use may be predominantly passive. Also, respondents in this group are more likely to resort to self-regulation strategies, in particular, to "relaxation". At the same time, in conditions of severe psychological distress, these coping methods are not effective enough for full-fledged adaptation, which is confirmed by high rates of psychopathological symptoms according to the SCL-90-R questionnaire.

The "Asthenic type" group, occupying an intermediate position in terms of the severity of coping strategies, does not have pronounced peaks, which is consistent with its relatively neutral psychological status.

For convenience, below is a summary table of characteristics for all 3 groups.

Table 4. Characteristics of the features in the three selected groups

Conclusion

The correlation and cluster analysis allowed us to identify three empirical profiles of psychosomatic response, differing in the level of mental adaptation, the features of coping strategies and the severity of psychosomatic manifestations. The selected profiles are typological rather than diagnostic in nature.

The first group, the "Conditional Norm", is characterized by low rates of psychological distress and somatic complaints on the SCL—90—R scales, as well as a wider and more flexible range of adaptive coping strategies. The variety of coping behaviors allows respondents in this group to cope more effectively with stressful situations and maintain psychological adaptation. Indicators on the scales of somatization, depression, anxiety, obsessive-compulsive manifestations and other symptomatic parameters are significantly lower compared with the group of "Mental maladjustment" (p < 0.001) and on most scales do not differ statistically from the values of the "Asthenic type" group. The results obtained allow us to consider this group as the most psychologically prosperous and adapted within the study sample.

The second group, "Mental maladaptation", is characterized by the highest scores on the SCL-90-R scales, including depression, anxiety, obsessions, and the somatization scale. The coping profile of this group is characterized by a predominance of emotionally expressive and less constructive response strategies, which is associated with a high level of psychological distress. An integral indicator of general psychological distress ("BOTTOM LINE"; cf. = 40.5) is more than three times higher than the indicator of the "Conditional norm" group (cf. = 13.3) and significantly higher compared to the "Asthenic type" group (cf. = 23,0). A statistically significant increase on most SCL-90-R scales, including depression, anxiety, somatization, and paranoia, indicates marked emotional stress, reduced psychological adaptation, and a high risk of mental maladaptation.

The third group, conventionally designated as the "Asthenic type", is characterized by an intermediate position between the first and second groups. Her indicators often do not reach the level of pronounced maladaptation, however, they reflect the lack of differentiation of coping behavior and the presence of individual signs of internal stress. According to the results of the statistical analysis, it was found that the "Asthenic type" group does not statistically differ from the "Conditional norm" group in a number of indicators, however, on separate scales, primarily obsession, psychoticism and additional issues of SCL-90-R, it significantly differs from the "Mental maladaptation" group. This suggests that, despite the presence of certain unfavorable trends, the general psychological state of the respondents in this group remains closer to the conditional norm and does not reach the level of pronounced mental maladaptation.

To summarize, the data obtained confirm the hypothesis that maladaptive coping strategies are associated with a greater severity of psychosomatic manifestations and psychological distress. At the same time, a variety of adaptive coping strategies is associated with a lower level of subjective bodily complaints.

According to the Giessen questionnaire, there were no statistically significant intergroup differences, therefore, the indicators of this methodology were used only for descriptive refinement of profiles and were not used as the basis for independent conclusions about differences between groups.

An alternative interpretation of the results is that the severity of psychosomatic manifestations may be related not only to coping behavior, but also to the features of emotional regulation, social support, health status, and subjective assessment of bodily sensations. Within the framework of correlation design, the established relationships do not allow us to assert causal relationships.

The comparison of the obtained profiles with classical personality typologies of the psychosomatic tradition (for example, with type A/B behavior ^[14]) can only be considered as a theoretical parallel and a direction for future research, since the corresponding personality types have not been empirically measured in this work.

The limitations of the study are the self-reporting nature of the methods, the lack of physiological indicators, the heterogeneity of the gender and age composition of the sample, as well as the exploratory nature of the cluster solution. The age factor in this study was considered as a descriptive characteristic of the distribution of respondents according to the selected types and requires further verification on more balanced age subsamples. The resulting typology needs to be tested on larger and more balanced samples.

The practical significance of the results lies in the possibility of their use in the development of preventive and correctional programs aimed at the formation of flexible and adaptive coping strategies among adolescents and adolescents.

Thus, the most promising area of further work is to clarify the role of adaptive coping, emotional regulation and social support in reducing the risk of psychosomatic manifestations in adolescence.

The article is published in its final version as approved following the last positive peer review recommending acceptance for publication. It incorporates revisions made by the author in response to prior negative peer review reports that did not recommend publication. All peer review reports, including initial negative reviews, are published in open access alongside the article. All versions of the author’s revisions are archived in the publisher’s repository and may be made available upon reasonable request in accordance with Elsevier’s editorial policies and applicable data availability requirements.
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