Psychosomatics: Communication of the Central Nervous System through Connection to Tissues, Organs, and Cells

Abstract

This study aimed to scrutinize existing evidence concerning the link between somatic symptoms and nervous system activity. The goal was to pinpoint areas for effective therapeutic interventions. Psychosomatic disorders, an often overlooked field of medicine, bears significance given the multitude of patients experiencing somatic symptoms due to specific emotions and experiences. The literature was explored using the methods of comparative analysis, synthesis and graphical representation. The study introduced pathological neural networks localized in brain regions such as the prefrontal cortex and hippocampus, leading to maladaptive behaviors and heightened negative focus. Activation of the sympathetic nervous system and the hypothalamus-pituitary-adrenal axis, alongside increased cortisol levels, induces chronic distress, inflammation, and disruptions in neurotransmitter metabolism. The gut microbiota significantly influences psychosomatic reactions. Patients with psychosomatic disorders require complex treatment with cognitive-behavioural therapy and hypnosis methods. Within the framework of pathological neural networks, the MindChat technique has yielded effectiveness with the purpose of “dehypnotization” and destruction of aberrant cognitive and emotional patterns. However, it should be noted that this technique requires further empirical support.

INTRODUCTION

Somatisation disorders are a common problem in the field of medicine and generate much discussion, including in classification systems such as the International Statistical Classification of Diseases and Related Health Problems, 11th revision (ICD-11) [1] or Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) [2], which is mostly due to the lack of a definite view on the pathogenesis of somatisation of psychological spectrum disorders.

According to DSM-5 [3], published by the American Psychiatric Association, “Disorders associated with somatic symptoms” is allocated in a separate category of mental disorders, excluding somatisation disorders, hypochondria, pain disorder and unspecified somatoform disorder in order to unify and systematize this group of problems from this rubric. But it is worth noting that quite often the term “Psychosomatics” or “Psychosomatic Disorder” is used in the medical and psychotherapy lobby, but none of the existing classifiers use these definitions. This is partly due to both difficulties in translation and differences in approach among different countries (e.g., ICD-11 presents the term “Bodily Distress”) [1]. This study will use the concept of “Psychosomatics” and its derivatives as a composite concept of bodily manifestations due to psychological problems, which has a high polymorphism of symptomatology in the absence of objective signs of other diseases that explain such a clinical picture.

Torrubia-Pérez et al. [4], in their study, grounded their findings on the biopsychosocial model of psychosomatic disorders. They noted that regardless of health problems, biological, psychological and social spheres of a person are affected, with women over 15 years of age being more susceptible to such manifestations. However, the issue of gender differences is still under critical evaluation. In a separate literature review, Tatayeva et al. [5] concluded that there’s growing evidence indicating that the combination of anxiety-depressive disorders and somatic diseases worsens the severity of the conditions. This combination also complicates diagnosing the presence of one or more somatic symptoms. These conclusions were drawn by a research team from Portugal, Spain, and other countries, specifically examining the relationship between chronic lower limb lymphedema and varying degrees of depression [6]. Such findings support the theory of an inseparable link between a person’s mental state and their physical well-being. This connection operates bidirectionally in the “body-brain-psychic” axis, suggesting that influence can flow in both direct and reverse directions. These data provide support for the theory of an inseparable connection between the mental state of a person and his physical well-being, where the vector of influence in the axis “body-brain-psyche” can have both direct and reverse direction.

Becker et al. [7] draw attention to the widespread prevalence of somatic manifestations in psychological traumas, and the Portuguese population represents a risk group among European countries. The authors consider such cases in medical practice to be very common and difficult to diagnose, which is a cause of consternation for doctors and patients, since it is also difficult to treat and can lead to the development of disability. Teodoro and Oliveira [8] emphasize the need to bridge the gap between the theoretical understanding of psychofunctional disorders and everyday clinical practice.

Rajna [9] takes a meta-analysis approach in calling psychosomatic disorders a “blind spot” of medicine, because at the moment there is no integral approach to the diagnosis and treatment of patients with psychosomatic disorders, and for the most part they are accustomed to ignoring or mask their symptoms, rather than approach their radical solution.

Thus, the aim of this study is to explore and interpret existing data on the nature of the relationship between somatic symptoms and the psyche, with the subsequent identification of application points for promising diagnostic and therapeutic interventions.

