Open research questions in Psychosomatic Disorders and Their Treatments

What the literature leaves open

• 4) likewise awaits direct empirical evaluation within occupational, rather than purely clinical or educational, samples; the R2MR and MABT evidence cited above, while supportive in adjacent contexts, has not yet been tested against alexithymia specifically as an occupational outcome.

  ALEXITHYMIA IN HIGH-STRESS OCCUPATIONS: AN INTEGRATIVE RISK AND INTERVENTION MODEL FOR MILITARY, HEALTHCARE, AND LAW ENFORCEMENT PERSONNEL · 2026 · DOI

• These findings suggest that visual imagery may represent a previously under-recognized cognitive factor contributing to emotional dysregulation and self-injurious behaviour in EUPD.

  Voluntary visual imagery and non-suicidal self-injury in patients with emotionally unstable personality disorder · 2026 · DOI

• In the present meta-regression analysis, increased CS dose was significantly associated with the worsening of depressive symptoms, although the evidence is limited by the small number of studies. Psychiatric Symptoms Associated with Corticosteroid Use In adults, the relationship between CS dosage and psychi- atric symptoms other than depression has been insufficiently investigated. Future research employing statistical methods to determine the threshold for psychiatric symptom onset is warranted.

  Psychiatric Symptoms Associated with Corticosteroid Use: A Systematic Review and Meta-analysis · 2026 · DOI

• Several limitations are present in this study, as in any other study. The first limitation pertains to gender and age differ- ences. Reporting on certain values, attitudes, and behaviours can be influenced by life experiences accumulated over time and psychological adaptation to events that occurred long ago in childhood. It’s worth noting that this study exclusively used self- report questionnaires, so the possibility that participants’ responses were either conservative or exaggerated com- pared to reality cannot be ruled out. Another limitation relates to the method used. Since only quantitative data collection methods were employed (all scales were Likert- type), participants were required to limit their responses. The inclusion of an additional method, such as interviews or observations, could have validated the accuracy of the responses and provided additional insights. The potential for false completion of questionnaires is another significant limitation. This could occur due to per- sonal reasons, misconceptions about oneself, misunder- standing of questionnaire items or response scales, as well as other factors such as fatigue, lack of concentration, or external influences. There is a possibility that questionnaire items were not completed entirely honestly. To limit this bias, we have computed the internal consistency of each instrument used to assess the main concepts and Cronbach`s alpha is good for each. Furthermore, participants completed questionnaires voluntarily and privacy was assured during the process of completion. We suggest that future research includes longi- tudinal studies to observe the evolution, frequency, and sig- nificance of symptoms in daily life at different stages of life. Although the present study identified significant predictive relationships between childhood trauma, attachment styles, alexithymia, and somatization, the cross-sectional design and analytical approach did not allow for formal testing of mediating or moderating mechanisms. Previous research has suggested that attachment insecurity and alexithymia may function as mediators in the relationship between early traumatic experiences and somatic symptom expression (Sheinbaum et al., 2014). Future studies should therefore employ longitudinal designs and structural equation model- ling to examine whether attachment styles and alexithymia mediate or moderate the impact of childhood trauma on somatization. Such approaches would allow for a more pre- cise clarification of the underlying mechanisms and tempo- ral pathways involved in the somatization process. Finally, because the process of how somatisation is determined and maintained is also a process of perceptual influence, comparative studies with people from different countries would be of value for future research. Further- more, therapeutic interventions focusing on improving emotional awareness, fostering secure attachment relation- ships, and addressing unresolved trauma may hold prom- ise for reducing somatic symptom severity, as suggested by contemporary evidence (Yavuz et al., 2019; De Vroege et al., 2018). Author Contribution RC and CMT contributed equally to designing, collecting data, analysing results and writing the manuscript. CMT re- vised the manuscript. Funding The authors declare that the research was conducted in the absence of any funding. Data Availability The raw data supporting the conclusions of this arti- cle will be made available by the authors, without undue reservation.

  The Predictive Role of Traumatic Experiences, Attachment, and Alexithymia on the Somatisation Process · 2026 · DOI

• • The BNUN group, although standardized, lacks more specific information on the subtypes of the sequences such as length and other protocols used in addition to the core sequence protocols. • Since the pragmatic group apparent reliance on the clinical decision-making process, the replicability of the outcome in other settings might vary. • This type of investigation is not intended to confirm a specific physiological mechanism for the treatment protocols but rather to evaluate whether the hypothesis for the pathology and treatment is consistent with the results. Mrs. Mischler contributed to this work with editing, revision, and conceptual elements.

  A Retrospective CDSS Analysis to Compare Standardized and Non-Standardized Treatment for Central Sensitization Using Systemic Manual Therapy · 2026 · DOI

• Candidate biomarkers, including functional connectivity alterations, autonomic dysregulation, and HPA axis measures, offer pathophysiological insight but remain insufficiently validated for routine diagnosis.

