Janet Baker 1 , David I. Ben-Tovim 2 , Andrew Butcher 1 , Adrian Esterman 3 , Kristin McLaughlin 2

1 Flinders University, Speech Pathology and Audiology, Adelaide

2 Flinders Medical Centre, Epidemiology, Adelaide

3 University of South Australia, Nursing and Midwifery, Adelaide

Background: Current themes regarding etiology suggest Functional Voice Disorders (FVD) may develop in response to negative emotions following stressful life events, that personality traits may influence ways of coping and that FVD may reflect the suppression or repression of negative emotions. To date, the empirical evidence for these etiological hypotheses is scarce. Objectives: To examine the life events and difficulties experienced by women with FVD during the 12 months preceding onset, and to determine the women's patterns of emotional expression, coping style and attachment in close adult relationships. Methods: The study was a case-control design involving women 18-80 years of age, with a recently diagnosed FVD (n=73) or Organic Voice Disorder (OVD) (n=55), and a control group (n=66) with perceptually normal voices, broadly matched for age and occupation. Diagnosis was made with reference to the Diagnostic Classification System for Voice Disorders (DCSVD) developed for this project. Data collected as putative risk factors for FVD included the Life Events and Difficulties Schedule (LEDS) and Conflict Over Speaking Out (COSO) situations. Additional data included Attachment Style and five standardized self-report questionnaires targeting Coping Styles and Personality Traits related to emotional expressiveness. Results: Univariate analysis showed women with FVD in comparison to OVD and Controls experienced more severe events, major difficulties, COSO events and COSO difficulties. Psychological traits data showed FVD women reported: higher levels of anxiety, anger and depression; lower levels of optimism and social support; emotional expression-in; anxious rather then repressive coping style; more ambivalence over the expression of negative emotion; less emotional expressiveness in family of origin; more insecure and fearful attachment and a stronger history of violence, strangulation or sexual abuse. Logistic regression showed four major components to be predictive of FVD group in comparison to the control group accounting for 84.9% of the variance: severe events, moderate events, severe COSO and mild COSO difficulties. Personality traits were not predictive of FVD or control group, and no confounding was present. Conclusion: This is the largest and most definitive study of its kind to show the possible inter-relationship between stressful life events and difficulties, COSO situations and dispositional factors in the etiology of FVD in women. The results support clinicians incorporating psychotherapeutic approaches in the assessment and management of FVD.  

Key Words: Functional voice disorders, Organic voice disorders, Etiology, Life events and difficulties, Conflict over speaking out, Coping style, Attachment style, Emotional expressiveness, Emotion processing deficits.

Janet Baker 1 , Richard D. Lane 2

1 Flinders University, Speech Pathology and Audiology, Adelaide

2 University of Arizona, Psychiatry and Neuroscience, Tucson

Cate Madill 1 , Robert Heard 1 , Christine Sheard 1 , Ross Menzies 1

1 University of Sydney, Faculty of Health Sciences, Sydney

Geert Berghs 1 , Annemie Gielis 2 , Marian Vervoort 2 , Felix de Jong 2

1 singing teacher, , Bussum

2 Lab.Exp.ORL, Dep.ENT, Head and Neck Surgery, Leuven