MATERIALS AND METHODS

This study presents a theoretical-integrative literature review with a semi-systematic approach. Data were gathered and analysed from review articles and published studies found in databases such as MEDLINE, PubMed, and Scopus. The search encompassed articles published between January 1, 2020, and October 15, 2023. Search queries were crafted in English, utilizing keywords like “psychosomatic,” “psychosomatic medicine,” “somatization,” “psychosomatic brain,” “psychosomatic treatment,” and “psychosomatic neurophysiology.” Additionally, other relevant studies were sourced from an academic search engine accessible via Google or from lists providing links to review articles. Thus, 41 sources were included in this literature review, 2 of which are references to current disease classifiers, namely ICD-11 [1] and DSM-5 [2].

Filtering of the retrieved data sources based on search queries was performed using inclusion and exclusion criteria for the study (Fig. 1). The review inclusion criteria were: articles must be review, comparative and experimental studies that have conducted research on the topic of psychosomatic disorders, psychosomatic medicine, treatments and neurophysiological features; articles must be published within the specified time frame; articles should be published in academically relevant resources.

Fig. 1.

Flow chart of document selection process.

Some articles did not meet the stated timeframes but were decided to be included in the review because their data overlapped with those of the initially filtered articles and aligned with the purpose of the study. Since psychosomatic disorders are a heterogeneous group of disease, it was decided to study psychosomatic disorders in more detail from the aspect of chronic pain syndrome unrelated to organic pathology and irritable bowel syndrome (IBS) as the most common and indicative.

Exclusion criteria were represented by the following items: unpublished research results or incomplete publication; repeated (more than 2) publications by the authors; studies in the context of psychiatric illnesses without inclusion of psychosomatic disorders; and studies without theoretical or empirical investigation of neurophysiology features in psychosomatic disorders.

Data extraction from the selected articles included the name of the first named author or all authors (if no more than co-authorship of 2 researchers), study characteristics (e.g., type and purpose of study), and the main findings of the study relevant to the search topic.

In this study, the method of comparative analysis, the method of graphic representation, and the method of synthesis were employed to uncover and identify neurophysiological characteristics among patients with psychosomatic disorders. This involved pinpointing features of nervous system interaction with peripheral tissues, emphasizing crucial pathophysiological aspects, and potentially identifying them as therapeutically relevant. In addition, promising directions for further research were identified based on the information obtained, and special attention was paid to the techniques of cognitive-behavioural therapy, hypnosis, and dehypnotization using the MindChat method.

RESULTS AND DISCUSSION

In order to provide a comprehensive overview of the methodologies, study subjects, and scientific interpretations of the cited works, the following table summarizes the key details of each study (Table 1) [10-42].

Table 1.

