Unraveling Psychological Distress in Temporomandibular Disorders: The Interplay of Somatization, Oral Behaviors, and Personality Traits.

PURPOSE: This study examined associations between temporomandibular disorders (TMDs), somatization, and their comorbidity with oral behaviors, personality traits, and psychological distress; explored interconnections among these factors; and identified predictors of moderate-to-severe distress in multiethnic Southeast Asian young adults.

METHODS

A cross-sectional survey among university students collected sociodemographic information and assessments using the Short-form Fonseca Anamnestic Index, Patient Health Questionnaire (PHQ)-15, Oral Behaviors Checklist (OBC), Big-Five Personality Inventory-10, and PHQ-4. Data were analyzed using Chi-square test, non-parametric methods, and logistic regression (α = 0.05).

RESULTS

Of 910 participants (mean age: 22.5±4.4 years; 65.9% female), 53.3% reported no TMDs/somatization (NS), 8.5% TMDs only (TO), 27.3% somatization only (SO), and 11.0% comorbidity (CS). Significant group differences were observed in OBC, personality traits (openness, conscientiousness, agreeableness, neuroticism), and PHQ-4 scores, with the highest burden in CS (p range: 0.001-0.006). Moderate correlations (rs = 0.40-0.52) were observed between TMD severity with OBC, somatization with OBC and PHQ-4 domains, and oral behavior with PHQ-4. In multivariate analysis, somatization (OR 3.99), comorbidity (OR 4.76), oral behavior (OR 1.04), and neuroticism (OR 0.81) were predictors of moderate-to-severe distress.

CONCLUSION

Somatization, rather than TMD, was the primary determinant of psychological distress, highlighting the need for integrative, culturally informed care.