Skip to main content Accessibility help

Neuroticism and Somatic Complaints: Concomitant Effects of Rumination and Worry

  • Andrew Denovan (a1), Neil Dagnall (a1) and George Lofthouse (a1)


Background: Neuroticism is associated with inflated somatic symptom reporting. Worry and rumination are a cognitive concomitant of neuroticism and potentially mediate the neuroticism–somatic complaint relationship. Aims: The present study examined the degree to which worry and rumination mediated the relationship between neuroticism and somatic complaints. Method: A sample of 170 volunteers, recruited via convenience sampling, took part. Participants completed a series of self-report measures: the Eysenck Personality Questionnaire Revised-Short Form, Penn State Worry Questionnaire, the Ruminative Response Scale and the Somatic Symptom Scale-8. Results: Analysis revealed significant positive correlations between neuroticism, rumination and worry. Neuroticism, rumination and worry also correlated positively with somatic complaints. Using structural equation modelling, a mediational model indicated that rumination fully mediated the relationship between neuroticism and somatic complaints. Conclusions: Findings are consistent with the symptom perception hypothesis and have implications for healthcare in terms of managing individuals who present with multiple somatic complaints. Future research would benefit from adopting a longitudinal approach to test how rumination interacts with neuroticism and somatic complaints over time.


Corresponding author

Correspondence to Andrew Denovan, Department of Psychology, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, Manchester M15 6GX, UK. E-mail:


Hide All
Addis, M. E. and Martell, C. R. (2004). Ending Depression One Step at a Time: The New Behavioral Activation Approach to Getting Your Life Back. Oakland, CA: New Harbinger.
Anderson, J. C. and Gerbing, D. W. (1988). Structural equation modeling in practice: a review and recommended two-step approach. Psychological Bulletin, 103, 411423. doi: 10.1037/0033-2909.103.3.411
Barlow, D., Ellard, K., Sauer-Zavala, S., Bullis, J. and Carl, J. (2014). The origins of neuroticism. Perspectives on Psychological Science, 9, 481496. doi: 10.1177/1745691614544528
Barsky, A. J., Orav, E. J. and Bates, D. W. (2005). Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Archives of General Psychiatry, 62, 903910. doi: 10.1001/archpsyc.62.8.903
Borkovec, T. D. (1994). The nature, functions, and origins of worry. In Davey, G. C. L. and Tallis, F. (eds), Worrying. Perspectives on Theory, Assessment and Treatment (pp. 533). New York, NY: Wiley.
Borkovec, T. D., Ray, W. J. and Stober, J. (1998). Worry: a cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes. Cognitive Therapy and Research, 22, 561576. doi: 10.1023/A:1018790003416
Borkovec, T. D., Robinson, E., Pruzinsky, T. and DePree, J. (1983). Preliminary exploration of worry: some characteristics and processes. Behaviour Research and Therapy, 21, 916. doi: 10.1016/0005-7967(83)90121-3
Brosschot, J. F. and van der Doef, M. (2006). Daily worrying and somatic health complaints: testing the effectiveness of a simple worry reduction intervention. Psychology and Health, 21, 1931. doi: 10.1080/14768320500105346
Browne, M. W. and Cudeck, R. (1993). Alternative ways of assessing model fit. In Bollen, K. A. and Long, J. S. (eds), Testing Structural Equation Models (pp. 136162). Beverly Hills, CA: Sage.
Cioffi, D. (1991). Beyond attentional strategies: a cognitive-perceptual model of somatic interpretation. Psychological Bulletin, 109, 2541. doi: 10.1037/0033-2909.109.1.25
Claridge, G. and Davis, C. (2001). What's the use of neuroticism? Personality and Individual Differences, 31, 383400. doi: 10.1016/S0191-8869(00)00144-6
Clark, L. A. and Watson, D. (2008). Temperament: an organizing paradigm for trait psychology. In John, O. P. and Robins, R. W. (eds), Handbook of Personality: Theory and Research (3rd edn, pp. 265286). New York, NY: Guilford Press.
Cohen, S., Doyle, W., Skoner, D., Fireman, P., Gwaltney, J. and Newsom, J. (1995). State and trait negative affect as predictors of objective and subjective symptoms of respiratory viral infections. Journal of Personality and Social Psychology, 68, 159169. doi: 10.1037/0022-3514.68.1.159
Coffman, D. L. and MacCallum, R. C. (2005). Using parcels to convert path analysis models into latent variable models. Multivariate Behavioral Research, 40, 235259. doi: 10.1207/s15327906mbr4002_4
Costa, P. T. Jr and McCrae, R. R. (1987). Neuroticism, somatic complaints, and disease: Is the bark worse than the bite? Journal of Personality, 55, 299316. doi: 10.1111/j.1467-6494.1987.tb00438.x
Costa, P. T. Jr and McCrae, R. (1992). Four ways five factors are basic. Personality and Individual Differences, 13, 653665. doi: 10.1016/0191-8869(92)90236-I
Dagnall, N., Denovan, A., Drinkwater, K., Parker, A. and Clough, P. (2016). Toward a better understanding of the relationship between belief in the paranormal and statistical bias: the potential role of schizotypy. Frontiers in Psychology, 7, 1045. doi: 10.3389/fpsyg.2016.01045
Danielsson, N. S., Harvey, A. G., MacDonald, S., Jansson-Fröjmark, M. and Linton, S. J. (2013). Sleep disturbance and depressive symptoms in adolescence: The role of catastrophic worry. Journal of Youth and Adolescence, 42, 12231233. doi: 10.1007/s10964-012-9811-6
De Gucht, V. and Maes, S. (2006). Explaining medically unexplained symptoms: toward a multidimensional, theory-based approach to somatization. Journal of Psychosomatic Research, 60, 349352. doi: 10.1016/j.jpsychores.2006.01.021
Denovan, A., Dagnall, N., Dhingra, K. and Grogan, S. (2017). Evaluating the Perceived Stress Scale among UK university students: implications for stress measurement and management. Studies in Higher Education, 114. Advance online publication. doi: 10.1080/03075079.2017.1340445
Ehring, T. and Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1, 192205. doi: 10.1521/ijct.2008.1.3.192
Eysenck, S., Eysenck, H. and Barrett, P. (1985). A revised version of the psychoticism scale. Personality and Individual Differences, 6, 2129. doi: 10.1016/0191-8869(85)90026-1
Flint, J. (2004). The genetic basis of neuroticism. Neuroscience and Biobehavioral Reviews, 28, 307316. doi: 10.1016/j.neubiorev.2004.01.004
Fresco, D. M., Frankel, A. N., Mennin, D. S., Turk, C. L. and Heimberg, R. G. (2002). Distinct and overlapping features of rumination and worry: the relationship of cognitive production to negative affective states. Cognitive Therapy and Research, 26, 179188. doi: 10.1023/A:1014517718949
Gierk, B., Kohlmann, S., Kroenke, K., Spangenberg, L., Zenger, M., Brähler, E. and Löwe, B. (2014). The Somatic Symptom Scale-8 (SSS-8). JAMA Internal Medicine, 174, 399407. doi: 10.1001/jamainternmed.2013.12179