Summary table of cited works

Research	Objective	Methodology	Sample size	Findings
Fazekas [10]	Diagnostic approaches in psychosomatic medicine	Review	Not applicable	Overview of diagnostic strategies and novel instruments in psychosomatic medicine
Zhang et al. [11]	Evolution and significance of the psychosomatic model in gastroenterology	Review	Not applicable	Challenges of conventional clinical model and significance of psychosomatic model in gastroenterology
Petito et al. [12]	Association of psychosomatic disorders and psychopathology with psoriasis severity	Cross-sectional study	282	Higher psychosomatic severity predicts higher severity of psoriatic symptoms
Fava [13]	Role of patients as health producers in psychosomatic medicine	Theoretical analysis	Not applicable	Patients as co-producers of health can enhance psychosomatic treatment outcomes
Jiang et al. [14]	Psychosomatic medicine in general hospitals	Research article collection	Not applicable	Encourages interdisciplinary collaboration in diagnosing and treating psychosomatic disorders
Satsangi and Brugnoli [15]	Anxiety and psychosomatic symptoms in palliative care	Review	Not applicable	Hypnosis and meditative states can help manage psychosomatic symptoms in palliative care
Császár-Nagy and Bókkon [16]	Association between hypnotherapy and IBS	Hypothesis and literature review	Not applicable	Stress-induced implicit memories may play a role in IBS development
Efremov [17]	Elimination of psychosomatic pain and negative emotions through dehypnosis	Theoretical analysis	Not applicable	De-hypnosis can eliminate psychosomatic pain and negative emotions
Fu et al. [18]	Brain and somatization symptoms in psychiatric disorders	Review	Not applicable	Somatization symptoms are key predictors of severity in psychiatric disorders
Owens et al. [19]	Interoceptive inference in brain, body, and behavior disorders	Theoretical analysis	Not applicable	Interoception is crucial for understanding holistic nervous system function and dysfunction
Strauss et al. [20]	Effect of graded motor imagery on complex regional pain syndrome	Randomized control study	21	Graded motor imagery reduces pain and improves function in complex regional pain syndrome
Harvey [21]	Role of ecological perspective in trauma recovery	Review	Not applicable	Ecological perspective emphasizes the role of fear and physical activity in trauma recovery
Magnon et al. [22]	Effect of deep and slow breathing on vagal tone and anxiety	Experimental study	47	Deep and slow breathing more beneficial to older adults for reducing anxiety
Eken et al. [23]	Classify somatic symptom disorder using fNIRS-based dynamic functional connectivity	Hyper-parameter optimized classification using fNIRS and dynamic functional connectivity analysis	19 SSD patients and 21 healthy controls	Highest specificity (85%), accuracy (82%), and sensitivity (81%) in distinguishing SSD from healthy controls using SVM classifier. Connections between specific brain regions may serve as robust biomarkers for SSD
Fiedorowicz and Mikocka-Walus [24]	Year in review for Journal of Psychosomatic Research	Review	Not applicable	Summary of significant research findings in psychosomatic medicine
Leistner and Menke [25]	Role of hypothalamic-pituitary-adrenal axis in stress	Review	Not applicable	Sex differences in HPA axis response to stress may explain female predominance in stress-related disorders
Hou et al. [26]	Brain function in functional gastroduodenal disease	Experimental study	Not applicable	Functional changes in prefrontal lobe associated with functional gastroduodenal diseases
Shiha and Aziz [27]	Physical and psychological comorbidities associated with IBS	Review	Not applicable	Comorbidities like anxiety and depression are common in IBS and complicate management
Werner [28]	Neural networks in neurological and psychiatric diseases	Review	Not applicable	Overview of neural networks’ role in neurological and psychiatric diseases
Jiang et al. [29]	Special issue for psychosomatic medicine	Review	Not applicable	Interdisciplinary studies are crucial for understanding psychosomatic interactions
Altamura et al. [30]	Association of psychosomatic disorders with IL-6 pro-inflammatory cytokine in heart failure patients	Cross-sectional study	41	IL-6 levels are associated with psychosomatic psychopathology in heart failure patients
Jacobs et al. [31]	Effect of cognitive behavioral therapy on brain-gut-microbiome axis in IBS patients	Randomized control study	84	CBT alters brain-gut-microbiome axis and improves IBS symptoms
Brizuela et al. [32]	Pruritogenic mechanisms and gut sensation in IBS	Review	Not applicable	Irritant mediators in the gut may trigger visceral hypersensitivity and pain in IBS
Millington et al. [33]	Somatization in dermatology	Review	Not applicable	Somatization symptoms are prevalent in dermatology and require interdisciplinary treatment approaches
Bicego et al. [34]	Role of hypnosis in chronic pain management	Review	Not applicable	Hypnosis can be an effective non-pharmaco-logical treatment for chronic pain
Császár et al. [35]	Neuroplasticity and epigenetics in hypnotherapy	Review	Not applicable	Hypnosis can induce changes in neuroplasticity and epigenetic mechanisms
Rustamov et al. [36]	Role of attention in altered pain inhibition in IBS patients	Experimental study	18	Attention influences pain inhibition processes in IBS patients
Wolf et al. [37]	Functional changes in brain activity using hypnosis	Systematic review	Not applicable	Hypnosis can alter functional brain activity related to pain and anxiety
Labrenz et al. [38]	Avoidance research in psychosomatic medicine	Review	Not applicable	Avoidance behaviors in psychosomatic disorders need more focused research
Gutkin et al. [39]	Effect of psychotherapy on functional neurological disorder	Systematic review	Not applicable	Psychotherapy can benefit patients with functional neurological disorder
Kano et al. [40]	Examine brain mechanisms in functional somatic syndromes and potential brain-based biomarkers	Review of brain imaging data on brain-body interactions in IBS using pattern recognition methods	Not applicable	Anticipation of unpredictablepain in IBS induces increased activity in brain areas associated with hypervigilance, reduced top-down regulation by mPFC and pACC. Possible brain-based biomarkers for FSS include insula response and hypervigilance-related areas
Kamp et al. [41]	Symptom management needs in IBS patients with anxiety/depression	Qualitative study	12	IBS with anxiety/depression requires integrated symptom management strategies
Izuno et al. [42]	Investigate the role of gut microbiota in stress-related disorders using neuroimaging studies	Review of observational and intervention studies combining gut microbiota and neuroimaging	Not applicable	Gut microbiota influences emotional response and stress-related disorders. Probiotic intervention can modulate emotional response and act as a buffer against stress

IBS, irritable bowel syndrome; fNIRS, functional near-infrared spectroscopy; SSD, somatic symptom disorder; SVM, support vector machine; HPA, hypothalamic-pituitary-adrenal; IL, Interleukin; CBT, cognitive behavioral therapy.