  Functional Neurological Disorder: Neurobiological Mechanisms, Biomarkers, and Integrated Treatment in a Female-Predominant Neuropsychiatric Condition · 2026 · DOI

• Additionally, future research should explore the individual effectiveness of EFT and EMDR in reducing alexithymia and its dimensions through comparative experimental studies.

  فعالية برنامج إرشادي قائم على العلاج المتمركز حول المشاعر (EFT) والعلاج بإبطال التحسس وإعادة المعالجة بحركات العين (EMDR) لخفض الألكسيثيميا لدى متأخرات الإنجاب بمحافظة جدة The effectiveness of a group therapy program combining Emotion-Focused Therapy (EFT) and Eye Movement Desensitization and Reprocessing Therapy (EMDR) in reducing alexithymia among women who d · 2025 · DOI

• OBJECTIVE: Neurocognitive underpinnings are implicated in the aetiology and maintenance of body dysmorphic disorder (BDD); however, inconsistent findings across a range of neurocognitive domains suggest that a comprehensive synthesis of the literature using a hierarchical framework of neurocognition is needed.

  A systematic review of neurocognition and social cognition in body dysmorphic disorder · 2025 · DOI

• Longitudinal results are scarce, mixed, and require refining, individual studies suggest self-concept of bodily weakness, anxiety and depression to be predictive for persistent SSD and physical functioning.

  Psychological risk factors of somatic symptom disorder: A systematic review and meta-analysis of cross-sectional and longitudinal studies · 2024 · DOI

• BACKGROUND: Despite its high prevalence in all psychiatric disorders and its widely demonstrated clinical relevance as a marker of both clinical severity and poorer treatment response, a scientifically validated definition of dissociation remains controversial, and the understanding of its pathogenesis is still somewhat lacking.

  Are Traumatic Disintegration, Detachment, and Dissociation Separate Pathogenic Processes Related to Attachment Trauma? A Working Hypothesis for Clinicians and Researchers · 2023 · DOI

• Presently, little is known about what specific facets of alexithymia might be impaired in ASD, or whether deficits are present for both negative and positive emotions.

  Alexithymia in autism spectrum disorder · 2023 · DOI

• Future studies that use depressive measures designed for ID populations, which control for confounds and which explore low mood irrespective of psychiatric diagnosis, are warranted to better delineate the behaviours associated with depression in this population (PROSPERO 2018: CRD42018103244).

  A systematic review of the behaviours associated with depression in people with severe–profound intellectual disability · 2021 · DOI

• However, little is known about SOC's temporal stability and its potential to predict changes in psychopathological symptom severity in different settings.

  <scp>Pre‐rehabilitation</scp> sense of coherence as a predictor of symptom change after rehabilitation · 2020 · DOI

• (2016) strongly argue against the proposal of WHO ICD-11 (International Classification of Diseases, 11th revision) to include Gaming Disorder as a new diagnostic category emphasizing the fact that no consensus exists on the definition and the risk that gaming will be demonized and gamers stigmatized resulting in a tsunami of false positive referrals to treatment.

  ICD-11 Gaming Disorder: Needed and just in time or dangerous and much too early? · 2017 · DOI

• Although clinical judgment generally remains a poorly understood and largely neglected skill (Lilienfeld, Ammirati, & David, 2012), we do know that it plays a more prominent role in instances of diagnostic uncertainty (Redelmeier, Ferris, Tu, Hux, & Schull, 2001).

  The messiness of LD identification: Contributions of diagnostic criteria and clinical judgment. · 2017 · DOI

• At present, diagnosing an LD is a challenging task given the lack of consensus regarding the best and more comprehensive method for the diagnosis of LDs (Berninger, Richards, & Abbott, 2015).

  The messiness of LD identification: Contributions of diagnostic criteria and clinical judgment. · 2017 · DOI

• This study clarified contradictory findings regarding whether depression and somatic symptoms are associated more strongly with each other in non-Western countries than in Western countries, by examining the relationships of the two variables with negative mood regulation expectancies (NMRE).

  Depression and somatic symptoms in Japanese and American college students: Negative mood regulation expectancies as a personality correlate · 2017 · DOI

• There is some suggestion of a differing presentation and course of unipolar depression between the common genetic subtypes of PWS which warrants further investigation.

  Prader Willi syndrome: systematic review of the prevalence and nature of presentation of unipolar depression · 2016 · DOI

• The purpose of Mixed Anxiety-Depression Disorder would have been to capture the many individuals who experience distress that does not fall neatly into the traditional set of disorders in the Anxiety or Mood Disorder categories, but critics believed it to be a poorly understood, unstable disorder that threatened to turn subthreshold symptoms into a diagnosis (Batelaan, Spijker, de Graaf, and Cuijpers, 2012).

