Somatization of Emotional Conflict Scale (SECS)

Sex (circle): Male Female  Age:____ Height:____ Weight: ____ Race:
Do you smoke cigarettes? Yes No
If yes‚ how many cigarettes per day? ____

How often do you get sick with the cold‚ flu‚ or similar common illness? (circle the number of the most accurate response):

1 = less than once a year‚ 2 =once or twice a year‚ 3 = three or four times a year‚ 4 =more than four times a year

Have you ever been diagnosed with the following (circle the appropriate response):

Chronic fatigue syndrome Yes No
Severe allergies Yes No
Irritable bowel syndrome Yes No
Fibromyalgia Yes No
Asthma Yes No
Conversion Disorder Yes No
Arthritis Yes No
Seizure Disorder Yes No
High blood pressure Yes No
Arteriosclerosis Yes No

Please list medications you are currently taking (including oral contraceptives):

 
 

You will be presented with several common physical difficulties that people experience followed by three columns. Column A is concerned with how frequently you experience these difficulties. You are to circle a number to indicate how frequently you experience the difficulties. Column B is concerned with how much of an impact the difficulties have on your life. You are to circle a number to indicate the impact of the physical problems. Column C is concerned with what kinds of moods or emotions contribute to the physical difficulties. You are to place a check-mark in as many ‚of the boxes as necessary to represent the emotional states that seem to lead to the physical problems. See the example below:

 
A
B
C
Migraine headache
Headache
Nausea or upset stomach
Numbness or tingling
3
4
2
0
3
2
4
0
X
x
 
 
x
X
 

Column-A: How frequently do you have the following problems? “0 =I have never had this problem‚ 1= less than once month‚ 2= once or twice month‚ 3=three or four times a month‚ and 4=more than four times a month”

Column-B: How much does this problem affect you? “0=Never a problem at all‚ 1=Barely noticeable; not a problems‚ 2= A minor problem; small discomfort‚ 3= A problem; but can be dealt with‚ 4= Huge negative impact on my life”.

Column – C: I have these problems when I feel … (Check All That Apply) “Stressed‚ anxious‚ frightened‚ or worried‚” “depressed‚ lonely‚ empty‚ or sad‚” “angry‚ irritated‚ mad‚ or agitated.”

 
A
B
C
Migraine headache
Headache
Nausea or upset stomach
Numbness or tingling
Trouble breathing or short of breath
Stomach aches or pains
Shakiness or trembling
Difficulty sleeping
Vomiting
Heart pounding or racing
Diarrhea
Blackouts or fainting
Cramps
Backaches
Appetite problems
Leg or foot pain
Dizziness
Fatigue or weakness
Indigestion
Impotence (males)
Chest pain
Blurred vision
Nose bleeds
Diffuse body aches and pains
Constipation
Hot or cold spells
Skin rash
Pain or aches in arms or hands
Genital/Sexual Pain
Cold sores or fever blisters
Twitching of eyelid
Premature ejaculation (males)
Heartburn
Ulcer
Ringing in ears
Dry or red eyes
Absence of menstruation (females)
Acne
Muscle tension
Severe PMS (females)
Inability to achieve orgasm
Excessive energy
 
 
 
 
 
 

 

This instrument can be found at: http://trace.tennessee.edu/utk_interstp2/108 trace.tennessee.edu/cgi/viewcontent.cgi?article=1107&context=utk_interstp2

 

Borckardt‚ J.J.‚ Younger‚ J.W.‚ Adams‚ B.J.‚ Nash‚ M.R. (2000). Toward a better understanding of the relationship between somatization and hypnotizabilility. Paper presented at the meeting of the Society for Clinical and Experimental Hypnosis‚ Seattle‚ WA.

Borckardt‚ Jeffrey J. (2002). Physiological reactivity to mental imagery as a predictor of somatization and psychopathology. University of Tennessee. Doctoral Dissertation

Willis‚ Leah‚ “Self-efficacy‚ Psychosomatic Illness‚ and Psychopathology” (2002). Senior Thesis Projects‚ 1993-2002. http://trace.tennessee.edu/utk_interstp2/108