Giessen Symptom Questionnaire

In the diagnosis and treatment of psychosomatic diseases, the patient’s subjective perception of the illness plays a crucial role. To find out how a patient perceives their illness, what they associate it with, and how they relate to their condition, psychologists use the Giessen Symptom Questionnaire.

Description of the Method

The Giessen Symptom Questionnaire for psychosomatic complaints was developed in 1967 by psychologists E. Brähler and J. Scheer. The method allows for the determination of the subjective perception of disease symptoms. The questionnaire covers several areas:

• Overall well-being of the patient;
• Autonomic disorders;
• Dysfunction of internal organs.

Patients are asked to analyze 57 symptoms in relation to themselves and rate their intensity on a 5-point scale (from 0 to 4):

• 4 – strongly pronounced;
• 3 – significant;
• 2 – minor;
• 1 – slight;
• 0 – not expressed.

Additionally, patients can indicate their complaints not listed in the Giessen Questionnaire. Psychological and physiological factors affecting symptoms can also be identified during diagnosis.

In 1993, the method was translated into Russian and adapted by a team of psychologists at the V.M. Bekhterev Psychoneurological Institute. According to this version of the Giessen Questionnaire, a person’s emotions and behavioral stereotypes affect their physical well-being, just as the subjective perception of illness reflects on their emotional state and behavior. This article discusses specifically the adapted version of the questionnaire.

Important to note! In 1968, another similar method was developed – the Giessen Personality Questionnaire. People not familiar with professional psychology sometimes confuse it with the Giessen Symptom Questionnaire. In reality, these are two completely different questionnaires, but psychologists sometimes use them together for a more comprehensive diagnosis.

Validation

The adapted test fully complies with translation rules, is recognized as valid and reliable. The translation was done by psychologists and philologists. However, the test was only approved in its second edition.

Internal Structure

To determine the subjective emotional attitude and perception of illness, please respond to the following statements (on a scale from 0 to 4):

1. General weakness.
2. Heart rhythm disturbances, palpitations or pausing.
3. Feeling of pressure in the abdomen, incomplete bowel emptying.
4. Tearfulness.
5. Itching.
6. Loss of consciousness.
7. Drowsiness.
8. Decreased libido.
9. Joint pain, in the arms.
10. Dizziness.
11. Lower back and back pain.
12. Hyperhidrosis.
13. Neck pain, occipital pain, shoulder pain.
14. Mobility issues.
15. Vomiting.
16. Vision problems.
17. Cramps, seizures, other attacks.
18. Nausea.
19. Weight gain.
20. Lump in the throat, spasm, sensation of throat constriction or other throat discomfort.
21. Frequent urination.
22. Skin diseases, defects, unpleasant sensations.
23. Belching.
24. Increased sensitivity to cold.
25. Heartburn or acidic belching.
26. Hand spasm while writing.
27. Cephalalgia.
28. Increased sensitivity to heat.
29. Low work capacity.
30. Sleep issues.
31. Increased libido.
32. Fatigue.
33. Coordination problems.
34. Swallowing difficulties.
35. Cough.
36. Confusion, ear stuffiness.
37. Limb numbness, burning, tingling.
38. Constipation.
39. Decreased appetite.
40. Hot flashes.
41. Leg heaviness and fatigue.
42. Lethargy.
43. Diarrhea.
44. Paralysis.
45. Chest tingling or pulling pain.
46. Tremors.
47. Sore throat.
48. Redness.
49. Limb freezing.
50. Increased hunger sensation.
51. Stomach pain.
52. Shortness of breath.
53. Lower abdominal pain.
54. Weight loss.
55. Feeling of increased head pressure.
56. Heart attack.
57. Speech disorder.

This is the complete form of the questionnaire. There is also an abbreviated version, which includes 24 questions. In a full diagnostic assessment, only answers to 24 questions are considered, but when examining individual complaints, it is important to consider the intensity of each symptom.

Processing and Interpretation

In processing results, scores are calculated based on scales (summing responses to questions):

• Exhaustion (E scale): 1+7+29+32+36+42.
• Gastrointestinal complaints (M scale): 3+15+18+23+25+51.
• Rheumatic complaints (G scale): 9+11+13+27+41+55.
• Cardiac complaints (H scale): 2+10+20+45+52+56.
• Pressure: sum of scores on the four main scales. Health status is evaluated relative to a normative sample of healthy individuals:
• 50% of healthy individuals score 14 points or less on the general scale;
• 75% score less than 20 points;
• 100% score less than 40 points.

When analyzing all 57 items, special attention should be paid to those with abnormally low and high scores. The psychosomatic significance of these complaints needs to be determined.

Interpretation of Assessment Scales

The results are evaluated using several scales (four main and one additional):

1. Exhaustion (E): Determines overall weakness and loss of interest in life, need for specialist help. Identifies tendencies toward depression and alexithymia.
2. Gastrointestinal complaints (M): Identifies irritable stomach, bowel, and other gastrointestinal organ syndromes.
3. Rheumatic nature (G): Reveals pain syndrome and subjective sensation of spasms.
4. Cardiac complaints (H): Indicates focus on heart and vascular diseases. A high score on this scale suggests a desire for attention or a subconscious wish for help through illness.
5. Pressure (D), or complaint intensity: Determines overall intensity of complaints.

Identifies tendencies toward hypochondria and anxiety. To determine the overall score on a scale, sum all the scores received for responses to questions from the corresponding scale.

Important! Besides interpreting scales, each indicator can be analyzed to create a disease profile in the form of a graph.

Scoring Principles

To calculate scores on scales, raw scores of a particular client are compared with a group of sick individuals and a control group of healthy people and converted into percentages. Gender and age of the subject are considered.

Key for Raw Scores

A specific client’s raw scores are translated into a percentile rank – the proportion of subjects from a standardized group with the same or lower score. As a result, each respondent receives 10 ratings: five from the standardized group of healthy people (K) and five from the standardized group of sick people (P).

For this, special tables are developed to match raw scores to percentile rank (considering gender and age of people in the sample):

• Women aged 18–30;
• Men aged 18–30;
• Women aged 31–45;
• Men aged 31–45;
• Women aged 46–60;
• Men aged 46–60.

Normative Data

Summarizing the test results involves comparing the subject’s outcomes with statistics and results from the standardized sample. In the original study (Germany), 1601 healthy individuals and 4076 individuals with psychosomatic diseases participated. In the analogous study (Russia), 286 healthy individuals and 467 patients with neurological and psychosomatic disorders participated.

Interpretation of Main Scales

The average scores on the scales are as follows (with which raw scores should be compared):

Clinical Significance

The test reveals the subjective level of illness, i.e., the emotional interpretation of the disease from the perspective of the individual. It assesses each subjective sensation and the overall intensity of symptom expression. This helps in finding an individual approach to treatment, diagnosing somatic diseases (if medical examination does not reveal any disturbances, but the patient is in agony).

The success of treatment depends on subjective perception, as does the nature of the patient’s relationships with others. The questionnaire can be used not only for individual diagnosis but also for monitoring the dynamics of psychotherapy, diagnosing dependent relationships (spouses sometimes adopt each other’s symptoms), and for adjusting family relations when complaints negatively affect members.

Important! The test is not suitable for medical diagnosis. It is a method of psychological diagnostics. The Giessen Symptom Questionnaire identifies not the real symptoms of a disease, but the subjective sensations of the client. The method can be applied in group and individual psychotherapy for primary and secondary diagnostics.