Premorbid Risk Factors for the Development of Psychosomatic Disorders

Psychosomatic medicine deals with the assessment, treatment, and modification of psychosocial factors in various medical specialities that contribute to the development of pathological conditions. Stress and adaptation to a stressful environment play an important role. In this regard, Fazekas [10] uses the concept of “psychosomatic competence” as a property of the human psyche that allows interpreting physical sensations and initiate self-regulation of interoreceptor reactions according to the principle of biofeedback. According to Zhang et al. [11] psychoemotional factors are involved in many functional disorders and organic diseases, not only in mental and psychological disorders. The concept of psychoemotional factors includes acute or chronic environmental factors mediated through the mental sphere, and have both cognitive and emotional effects that are largely counterbalanced by organic factors (traumatic, infectious, toxic, hypoxic, etc.). This creates a premorbid background for the development of dysfunction of integrative brain systems, the main component being the cortico-limbico-reticular complex [12].

Fava [13] describes the principle of allostatic load as a chronic exposure to unstable or out-of-threshold nervous and psysiological reactions that exceed the physical and mental resources of a person. This load contributes to the accumulation of biopsychosocial experiences in daily life, which includes chronic stress (both eu- and distress), multiple life circumstances such as work experience, unemployment, disadvantageous living conditions, social and educational experiences, and income levels across the lifespan.

Although molecular genetic diagnosis does not hold a great importance in psychology and psychiatry, Jiang et al. [14] note that that importance of genetic loci in the development of anxiety was determined, namely: rs2071345 (in combination with alcohol dependence), Val66Met (in combination with panic disorder). And the number of such genetic predictors is unfathomable, making therapeutic influence on these factors currently impossible. The authors also demonstrated data on the influence of hypothyroidism (reduced functional activity of the thyroid gland) and proinflammatory cytokines (interleukins-1β,-2, -4, -10) on the development of somatic manifestations of depression and anxiety, which will be discussed further.

The Concept of Pathological Neural Networks as the Core of Psychosomatic Reactions

Thus, symptoms in psychosomatic pathology develop as a complex system of physiological manifestations of the current emotional state under the influence of contributing genetic, metabolic and organic factors. Satsangi and Brugnoli [15] give an example of a state of anger or fear in a person, which can provoke an increase in blood pressure, heart rate and respiratory rate. When the acute period of experiencing fear passes, the manifestation of these physiological processes usually subsides. However, if a person is in a state of chronic anxiety, which they cannot express openly, and the emotional state remains unchanged for a long time, then physiological symptoms can persist and shift the focus of attention from the emotional component of the experience to the physical.

In their study about IBS, Császár-Nagy and Bókkon [16] suggested that hidden memories caused by a traumatic life episode may persist throughout life due to epigenetic processes in the enteric (intestinal) nerve plexus, which may play an important role in the onset and course of the disease. The authors note the positive impact of hypnosis in the treatment of IBS. This theory resonates with the concept put forward in a previous study of the existence of perineuronal nets as a neuronal population within which circulate emotional trigger signals that energize bodily manifestations and subsequently form a symptom complex of functional disorders [17]. The pathological circulation of neuronal impulses can be indirectly evidenced by data compiled by Fu et al. [18], demonstrating that depressed patients are prone to high sensitivity to negative information, a general decrease in attention and lack of positive biases; this was more pronounced in patients with somatic symptoms.

Stress and trauma can lead to changes in gene expression without altering the DNA sequence, affecting how neurons function and communicate. These epigenetic changes can sustain the heightened state of alert and emotional dysregulation, making it difficult for the individual to return to a baseline state of calm. The persistent activation of stress-responsive neural circuits can also influence bodily systems through the autonomic nervous system (ANS). The sympathetic branch of the ANS, responsible for the ‘fight or flight’ response, may become overactive, leading to symptoms such as increased heart rate, blood pressure, and respiratory rate. Simultan-eously, the parasympathetic branch, which promotes ‘rest and digest’ functions, may be underactive, contributing to digestive issues and other somatic symptoms.

The visual model in Figure 2 illustrates these interactions, showing how key brain regions and the ANS contribute to the development and maintenance of psychosomatic symptoms. This simplified diagram helps to understand the complex interplay between emotional states and physical health, emphasizing the need for therapeutic interventions that address both psychological and physiological aspects.

Fig. 2.

Model of pathological neural networks in psychosomatic disorders.

ANS, autonomic nervous system.

Neurophysiology in Psychosomatic Medicine and Practical Implementation of the Theory of Perineuronal Nets

For determining the morphological substrate of the existence of pathological neural networks, Owens et al. [19] is an important work. The authors lay out the neurobiological features of the human psyche, detailing the coordinated functioning of the central and peripheral nervous system, including such structures as the spinal cord, brainstem and hypothalamus, which primarily mediate autonomic regulation and descending cortical inhibition. The cortical representation of pain sensitivity and interoception is the dorsal anterior cingulate gyrus [20].

In his literature review of the impact of psychological trauma on the emotional and bodily experiences of the individual, Harvey [21] describes 3 key perceptual areas: sensory-distinguishing – determines the location and nature of the trigger; affective-motivational – determines the significance of this trigger in the context of a person’s priority system and motivation; and cognitive-behavioural – responsible for the formation of appropriate behavioural patterns.

In the cardiovascular system, changes in heart rate and blood pressure are associated with activity in the amygdala, as well as the dorsal anterior cingulate and insular cortex, which provide descending signals to the hypothalamus and brainstem with the development of autonomic responses associated with emotion. These are the structures associated with somatic manifestations of fear, anxiety, anger, and irritation [19,21]. For instance, in the structure of the brainstem, the periaqueductal grey zone regulates the flow of nociceptive (pain) and visceral (from internal organs) signals. The cortex of the anterior and posterior insular lobes exhibit increased neuronal activity during breathing and during vagal testing (Valsava), so breathing exercises can be used to reduce sympathetic activity [22]. It is also significant that sympathetic responses are lateralized on the right side of the brain, while the parasympathetic nervous system finds its base in the left hemisphere [23]. In the insular cortex, sensory information is integrated with cognitive-affective distortions, acquiring an emotional component, and is further involved in the formation of motor reactions. Fiedorowicz and Mikocka-Walus [24] reviewed the data that the severity of pain syndrome was positively correlated with the severity of emotional evaluation of pain, so psychotherapy has an important role in the treatment of chronic pain syn-dromes.

It should be noted that the descending levels house the baroreflex arc, which includes the mechanoreceptors of the carotid arteries and aortic arch, the nucleus of the solitary tract, and the rostral ventrolateral portion of the brainstem. It is during emotional or cognitive stress that the baroreflex feedback loop is disrupted by descending cortical influences (from the prefrontal cortex, hippocampus and hypothalamic nuclei) increasing heart rate and blood pressure [19,21].

However, for adequate interaction between nerve stimulation/inhibition and peripheral tissues there is endocrine signalling, for which adrenal glands play a central role. The hypothalamic-pituitary-adrenal axis is a major component of the neuroendocrine network that responds to internal and external triggers with the release of the stress hormones cortisol and adrenaline. Leistner and Menke [25] note that in preclinical models this system is activated in women faster and produces a greater hormonal release than in men, but in human models these data are ambiguous, because it is necessary to take into account the differences in the stressors studied, the use of contraceptives and the different stages of the menstrual cycle in women. The authors also note the importance of the anterior cingulate and right insular lobe in the development of the response to chronic stress.

Hou et al. [26] also recorded decreased activity of left prefrontal lobe regions in patients with functional gastroduodenal disease, and the ANS refers to the communication system between the regulatory centres in the brain and the internal organs of the gastrointestinal tract. In the context of IBS, it is worth noting that frequent extraintestinal comorbidities associated with this functional disorder include anxiety, depression, fibromyalgia, chronic fatigue syndrome, chronic pelvic pain, interstitial cystitis, sexual dysfunction and insomnia, which are physiologically related to the aforementioned neural structures, although with their own peculiarities, which deserves a separate detailed study [27].

Werner [28] draws attention to the fact that in this period of time there are no adequate methods of development of artificial neural networks for modelling all the subtleties of the structure of the nervous system, then the study of its functional features occurs with the use of drugs that have agonistic or antagonistic effect on one or another neuronal receptor. Serotonin, whose impaired metabolism is the pathophysiological basis for the development of psychosomatic disorders, also represents a key application point for pharmacological interventions (such as the serotonin reuptake inhibitor group of drugs).

MindChat therapy, on the other hand, as a form of dehypnotization, aims to achieve a state of “absolute nothingness” by destroying inhibitory pathological neural networks, which is similar to the concept of sensory attenuation described above by Owens et al. [19]. Preliminary studies and trials have suggested that MindChat, which focuses on de-hypnotizing pathological neural networks, can effectively reduce psychosomatic pain and negative emotions by targeting and restructuring maladaptive neural pathways. Initial findings indicate that MindChat can facilitate a state of “absolute nothingness,” purportedly eliminating the pathological neural signals that sustain psychosomatic symptoms. When compared to more established techniques like cognitive behavioral therapy (CBT) and hypnosis, MindChat appears promising but lacks the extensive body of evidence that supports these traditional methods. CBT is widely recognized for its robust empirical support and practical applications, effectively addressing a wide range of psychological and psychosomatic issues by modifying dysfunctional thoughts and behaviors. CBT’s efficacy is well-documented through numerous clinical trials and meta-analyses, making it a cornerstone in the treatment of psychosomatic disorders.

The influence of gut microbiota on psychosomatic reactions has garnered increasing attention in recent years, with emerging research highlighting the intricate relationship between the gut and the brain, often referred to as the gut-brain axis. This bidirectional communication system involves complex interactions between the central nervous system (CNS), the enteric nervous system (ENS), and the gut microbiota, influencing both physical and mental health. Recent studies have demonstrated that the gut microbiota can significantly affect mood, behavior, and cognitive functions. For instance, Jiang et al. [29] documented that monks with an enriched microbiota exhibited lower risks of anxiety and depression, as well as enhanced immune capacity and reduced cardiovascular diseases. These findings suggest that a diverse and balanced gut microbiota can positively influence mental health and overall well-being. Conversely, dysbiosis, or an imbalance in gut microbiota, has been linked to various psychiatric and psychosomatic conditions, including anxiety, depression, and IBS.

Altamura et al. [30] further underscored this connection in their study on heart failure patients, where they observed that heightened levels of proinflammatory cytokines were associated with adverse outcomes and a pronounced psychosomatic component. The gut-brain axis is also influenced by the production of neurotransmitters and neuroactive compounds by gut bacteria. For example, certain gut microbes can produce serotonin, a key neurotransmitter involved in mood regulation. Jacobs et al. [31] explored the impact of CBT on the gut-brain-microbiota axis and found that CBT not only altered the functional connectivity in sensorimotor areas and brainstem structures but also induced changes in the gut microbiota composition. Specifically, they noted an increase in serotonin levels in feces, an increase in Clostridiales, and a decrease in Bacteroides, which were correlated with improvements in IBS symptoms.

These findings suggest that therapeutic strategies targeting gut microbiota could be beneficial in treating psychosomatic disorders. Potential approaches include the use of probiotics, prebiotics, and dietary interventions to restore and maintain a healthy gut microbiota. Probiotics, which are live beneficial bacteria, can help to rebalance gut microbiota and have shown promise in reducing symptoms of anxiety and depression in clinical trials. Prebiotics, which are non-digestible food components that promote the growth of beneficial bacteria, can also support gut health and influence the gut-brain axis [42].

Dietary interventions, such as increasing the intake of fiber-rich foods and fermented products, can further support a healthy gut microbiota. Additionally, personalized nutrition plans based on individual microbiota profiles may offer tailored therapeutic benefits. Integrating these strategies into treatment plans for psychosomatic disorders involves a multidisciplinary approach. Healthcare providers can combine psychopharmacological treatments and psychological therapies with interventions targeting the gut microbiota to address the multifaceted nature of these conditions. For instance, a patient with IBS and comorbid anxiety might benefit from a combined treatment plan that includes CBT, selective serotonin reuptake inhibitors (SSRIs), and a regimen of probiotics and dietary modifications aimed at restoring gut health [43,44].

Brizuela et al. [32] note the importance of such factors as pruritogenic (skin itching) mediators and their receptors, the activation of which causes specific changes in neural excitability of sensory pathways responsible for the transmission of nociceptive information from peripheral tissues to cortical structures, which leads to visceral hypersensitivity and visceral pain. Such pruritogenic factors include histamine, bradykinin, prostaglandin, and others. In the context of somatisation in dermatology, it is worth mentioning the study by Millington et al. [33], where the authors describe skin symptoms that lie on the borderline between dermatovenerology and psychiatry and that are difficult to differentiate. The authors state that they may predispose to somatic diseases such as atopic dermatitis and psoriasis, but somatisation can occur with or without the presence of dermatological disease. Exclusively psychosomatic dermatological conditions include genital pain syndromes and Gardner-Diamond syndrome (psychogenic purpura). Psychotherapeutic and pharmacological methods are also used to treat these conditions.

Figure 3 shows a simplified flowchart depicting the key structural elements from perceptual organs to peripheral tissue cells.

Fig. 3.

Fundamental positions of interaction between the human psyche and body during the development of psychosomatic reactions.

IL, interleukin; TNF, tumour necrosis factor; CRP, C-reactive protein.

Source: compiled by the author.

The structural elements shown in Figure 3 are involved in the development of psychosomatic reactions based on pathological neural networks.

Integration of Psychopharmacological Interventions in the Treatment of Psychosomatic Disorders

Psychopharmacological interventions play a crucial role in complementing psychological therapies such as CBT and hypnosis in the treatment of psychosomatic disorders. These medications can address the underlying neurochemical imbalances that contribute to the emotional and physiological symptoms associated with these conditions. SSRIs are commonly used to treat depression and anxiety, which are often comorbid with psychosomatic disorders. SSRIs work by increasing the levels of serotonin in the brain, enhancing mood regulation and reducing the severity of symptoms. By alleviating the depressive and anxious states, SSRIs can help patients become more responsive to psychological therapies, facilitating a more holistic recovery process.

Anxiolytics, such as benzodiazepines, are another class of drugs used to manage acute anxiety symptoms. These medications enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA-A receptor, promoting a calming effect on the CNS. While anxiolytics can provide rapid relief from anxiety symptoms, their long-term use is generally limited due to the risk of depend-ence. Nonetheless, they can be useful in conjunction with CBT to manage severe anxiety, allowing patients to engage more effectively in therapeutic sessions.

Mood stabilizers, such as lithium and anticonvulsants, can be beneficial for patients with mood swings or bipolar disorder that may exacerbate psychosomatic symptoms. These medications help to regulate mood fluctuations, providing a stable emotional baseline that can enhance the efficacy of psychological interventions. In addition to these specific classes of drugs, tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors can also be effective in treating chronic pain syndromes often associated with psychosomatic disorders. These medications work by increasing the levels of norepinephrine and serotonin, which can modulate pain perception and reduce the intensity of pain symptoms.

Treatment Methods for Psychosomatic Disorders, Effectiveness, Difficulties, and Prospects

In the context of therapeutic interventions, Bicego et al. [34] demonstrate that among patients with chronic pain, the use of hypnosis techniques allowed for emotional and cognitive modulation of pain involving the anterior cingulate gyrus. Similar conclusions were reached by Császár et al. [35], who observed that the neurophysiological mechanisms underlying hypnosis are far from being sufficiently understood, but the effect on specific psychological functions may affect human neurophysiology with the subsequent elimination of pathological neural networks.

Psychosomatic symptoms are often linked to dysregulation within the CNS, where emotional and cognitive factors translate into physical symptoms. One of the critical neural pathways involved in this process is the connection between the amygdala, which processes emotional responses, and the prefrontal cortex, responsible for higher-order cognitive functions and emotion regulation. Dysregulation in these areas can lead to a persistent state of hyperarousal and heightened sensitivity to pain and discomfort. Neurotransmitters play a vital role in this dysregulation. Serotonin and norepinephrine, for instance, are crucial in mood regulation and pain perception. Im-balances in these neurotransmitters can exacerbate symptoms of depression, anxiety, and chronic pain, which are common in psychosomatic disorders. Additionally, GABA, an inhibitory neurotransmitter, helps regulate neuronal excitability and anxiety levels. A deficiency in GABA can result in heightened anxiety and stress responses.

Recent neuroimaging studies have provided insights into these mechanisms. Kano et al. [40] investigated brain-body interactions in IBS, a well-known functional somatic syndrome (FSS). Their study revealed that anticipation of unpredictable pain increased activity in brain areas associated with hypervigilance, such as the insula and anterior cingulate cortex (ACC). Dysfunctional inhibitory influences of the medial prefrontal cortex (mPFC) and pregenual anterior cingulate cortex (pACC) on stress regulation systems were also observed. This dysregulation resulted in an activated ANS and neuroendocrine system, stimulated by corticotropin-releasing hormone. These findings suggest that reduced top-down regulation by the mPFC and pACC and discordance between insula response and subjective pain sensation could serve as candidate brain-based biomarkers for FSS.

