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Mentalization deficits and disturbances in emotional functioning may contribute to somatization in patients with medically unexplained somatic symptoms (MUSS). The present study aimed to increase understanding the psychological factors that contribute to somatization by examining associations between attachment, crying attitudes and behavior, and somatic symptoms in these patients. Attachment security was measured with the Experiences in Close Relationships Questionnaire in sixty-eight outpatients diagnosed with MUSS. Somatic symptom severity was measured with the RAND-36, crying frequency, and attitudes with the Adult Crying Inventory. Patients were asked to evaluate photographs of crying individuals in order to assess the perception of crying and empathic responses to crying. Attachment anxiety was significantly related to somatic symptom severity and negative attitudes toward crying. In addition, somatic symptom severity was related to a more negative attitude toward crying and less awareness of the interpersonal impact of crying on others. The association between attachment anxiety and somatic symptoms was, however, not mediated by crying or negative attitude toward crying. Neither were there significant associations between attachment, somatic symptoms, and empathic responses to crying. Altered attitudes to crying may stem from a history of insecure attachment experiences and may reflect maladaptive emotion strategies in MUSS patients.

Background Involvement of metals or silica in the pathogenesis of sarcoidosis has been suggested by several case reports and specific epidemiological studies. However, the combination of occupational exposure and an immunological reaction has not been studied before in a group of sarcoidosis patients and non-sarcoidosis controls. Methods In 256 sarcoidosis patients and 73 control patients with obstructive sleep apnea, exposure to metal and silica was assessed using a questionnaire consisting of a complete occupational history subsequently linked to job-exposure matrices. Next, immunoreactivity to aluminium, beryllium, zirconium and silica was determined in 33 sarcoidosis and 19 control patients using a lymphocyte proliferation test. Results In sarcoidosis, 83 out 256 patients (32.4%) had occupational exposure to metals or silica, compared to 24.7% in the control group (p = 0.21). A significantly higher percentage of the sarcoidosis patients tested showed immunoreactivity to metals or silica compared to the control group (21.2 and 0% respectively, p = 0.039). Conclusions Immunoreactivity to silica and metals was only found in sarcoidosis patients, supporting the hypothesis that these antigens may be involved in the pathogenesis of a distinct subgroup of sarcoidosis patients. This indicates that when searching for causative agents in sarcoidosis patients, besides beryllium, also zirconium, aluminium and silica deserve clinical investigation.

Additional file 1 Table S1. Estimated odds ratios for sarcoidosis and JEM assigned exposure