Gray, J. A. (1982). The Neuropsychology of Anxiety: An Enquiry into the Functions of the Septo-Hippocampal System. New York, NY: Oxford University Press.
Hecht, D. (2013). The neural basis of optimism and pessimism. Experimental Neurobiology, 22, 173199. doi: 10.5607/en.2013.22.3.173
Hogan, B. E. and Linden, W. (2004). Anger response styles and blood pressure: at least don't ruminate about it! Annals of Behavioral Medicine, 27, 3849. doi: 10.1207/s15324796abm2701_6
Hooper, D., Coughlan, J. and Mullen, M. (2008) Structural equation modelling: guidelines for determining model fit. Electronic Journal of Business Research Methods, 6, 5360.
Howren, M. B. and Suls, J. (2011). The symptom perception hypothesis revised: depression and anxiety play different roles in concurrent and retrospective physical symptom reporting. Journal of Personality and Social Psychology, 100, 182195. doi: 10.1037/a0021715
Hoyer, J., Gloster, A. T. and Herzberg, P. Y. (2009). Is worry different from rumination? Yes, it is more predictive of psychopathology! GMS Psycho-Social-Medicine, 6. doi: 10.3205/psm000062
Jacobs, R. H., Watkins, E. R., Peters, A. T., Feldhaus, C. G., Barba, A., Carbray, J. and Langenecker, S. A. (2016). Targeting ruminative thinking in adolescents at risk for depressive relapse: rumination-focused cognitive behavior therapy in a pilot randomized controlled trial with resting state fMRI. PLOS ONE, 11, e0163952. doi: 10.1371/journal.pone.0163952
Janca, A., Isaac, M. and Ventouras, J. (2006). Towards better understanding and management of somatoform disorders. International Review of Psychiatry, 18, 512. doi: 10.1080/09540260500466766
Jylhä, P. and Isometsä, E. (2006). The relationship of neuroticism and extraversion to symptoms of anxiety and depression in the general population. Depression and Anxiety, 23, 281289. doi: 10.1002/da.20167
Johnson, M. (2003). The vulnerability status of neuroticism: over-reporting or genuine complaints? Personality and Individual Differences, 35, 877887. doi: 10.1016/S0191-8869(02)00303-3
Lackner, R. J. and Fresco, D. M. (2016). Interaction effect of brooding rumination and interoceptive awareness on depression and anxiety symptoms. Behaviour Research and Therapy, 85, 4352. doi: 10.1016/j.brat.2016.08.007
Lam, D., Smith, N., Checkley, S., Rijsdijk, F. and Sham, P. (2003). Effect of neuroticism, response style and information processing on depression severity in a clinically depressed sample. Psychological Medicine, 33, 469479. doi: 10.1017/S0033291702007304
Lauriola, M. and Iani, L. (2015). Does positivity mediate the relation of extraversion and neuroticism with subjective happiness? PLOS ONE, 10, e0121991. doi: 10.1371/journal.pone.0121991
Magnus, K., Diener, E., Fujita, F. and Pavot, W. (1993). Extraversion and neuroticism as predictors of objective life events: a longitudinal analysis. Journal of Personality and Social Psychology, 65, 10461053. doi: 10.1037/0022-3514.65.5.1046
Marcus, D. K., Hughes, K. T. and Arnau, R. C. (2008). Health anxiety, rumination, and negative affect: a mediational analysis. Journal of Psychosomatic Research, 64, 495501. doi: 10.1016/j.jpsychores.2008.02.004
McLaughlin, K. A. and Nolen-Hoeksema, S. (2011). Rumination as a transdiagnostic factor in depression and anxiety. Behaviour Research and Therapy, 49, 186193. doi: 10.1016/j.brat.2010.12. 006
Meyer, T., Miller, M., Metzger, R. and Borkovec, T. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487495. doi: 10.1016/0005-7967(90)90135-6
Miers, A. C., Rieffe, C., Terwogt, M. M., Cowan, R. and Linden, W. (2007). The relation between anger coping strategies, anger mood and somatic complaints in children and adolescents. Journal of Abnormal Child Psychology, 35, 653664. doi: 10.1007/s10802-007-9120-9
Muris, P., Roelofs, J., Meesters, C. and Boomsma, P. (2004). Rumination and worry in non-clinical adolescents. Cognitive Therapy and Research, 28, 539554. doi: 10.1023/B:COTR.0000045563.66060.3e
Muris, P., Roelofs, J., Rassin, E., Franken, I. and Mayer, B. (2005). Mediating effects of rumination and worry on the links between neuroticism, anxiety and depression. Personality and Individual Differences, 39, 11051111. doi: 10.1016/j.paid.2005.04.005
Neeleman, J., Bijl, R. and Ormel, J. (2004). Neuroticism, a central link between somatic and psychiatric morbidity: path analysis of prospective data. Psychological Medicine, 34, 521531. doi: 10.1017/S0033291703001193
Neeleman, J., Sytem, S. and Wadsworth, M. (2002). Propensity to psychiatric and somatic ill-health: evidence from a birth cohort. Psychological Medicine, 32, 793803. doi: 10.1017/S0033291702005901
Nigg, J. T., Nikolas, M., Miller, T., Burt, S. A., Klump, K. L. and von Eye, A. (2009). Factor structure of the Children's Perception of Interparental Conflict Scale for studies of youths with externalizing behavior problems. Psychological Assessment, 21, 450456. doi: 10.1037/a0016564
Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569582. doi: 10.1037/0021-843X.100.4.569
Nolen-Hoeksema, S. (1998). Ruminative coping with depression. In Heckhausen, J. and Dweck, C. S. (eds), Motivation and Self-Regulation Across the Life Span (pp. 237256). New York, NY: Cambridge University Press.
Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109, 504511. doi: 10.1037/0021-843X.109.3.504
