Onset conditions for psychosomatic symptoms: a comparative review of immediate observation with retrospective research.

A systematic review of 53 studies of the onset conditions revealed: (1) No symptoms were reported which were without psychological antecedents, although the level of the relationship between psychological antecedent and symptom was usually only moderate or weak; (2) the psychological antecedents, in order of rank with highest first, were resentment, frustration, depression, anxiety, and helplessness; (3) the special uniqueness of the review is in its systematic coverage of the "immediate-context" research (23 studies) and the comparison of those with a sample of "broad-context," mainly retrospective, research studies (30 studies). The same main types of psychological antecedents were reported by both types of studies with frequencies which were not significantly different except for frustration and separation. Frustration was more often reported in the immediate observation studies, separation more often in the broad-context studies. The review ends with suggestions of methods for understanding the mediation of psychological antecedents and symptoms.