A Clinimetric Evaluation of Allostatic Overload in the General Population

orders [9] , and the interview for the DCPR for measuring the presence of psychosomatic syndromes [5] . Subjects were asked to complete the Psychosocial Index, a selfrated questionnaire providing an appraisal of daily, work and interpersonal stress along with distress and psychological well-being [10] . A two-tailed Student’s t test and 2 were used to compare subjects with and without AO according to sociodemographic and psychiatric variables. Due to the exploratory nature of the study, Bonferroni’s correction was not applied. The sample consisted of 67 subjects (35 females and 32 males) recruited by advertisements. The age ranged from 22 to 59 years (mean = 38.24, SD = 12.01); 34.3% of the participants were married, 7.5% separated or widows and 58.2% unmarried. Concerning psychiatric variables, 14.9% of subjects (n = 10) were diagnosed with anxiety disorders (4 GAD, 3 social phobia, 2 panic and 1 agoraphobia), whereas about 45% (n = 30) fulfilled the criteria for one or more DCPR syndromes (2 somatization conditions, 10 abnormal illness behavior and 18 type A behavior, demoralization or irritable mood). Based on the clinimetric criteria [3] , 29 individuals were evaluated as having AO. Results showed no differences between subjects with and without AO in sociodemographic variables and prevalence of anxiety disorders. Individuals reporting AO were more likely to present with DCPR syndromes (  2 = 3.96, d.f. = 1, p ! 0.05). Table 1 shows the clinimetric differences between the two samples. Patients with AO were found to have higher scores The concept of allostatic load represents the cost of the continual adjustment of the internal milieu required by the organism to adapt to different environmental demands [1] . The majority of studies on allostatic load have focused mainly on identifying its biological components, which are believed to mediate the relationship between stress and illness. Recently, according to the clinimetric approach [2] , Fava et al. [3] introduced specific criteria for evaluating allostatic overload (AO) in the clinical setting. AO refers to a state due to the cumulative interactions of life events and chronic life stressors that, by exceeding the individual’s resources, may constitute a danger to health [3] . The first criterion deals with the specification of the stressor. Stress is measured by evaluating the occurrence of stressful situations in areas of major importance to the patient, resulting in major changes in the patient’s living conditions, social and family circle, and work, as well as subtle and longstanding life situations, such as those occurring at work. In both cases the situation needs to be experienced by the individual as taxing or exceeding his/her coping skills. The second criterion is concerned with the clinical manifestations ranging from psychiatric to psychosomatic/subclinical symptoms, as defined by DSM-IV [4] and/or the Diagnostic Criteria for Psychosomatic Research (DCPR) [5] , and from impairment in social and occupational functioning to decrease in wellbeing [6] . These criteria were shown to yield discrimination of biomarker profiles [7] . According to such criteria, individuals reporting AO presented lower levels of serum proteins, erythrocytes and immune differential count than subjects without AO [7] . Our study aims to evaluate the clinimetric feasibility of this new definition of AO in a sample of the general population. Specifically, our goal is to verify if such clinimetric criteria may discriminate not only among biological correlates, but also among psychometric variables. Sixty-seven individuals recruited by advertisements in the general population participated in the study. Participants were evaluated using the following interviews: a structured interview based on clinimetric criteria for AO [3] , the Structured Clinical Interview for DSM-IV for evaluating the presence of psychiatric diagnoses [8] , the Clinical Interview for Depression (CID) for assessing symptoms related to depression and other psychiatric disReceived: February 2, 2012 Accepted after revision: February 11, 2012 Published online: September 6, 2012