  Expansion of the Concept of Mental Disorder in the DSM-5 · 2014

• Although pain insensitivity has received considerable specific discussion, the likelihood of a generalized dysfunction in the somatosensory systems in BPD has not been explored.

  Somatosensory Processing and Borderline Personality Disorder Features: A Signal Detection Analysis of Proprioception and Exteroceptive Sensitivity · 2013 · DOI

• BACKGROUND: While optimally activities are provided at those moments when the individual with profound intellectual and multiple disabilities (PIMD) is 'focused on the environment' or 'alert', detailed information about the impact that the design and timing of the activity has on alertness is lacking.

  Catch the wave! Time‐window sequential analysis of alertness stimulation in individuals with profound intellectual and multiple disabilities · 2012 · DOI

• Several studies have reported dissociative symptoms in different somatoform and conversion disorders, but limited data are available on dissociation among patients with FSD.

  Somatoform and Psychoform Dissociation Among Women with Orgasmic and Sexual Pain Disorders · 2011 · DOI

• The current analyses have demonstrated for the first time that the latent pathology associated with each PD threshold varies widely, and thus has quantified what others accurately have speculated.

  Personality Disorder Diagnostic Thresholds Correspond to Different Levels of Latent Pathology · 2011 · DOI

• The Depression factor was also made up of three items (G2: dysphoric mood, G4: impaired tolerance to normal stress, and D4: personal hygiene/social attentiveness), and could be validated with the BDI.

  Factor Analysis of the Scale of Prodromal Symptoms: Differentiating between Negative and Depression Symptoms · 2011 · DOI

• The Negative symptom factor consisted of three items (N1: social anhedonia and withdrawal, N3: decreased expression of emotion; N4: decreased experience of emotions and self), and could be validated with the PANSS Negative symptoms subscale.

  Factor Analysis of the Scale of Prodromal Symptoms: Differentiating between Negative and Depression Symptoms · 2011 · DOI

Most-cited papers in Psychosomatic Disorders and Their Treatments

• Development, Reliability, and Validity of a Dissociation Scale · The Journal of Nervous and Mental Disease · 1986 · 2,847 citations
• The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. · Journal of Abnormal Psychology · 2017 · 2,542 citations
• An introduction to the Rasch measurement model: An example using the Hospital Anxiety and Depression Scale (HADS) · British Journal of Clinical Psychology · 2007 · 778 citations
• Life Event Dimensions of Loss, Humiliation, Entrapment, and Danger in the Prediction of Onsets of Major Depression and Generalized Anxiety · Archives of General Psychiatry · 2003 · 664 citations
• Validating an Efficient Method to Quantify Motion Sickness · Human Factors The Journal of the Human Factors and Ergonomics Society · 2011 · 573 citations
• The Development and Psychometric Characteristics of the Somatoform Dissociation Questionnaire (SDQ-20) · The Journal of Nervous and Mental Disease · 1996 · 484 citations
• A Short Clinical Diagnostic Self-rating Scale for Psychoneurotic Patients · The British Journal of Psychiatry · 1966 · 469 citations
• Disintegrated experience: The dissociative disorders revisited. · Journal of Abnormal Psychology · 1991 · 413 citations
• Somatization and the recognition of depression and anxiety in primary care · American Journal of Psychiatry · 1993 · 401 citations
• Bruxism is mainly regulated centrally, not peripherally · Journal of Oral Rehabilitation · 2001 · 398 citations

Most recent work

• An Empirical Examination of the Association Between Alexithymia and Some Imaginal Characteristics: Theoretical and Methodological Considerations · Current Problems of Psychiatry · 2026
• Bridging global gaps in somatoform disorder · Annals of Medicine & Surgery · 2026
• PSYCHOSOMATIC STATUS OF EMERGENCY RESPONSE MEDICAL TEAM PERSONNEL IN THE DISASTER MEDICINE SERVICE OF THE REPUBLIC OF CRIMEA · Crimea Journal of Experimental and Clinical Medicine · 2026
• Relationship between alexithymia and quality of life in intensive care worker: a correlational study · Annals of Medicine & Surgery · 2026
• Somatoform Bozukluklarda Bilişsel Davranışçı Terapi: Sistematik Bir Derleme · Journal of Social Research and Behavioral Sciences · 2026
• Developing a prediction model for the risk of dissociative psychopathology from trauma and trait responsiveness to verbal suggestion · medRxiv · 2026
• Civilian post-traumatic epilepsy: Clinical and socioeconomic characteristics · Epilepsy & Behavior · 2026
• Phenomenology and clinical relevance of minor neurological signs in child neurology and psychiatry · Frontiers in Neurology · 2026
• Neurovascular Conflicts of the Anterior Inferior Cerebellar Artery: A Case Series from a Psychiatry Outpatient Department · Academic Bulletin of Mental Health · 2026
• Seizure duration in functional/dissociative seizures: measurement, variability and diagnostic significance · Seizure · 2026

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