Open research questions in Psychosomatic Disorders and Their Treatments

What the literature leaves open

• There is a lack of research on the effects of alternative interventions, such as the Twiddle muff, on the emotional responses of hospitalized cognitively impaired persons. There is a need to explore the use of AI-based facial emotion analysis in clinical settings.

  The effects of Twiddle muff vs. physical restraints on facial emotions of hospitalized cognitively impaired persons · 2026 · DOI

• To complement the AI-based facial emotion analysis, which has not been validated in this population, we used the Faces Rating Scale as an intuitive clinician-rated measure because of its practicality and established use in pain assessment.

  The effects of Twiddle muff vs. physical restraints on facial emotions of hospitalized cognitively impaired persons · 2026 · DOI

• Investigating the neural mechanisms underlying the Emotion Egocentricity Bias, - Examining the relationship between the HGF model and other cognitive biases, - Exploring the applications of the HGF model in real-world situations

  Emotional egocentricity bias is modulated by implicit expectations of interpersonal emotional contingencies and perceptual noise · 2026 · DOI

• The lack of understanding of how implicit expectations of interpersonal emotional contingencies and perceptual noise modulate Emotion Egocentricity Bias, - The need for a computational model to examine the influence of one's own emotional state on judgments of others' emotions

  Emotional egocentricity bias is modulated by implicit expectations of interpersonal emotional contingencies and perceptual noise · 2026 · DOI

• Most research has studied functional seizures or functional motor symptoms separately. The few studies that have directly compared the subtypes have been relatively small.

  Evidence for a diagnostic distinction between functional seizures and functional motor symptoms from the TriNetX electronic health record database · 2026 · DOI

• Single-centre study, - Limited sample size, - Recruitment and data collection proceeded from 11/2023 to 04/2025, - No long-term follow-up

  Cognition and metacognition in functional motor symptoms and functional seizures: a case–control study · 2026 · DOI

• Investigate the relationship between cognitive symptoms and metacognitive confidence in FND, - Examine the effectiveness of interventions targeting cognitive symptoms in FND, - Explore the neural mechanisms underlying cognitive symptoms in FND

  Cognition and metacognition in functional motor symptoms and functional seizures: a case–control study · 2026 · DOI

• The specific dimensions of childhood trauma and their relationships to FMD symptoms are unclear. The mediating roles of affective symptoms and multimorbidity in the relationship between childhood trauma and FMD symptoms are unclear.

  Developmental trauma in functional motor disorder: the mediating roles of affective symptoms and multimorbidity · 2026 · DOI

• The study identifies a gap in knowledge regarding the specific characteristics of stressors that are most strongly linked to anxiety and depressive symptoms. The study notes that prior work has not fully considered the diversity of stressor characteristics and their associations with mental health outcomes.

  Life experiences of humiliation, entrapment, and frontoparietal-cerebellar connectivity predict adolescent anxiety and depression symptoms · 2026 · DOI

• The complexity of interoception and its relation to various physiological and psychological processes. The need to develop effective methodologies to analyze HEP and its clinical applications. The challenge of exploring the clinical relevance of HEP in various disorders, such as psychiatric disorders and cardiac-related conditions.

  Heartbeat-evoked potentials reveal interoceptive dysfunction in clinical disorders: Experimental frameworks and promising applications · 2026 · DOI

• The need for a comprehensive understanding of the neural mechanisms underlying interoception and HEP. The lack of research on top-down predictive perception and top-down regulation in clinical contexts. The need to explore the clinical relevance of HEP in various disorders.

  Heartbeat-evoked potentials reveal interoceptive dysfunction in clinical disorders: Experimental frameworks and promising applications · 2026 · DOI

• future studies may strive to unravel the mechanisms linking SSD potentially with alexithymia, narcissism, ERI, and burnout, - further research is needed to examine the associations between SSD and other psychological factors in different populations and settings

  Associations of personality traits and work-related stress with positive somatic symptom disorder screening – A cross-sectional study · 2026 · DOI

• Empirical evidence on psychological factors associated with SSD is scarce. Results of empirical studies examining SSD may apply in large parts to BDD, but are still missing.

  Associations of personality traits and work-related stress with positive somatic symptom disorder screening – A cross-sectional study · 2026 · DOI

• The complexity and diversity of interoceptive phenomena make it challenging to develop a unified theory of interoception. The lack of transfer of interoceptive training across modalities is a challenge for the development of effective interventions. The dissociability of interoceptive modalities poses a challenge for the measurement and clinical application of interoception.

  There is no such thing as interoception · 2025 · DOI

• Examining the neural substrates specific to each modality, - Investigating the cognitive processes involved in different interoceptive tasks, - Longitudinal studies tracking the development of interoceptive abilities across modalities

  There is no such thing as interoception · 2025 · DOI

• One of the challenges identified is the difficulty in describing and measuring DPDR. Another challenge is the lack of established interventions targeting transdiagnostic DPDR. The paper also highlights the challenge of generalising the findings to different populations and contexts.

  Depersonalisation-derealisation as a transdiagnostic treatment target: a scoping review of the evidence in anxiety, depression, and psychosis · 2025 · DOI

• further research is needed to develop effective treatments targeting transdiagnostic DPDR, - studies with larger samples and follow-up assessments are needed, - research on the relationship between depressive disorders and transdiagnostic DPDR is needed

  Depersonalisation-derealisation as a transdiagnostic treatment target: a scoping review of the evidence in anxiety, depression, and psychosis · 2025 · DOI

• Inconsistent results in prior meta-analyses regarding the impact of dissociation on treatment outcomes in PTSD patients. Limited high-quality clinical trials investigating the relationship between dissociation and treatment efficacy.

  Is dissociation predicting the efficacy of psychological therapies for PTSD? Results from a randomized controlled trial comparing Dialectical Behavior Therapy for PTSD (DBT-PTSD) and Cognitive Processing Therapy (CPT) · 2025 · DOI

• The study did not disentangle genetic from shared environmental influences. An estimation of shared environment based on a comparison of first-and second-degree relatives would have limited power. Selective dropout could lead to underestimating disease prevalence in relatives of affected individuals

  Familial coaggregation and shared familiality of functional and internalizing disorders in the Lifelines cohort · 2025 · DOI

• The challenge of managing persistent physical symptoms in healthcare settings. The difficulty of classifying and treating persistent physical symptoms. The need to investigate the effectiveness of internet-delivered exposure therapy for patients with persistent physical symptoms.

  Effect of internet-delivered exposure therapy versus healthy lifestyle promotion for patients with persistent physical symptoms (SOMEX1): a randomized controlled trial with planned moderator analysis · 2025 · DOI

• The extent to which exposure therapy has effects beyond existing routine care interventions is unclear. It is unclear who benefits the most from exposure therapy. The effectiveness of internet-delivered exposure therapy for patients with persistent physical symptoms is not well established.

  Effect of internet-delivered exposure therapy versus healthy lifestyle promotion for patients with persistent physical symptoms (SOMEX1): a randomized controlled trial with planned moderator analysis · 2025 · DOI

• The complexity of the self and its definition. The mixed results in meditation literature. The need to distinguish between different types of meditation and their effects on the self.

  Meditation and interoception: a conceptual framework for the narrative and experiential self · 2024 · DOI

• distinguish and specify between different meditations and include meditation experience to explore their individual effects, - clearly differentiate between mindfulness and interoception as these are two similar yet distinct mind-body constructs and teasing those apart should help clarify some of the confusion, - consider and incorporate individual practitioner histories through the lens of early life experiences, trauma, and the attachment relationship

  Meditation and interoception: a conceptual framework for the narrative and experiential self · 2024 · DOI

• The study identifies several challenges, including the complexity of the condition and the need to develop effective interventions. The paper notes that the mechanisms of action of CBT are not well understood. The study highlights the need for further research to develop effective treatments for dissociative seizures.

  How does cognitive behavior therapy for dissociative seizures work? A mediation analysis of the CODES trial · 2024 · DOI

• The mechanisms of action of CBT for dissociative seizures are not well understood. There is a need to identify the mediators of the DS-CBT effect on outcome variables. The study aims to address this gap by evaluating the putative treatment mechanisms of DS-CBT.

  How does cognitive behavior therapy for dissociative seizures work? A mediation analysis of the CODES trial · 2024 · DOI

Most-cited papers in Psychosomatic Disorders and Their Treatments

• An Inventory for Measuring Depression · Archives of General Psychiatry · 1961 · 28,411 citations
• Comparison of Beck Depression Inventories-IA and-II in Psychiatric Outpatients · Journal of Personality Assessment · 1996 · 4,942 citations
• The twenty-item Toronto Alexithymia scale—I. Item selection and cross-validation of the factor structure · Journal of Psychosomatic Research · 1994 · 4,162 citations
• Development, Reliability, and Validity of a Dissociation Scale · The Journal of Nervous and Mental Disease · 1986 · 2,847 citations
• Behavioral Study of obedience. · Journal of Abnormal & Social Psychology · 1963 · 2,833 citations
• The Brief Illness Perception Questionnaire · Journal of Psychosomatic Research · 2006 · 2,809 citations
• Hopelessness depression: A theory-based subtype of depression. · Psychological Review · 1989 · 2,618 citations
• Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. · Journal of Consulting and Clinical Psychology · 1996 · 2,602 citations
• The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. · Journal of Abnormal Psychology · 2017 · 2,542 citations
• The Revised Illness Perception Questionnaire (IPQ-R) · Psychology and Health · 2002 · 2,330 citations

Most recent work

• Stigma in functional neurological disorder; a longitudinal study · Journal of Psychosomatic Research · 2026
• Splitting FND: Differences in targeted therapies for functional movement disorders and functional seizures · Social Science & Medicine · 2026
• Temporal pathways between alexithymia, psychological distress, and pain: An autoregressive mediation analysis. · Health Psychology · 2026
• Impaired Processing of Bodily Signals Is Associated With Borderline Personality Traits: Insights From the Predictive Coding Model · International Journal of Psychology · 2026
• The Relation Between Childhood Experiences and Borderline Personality Symptoms in Non-Clinical Population. The Role of Dissociative Experiences and Invalidating Environment · The Journal of Psychology · 2026
• The conceptualization and assessment of dissociation: An umbrella review of synthesis studies · Clinical Psychology Review · 2026
• Evidence for a diagnostic distinction between functional seizures and functional motor symptoms from the TriNetX electronic health record database · Psychological Medicine · 2026
• An Empirical Examination of the Association Between Alexithymia and Some Imaginal Characteristics: Theoretical and Methodological Considerations · Current Problems of Psychiatry · 2026
• Psychiatric Symptoms Associated with Corticosteroid Use: A Systematic Review and Meta-analysis · CNS Drugs · 2026
• From symptoms to function: the PAD-S decision matrix for severe mental illness—a transdiagnostic clinical translation framework for ICD-11/ICF-aligned psychotherapy documentation · Frontiers in Psychiatry · 2026

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