The Four-Cluster Spectrum of Mind-Body Interrelationships: An Integrative Model

Abstract

Despite the shift toward a biopsychosocial paradigm of medicine, many physicians and mental health professionals (MHPs) find it difficult to treat patients with psycho-somatic disorders. This situation is particularly troublesome due to the high prevalence of these conditions. Although progress has been made over the last few decades in understanding mechanisms underlying the mind-body relationship, disparities remain between research and its clinical implementation. One possible reason for this is the lack of a comprehensive, agreed-upon model that incorporates a biopsychosocial framework and is rooted in an understanding of the various psychobiological pathways. Such a model would enable better communication between physicians and MHPs, allowing them to provide coordinated, stratified treatment. In this paper, four archetypal case studies, together with standard care options are presented to illustrate the current state of affairs. A four-tiered conceptual model of mind-body interrelationships based on pathophysiological and psychopathological mechanisms is suggested to help optimize the treatment of somatic complaints. This Four-Cluster model consists of: (1) Organic Conditions: Structural, or degenerative processes that can affect mood and psychological responses but are not clearly exacerbated by stress. (2) Stress Exacerbated Diseases: Biological disorders with a distinct pathophysiology, such as inflammatory or autoimmune diseases, whose progression is clearly 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 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. Finally, suggested management of the aforementioned case studies is presented through the lens of the Four-Cluster model and a proposed integration of our model with existing theories is discussed. As it is rooted in an understanding of psychobiological pathways of illness, the proposed model enables a new way to discern which form of mind-body interaction is manifesting in different diseases and proposes a way to coordinate treatment plans accordingly, to enhance the accuracy and efficacy of care.

Characteristics and economic burden of frequent attenders with medically unexplained symptoms in primary care in Israel

“…In addition to physician-patient communication, psychological factors play an important role in maintaining MUS [ 3 ]. Emotional distress and catastrophic thinking can exacerbate MUS and psychiatric illness can increase FA/MUS’ healthcare utilisation [ 4 ], as anxious patients are more likely to seek consultation [ 12 ]. This corresponds to the definition of Somatic Symptoms Disorder in the DSM-5 as ‘excessive thoughts, feelings, or behaviours related to somatic symptoms’ [ 25 ].…”

When a Head Is about to Burst: Attachment Mediates the Relationship Between Childhood Trauma and Migraine

“…According to bio-psycho-social concept of illness [73,74], a new integrative four-cluster model of mind-body interrelationships was proposed [75]. In this model, migraine is in a cluster of stress-exacerbated diseases, where chronic stress and emotional processes play a substantial role in the exacerbations [75].…”

“…According to bio-psycho-social concept of illness [73,74], a new integrative four-cluster model of mind-body interrelationships was proposed [75]. In this model, migraine is in a cluster of stress-exacerbated diseases, where chronic stress and emotional processes play a substantial role in the exacerbations [75]. It seems that the impact of stress and medication overuse and other risk factors can lead to a reduced threshold for an induction of headache and abet the transformation of episodic migraine into chronic daily headache [76].…”

Prevalence and correlates of somatization in anxious individuals in a Chinese online crisis intervention during COVID-19 epidemic

“… Asmundson and Hadjistavropoulos, 2007 , Ezra et al, 2019 , Garrusi et al, 2019 , Katon et al, 2001 , Asmundson and Katz, 2009 , Lipowski, 1987 , Ploghaus et al, 2001 , Ren, 2009 , Rosmalen et al, 2020 , Rothe et al, 2020 , Sandberg and Ekström, 2019 , Tang et al, 2018 , Tang et al, 2017 , Vachon-Presseau, 2018 , Wang et al, 1999 , Wilhelmsen, 2005 , World Health Organization 2003 , World Health Organization 2020 , World Health Organization 2020 , Cheng and Tang, 2004 , den Boeft et al, 2016 …”