The four-cluster spectrum of mind-body interrelationships: An integrative model

• Published in: Journal of psychosomatic research Vol. 121; pp. 148 - 149
• Main Authors: Ezra, Yacov, Hammerman, Oded, Shahar, Golan
• Format: Journal Article
• Language: English
• Published: London Elsevier Inc 01.06.2019; Elsevier Science Ltd
• Subjects: Autoimmune diseases; Biopsychosocial aspects; Complaints; Conceptual models; Conversion disorder; Efficacy; Learning processes; Medical personnel; Mental disorders; Mental health professionals; Mind and body; Pathology; Pathophysiology; Physical symptoms; Physicians; Psychobiology; Psychological distress; Psychological mechanisms; Psychological processes; Reactivity; Selective attention; Sensitization; Stress
• ISSN: 0022-3999; 1879-1360
• DOI: 10.1016/j.jpsychores.2019.03.147

Aim: Despite the shift towards a biopsychosocial paradigm of medicine, many physicians and Mental Health Professional (MHPs) find it difficult to treat patients with psychosomatic disorders. One possible reason for this is the lack of a comprehensive model, incorporating a biopsychosocial framework and rooted in an understanding of psychobiological pathways. This would enable better communication between physicians and MHPs, allowing them to deliver coordinated and stratified treatments. Methods: A four-tiered conceptual model of mind-body interrelationships is suggested, based on pathophysiological and psychopathological mechanisms, to help optimize the treatment of somatic complaints. Results: This four clusters consist of: (1) Organic Conditions: Structural, or degenerative processes that can affect psychological responses but are not exacerbated by stress. (2) Stress Exacerbated Diseases: Biological disorders with distinct pathophysiology, such as inflammatory or autoimmune diseases, whose progression is exacerbated by stress. (3) Functional Somatic Syndromes: Conditions wherein heightened sensitivity to stimuli together with hyper-reactivity of the autonomic system form a "vicious cycle" of mutually enhancing learning processes. These processes involve both biological mechanisms, such as central sensitization and psychological mechanisms such as catastrophization and selective attention. (4) Conversion Disorder: Physical manifestations of psychological distress, expressed somatically. Symptoms are solely an expression of problems in patients' psychic functioning and are not caused by biological pathology. Conclusion: Being rooted in an understanding of psychobiological pathways of illness, the proposed model enables a new way of discerning which form of mind-body interaction exists in different diseases and proposes a way of matching treatment plans accordingly, to enhance the efficacy of treatment.