Ozer, D. and Benet-Martínez, V. (2006). Personality and the prediction of consequential outcomes. Annual Review of Psychology, 57, 401421. doi: 10.1146/annurev.psych.57.102904.190127
Pennebaker, J. (1982). The Psychology of Physical Symptoms. New York, NY: Springer-Verlag. doi: 10.1007/978-1-4613-8196-9
Rosmalen, J., Neeleman, J., Gans, R. and de Jonge, P. (2007). The association between neuroticism and self-reported common somatic symptoms in a population cohort. Journal of Psychosomatic Research, 62, 305311. doi: 10.1016/j.jpsychores.2006.10.014
Ryckman, N. A. and Lambert, A. J. (2015). Unsuccessful suppression is associated with increased neuroticism, intrusive thoughts, and rumination. Personality and Individual Differences, 73, 8891. doi: 10.1016/j.paid.2014.09.029
Scheuren, R., Sütterlin, S. and Anton, F. (2014). Rumination and interoceptive accuracy predict the occurrence of the thermal grill illusion of pain. BMC Psychology, 2, 22. doi: 10.1186/2050-7283-2-22
Segerstrom, S., Tsao, J., Alden, L. and Craske, M. (2000). Worry and rumination: repetitive thought as a concomitant and predictor of negative mood. Cognitive Therapy and Research, 24, 678688. doi: 10.1023/A:1005587311498
Steimer, T. (2002). The biology of fear-and anxiety-related behaviors. Dialogues in Clinical Neuroscience, 4, 231249.
Suls, J. and Martin, R. (2005). The daily life of the garden-variety neurotic: reactivity, stressor exposure, mood spillover, and maladaptive coping. Journal of Personality, 73, 14851510. doi: 10.1111/j.1467-6494.2005.00356.x
Thompson, B. and Melancon, J. G. (1996). Using Item “Testlets”/“Parcels” in Confirmatory Factor Analysis: An Example Using the PPSDQ-78. ERIC Document No. ED 404 349.
Thomsen, D. K., Mehlsen, M. Y., Olesen, F., Hokland, M., Viidik, A., Avlund, K. and Zachariae, R. (2004). Is there an association between rumination and self-reported physical health? A one-year follow-up in a young and an elderly sample. Journal of Behavioral Medicine, 27, 215231. doi: 10.1023/B:JOBM.0000028496.41492.34
Tiwari, S., Verma, P. C., Singh, P. K. and Tuli, R. (2009). Plants as bioreactors for the production of vaccine antigens. Biotechnology Advances, 27, 449467. doi: 10.1016/j.biotechadv.2009.03.006
Treynor, W., Gonzales, R. and Nolen-Hoeksema, S. (2003). Rumination reconsidered: a psychometric analysis. Cognitive Therapy and Research, 27, 247259. doi: 10.1023/A:1023910315561
Tylee, A. and Gandhi, P. (2005). The importance of somatic symptoms in depression in primary care. Primary Care Companion to the Journal of Clinical Psychiatry, 7, 167176. doi: 10.4088/PCC.v07n0405
Villemure, C. and Bushnell, C. M. (2002). Cognitive modulation of pain: how do attention and emotion influence pain processing? Pain, 95, 195199. doi: 10.1016/S0304-3959(02)00007-6
Watkins, E. (2008). Constructive and unconstructive repetitive thought. Psychological Bulletin, 134, 163206. doi: 10.1037/0033-2909.134.2.163
Watkins, E. and Moulds, M. L. (2007). Reduced concreteness of rumination in depression: a pilot study. Personality and Individual Differences, 43, 13861395. doi: 10.1016/j.paid.2007.04.007
Watkins, E., Scott, J., Wingrove, J., Rimes, K., Bathurst, N., Steiner, H., Kennell–Webb, S., Moulds, M. and Malliaris, Y. (2007). Rumination-focused cognitive behaviour therapy for residual depression: a case series. Behaviour Research and Therapy, 45, 21442154. doi: 10.1016/j.brat.2006.09.018
Watson, D. and Pennebaker, J. (1989). Health complaints, stress, and distress: exploring the central role of negative affectivity. Psychological Review, 96, 234254. doi: 10.1037/0033-295X.96.2.234
Williams, P. G., O'Brien, C. D. and Colder, C. R. (2004). The effects of neuroticism and extraversion on self-assessed health and health-relevant cognition. Personality and Individual Differences, 37, 8394. doi: 10.1016/j.paid.2003.08.001
Yang, M., Kim, B., Lee, E., Lee, D., Yu, B., Jeon, H. and Kim, J. (2014). Diagnostic utility of worry and rumination: a comparison between generalized anxiety disorder and major depressive disorder. Psychiatry and Clinical Neurosciences, 68, 712720. doi: 10.1111/pcn.12193
Zhao, X., Lynch, J. G. and Chen, Q. (2010). Reconsidering Baron and Kenny: myths and truths about mediation analysis. Journal of Consumer Research, 37, 197206. doi: 10.1086/651257
Zhong, J., Wang, C., Li, J., and Liu, J. (2009). Penn State Worry Questionnaire: structure and psychometric properties of the Chinese version. Journal of Zhejiang University Science B, 10, 211218. doi: 10.1631/jzus.B0820189
Zoccola, P. M. (2010). Prolonging the Physiological Stress Response: The Role of Rumination and Recall. University of California, Irvine.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Behavioural and Cognitive Psychotherapy
  • ISSN: 1352-4658
  • EISSN: 1469-1833
  • URL: /core/journals/behavioural-and-cognitive-psychotherapy
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Neuroticism and Somatic Complaints: Concomitant Effects of Rumination and Worry

  • Andrew Denovan (a1), Neil Dagnall (a1) and George Lofthouse (a1)
Submit a response


No Comments have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *