Abstract
Objective: To examine the associations between somatic symptoms, emotional features (alexithymia), and cognitive functions (specifically, premorbid intelligence and verbal fluency) among patients attending a psychiatric outpatient clinic. While previous studies have frequently linked somatization with emotional dysregulation and cognitive dysfunction, these relationships have not been adequately evaluated in diverse clinical populations encompassing multiple psychiatric diagnoses. Our study aimed to fill this gap by analyzing these variables in a heterogeneous patient sample.

Methods: A total of 72 patients (62.5% female; mean age = 34.35±12.59 years) attending a university hospital psychiatric outpatient clinic were recruited to this study. The diagnoses included anxiety disorders, major depressive disorder, bipolar disorder, psychotic disorders, obsessive-compulsive disorder, and attention deficit hyperactivity disorder. Data were collected using a sociodemographic form and validated psychometric instruments, including the Patient Health Questionnaire-15 (PHQ-15) to assess somatic symptom severity, the Toronto Alexithymia Scale-20 (TAS-20) to evaluate alexithymia, the Verbal Fluency Test, and the National Adult Reading Test-Turkish version (NART-TR) to estimate premorbid intelligence. Participants were grouped into high and low somatization categories based on their PHQ-15 scores. Comparative analyses and multiple linear regression models were used to investigate the predictive factors.

Results: Patients with high somatic symptoms displayed significantly elevated TAS-20 total scores, particularly in the Difficulty Identifying Feelings and Difficulty Describing Feelings subscales (p < 0.001). Higher premorbid intelligence, reflected by lower NART-TR error scores, was significantly associated with greater somatic symptom severity (B = -0.21, p = 0.007). Verbal fluency showed a weak positive correlation with somatization (r = 0.237, p < 0.05) but was not a significant predictor in the regression model (p = 0.976). Male sex was a significant negative predictor (B = -4.47, p = 0.002), while the presence of acute psychiatric disorder positively predicted somatization severity (B = 4.75, p = 0.006). The final regression model accounted for a significant proportion of the variance in somatic symptom scores (p < 0.001).

Conclusion: Somatization is intricately linked to emotional processing deficits, as reflected by high alexithymia scores, and correlates with higher premorbid cognitive capacity. Thus, individuals with higher cognitive functioning may exhibit increased somatic concerns, potentially due to enhanced interoceptive awareness or heightened attention to physical symptoms. However, verbal fluency did not emerge as a significant predictor, underscoring the nuanced role of specific cognitive domains in somatization. Clinically, the results highlight the need to assess both emotional awareness and cognitive characteristics when addressing somatic symptoms in psychiatric populations. Future research should further explore these associations using larger,

Key words: Alexithymia, Premorbid intelligence, Psychiatric outpatients, Somatization, Verbal fluency