Patrick Luyten

University of Leuven

Functional somatic disorders and (embodied) mentalization: A mentalization-based approach to the understanding and treatment of functional somatic complaints

Patients with functional somatic disorders (FSD) represent a highly prevalent group of patients in our health care system, are characterized by excessive health care use, and are known to be difficult to treat. Although the precise causation of FSD remains elusive, there is increasing evidence to suggest that these disorders are associated with impairments in the stress system. In addition, problems with social cognition, and particularly embodied social cognition, have historically received much attention in these patients, and research in this context recently has been reinvigorated by a focus on mentalization (i.e. the ability to perceive mental states in self and other) as a multi-dimensional concept by linking problems with (embodied) mentalization to attachment disruptions and associated impairments in stress regulation.
In this paper, I will discuss the theoretical background of this approach, as well as the treatment approach that is directly based on these views. First, I review research findings from both animal and human research demonstrating the close relationship between attachment, stress regulation, and immune and pain-regulating systems, with a special focus on developmental research. I will highlight research findings concerning the high metabolic costs associated with the use of insecure secondary attachment strategies (i.e., attachment deactivating and hyperactivating strategies) leading to increased vulnerability for stress in these patients. Next, I will review evidence suggesting that impairments in (embodied) mentalization in these patients are often the result of and/or are further exacerbated by functional somatic complaints, leading to the reemergence of so-called non-mentalizing modes, i.e., modes of subjectivity that antedate the capacity for full mentalizing that often determine these patient’s experience of their body and complaints. Based on these views, a recently developed mentalization-based intervention for patients with FSD is presented.

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