The Effect of Attention-Deficit/Hyperactivity Disorder Symptoms on Somatization and Dissociation: The Mediating Role of Difficulties in Emotion Regulation

Objective: The aim of this study was to explore the relationship of Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms with somatization and dissociation among university students. Another aim of this study is to examine whether difficulties in emotion regulation play a mediating role in this possible relationship. Methods: Patients were enrolled (n=51) after screening with Structured Clinical Interview for DSM-IV-TR axis I disorders (SCID-I), Hamilton Depression Rating Scale (HAM-D-17) and Young Mania Rating Scale (YMRS). Neurocognitive functions were evaluated with Stroop Colour Word and Interference Test TBAG Form (SCWT) and Trail Making Tests A and B (TMT-A/B). Dysfunctional attitudes were evaluated with Dysfunctional Attitude Scale Revised Form (DAS-R), functioning was evaluated with Sheehan Disability Scale (SDS). Results: ASRS total score was significantly correlated with the SCL-90-R somatization score (r = 0.489, p < 0.001), the DERS-16 score (r = 0.576, p < 0.001) and the DES II score (r = 0.548, p < 0.001). The DERS-16 total score was significantly correlated with the SCL-90-R somatization score (r = 0.513, p < 0.001) and the DES II score (r = 0.512, p < 0.001). Two different hierarchical regression analyses were performed to examine the mediating role of emotion regulation difficulties in the effect of ADHD symptoms on both somatization and dissociation. In the first model of first regression analysis, ASRS total score was the independent variable where DES II score was the dependent variable and the analysis revealed a regression coefficient (beta) of 0.548 (p < 0.05). The second model with ASRS total score and DERS-16 score as independent variables, and DES II score as the dependent variable revealed a regression coefficient (beta) of 0.379 for ASRS total score (p < 0.05). In the second regression analysis, the first model with ASRS total score as the independent variable and SCL-90 somatization score as the dependent variable revealed a regression coefficient (beta) of .489 (p < 0.05). The second model with ASRS total score and DERS-16 total score as independent variables, and SCL-90 somatization as the dependent variable revealed a regression coefficient (beta) of .290 for ASRS total score (p < 0.05). Conclusion: In our study, correlation analysis revealed that there were significant relationships between ADHD symptoms, difficulties in emotion regulation, somatization and dissociation in university students. Regression analyses revealed that difficulties in emotion regulation had a partially mediating role in the effect of ADHD symptoms on both somatization and dissociation. Our findings suggest that it is important to assess individuals with ADHD symptoms for symptoms of somatization and dissociation as well as emotion regulation difficulties. Interventions for emotion regulation difficulties in individuals with ADHD symptoms may be effective in reducing the symptoms of somatization and dissociation among these individuals.