Another significant study by Eken et al. [23] utilized functional near-infrared spectroscopy (fNIRS) to explore the neurobiology of somatic symptom disorder (SSD). By applying pain stimuli at different levels, they were able to distinguish SSD patients from healthy controls with high specificity and accuracy. Their findings indicated that connections between specific brain regions, such as the right superior temporal and left angular gyri, right middle frontal and left supramarginal gyri, and right middle temporal and left middle frontal gyri, could be robust biomarkers for SSD neurobiology. This study highlights the potential of fNIRS in identifying neurobiological markers for SSD through dynamic functional connectivity analysis.

Therapeutic strategies targeting gut microbiota also play a crucial role in managing psychosomatic disorders. The gut-brain axis, which involves bidirectional communication between the CNS and the ENS, is influenced by gut microbiota. Imbalances in gut microbiota, or dysbiosis, can contribute to the development of psychosomatic symptoms. Probiotics and prebiotics, which help restore and maintain healthy gut microbiota, have shown promise in reducing symptoms of anxiety, depression, and IBS. Dietary interventions, such as increasing fiber-rich foods and fermented products, can also support a healthy gut microbiota and improve gut-brain communication.

Further, Rustamov et al. [36] investigate counterstimulation and distraction by means of electroencephalo-graphy (EEG) in patients with IBS. High gamma activity was seen in the sensorimotor, anterior cingulate and left dorsolateral prefrontal cortex, which was not reduced by counterstimulation or selective attention. This demonstrated that psychosomatic disorders are associated with deficits in central inhibition, which displays an interaction between several brain centres associated with pain and attention. Wolf et al. [37] conducted a meta-analysis in which they investigated the EEG method to evaluate the effectiveness of hypnosis among patients with anxiety and pain syndrome (of different aetiologies, not only psychosomatic).

Labrenz et al. [38] focused on an important element of psychosomatic disorders – the formation of avoidance behaviour in response to fear of impending threats, especially physical harm. Such persistent or excessive fear and inadequate avoidance may increase the risk of comorbid psychiatric illnesses and interfere with the effectiveness of therapies based on the disappearance of fear. Gutkin et al. [39] highlight cognitive-behavioural therapy and psychodynamic therapy among such therapeutic approaches, but also note that such techniques require long-term patient education and supervision. Some patients with functional disorders initially attribute their symptoms to non-psychological causes, which can make it difficult to overcome trigger emotions [40]. Based on this, an important goal of future research is to identify patient characteristics that might provide a better response to a particular psychotherapy technique in order to identify a specific treatment method and improve patients’ condition. In daily practice, there is also a significant proportion of participants who are unwilling to accept psychological treatment for psychosomatic disorders [41]. There is a need to increase the number of studies investigating different treatment methods, in particular the mentioned MindChat technique, in comparison to CBT and hypnosis. Future studies should include participants from different age groups and follow-up re-evaluations for at least one year after the end of treatment.

Based on the above data, it is possible to tentatively assume that the concept of pathological neural networks may underlie psychosomatic reactions. The basis for the creation of a neural network in response to a psychotraumatic event in the past or under the influence of a chronic stressful environment is the disruption of cortical inhibition and predominance of subcortical structures with the formation of maladaptive behaviour. During subsequent sympathetic and hormonal stress activation and release of pro-inflammatory cytokines, functional disruption of organ systems occurs, leading to unpleasant somatic symptoms for patients. The patients themselves focus more on their bodily sensations than on their emotional sensations, which is misleading not only for them but also for the medical staff involved in dealing with the problem. These patients require a comprehensive approach using symptom management, pharmacological therapy and psychotherapy. In the latter category, CBT, hypnosis and, in some cases, MindChat hypnotization techniques have been shown to be particularly effective, but this requires further empirical corroboration.

CONCLUSIONS

The activation of the neural networks triggers a cascade within the CNS, leading to sympathetic nervous system activation and a stress response involving the hypothalamus-pituitary-adrenal axis, which elevates cortisol levels. At the cellular level, this is associated with neurotransmitter dysfunction, specifically impaired serotonin and dopamine metabolism, and the release of pro-inflammatory cytokines and pruritogenic factors. Additionally, the gut microbiota significantly influences brain function through the ENS and chemokines, further contributing to psychosomatic reactions. Effective treatment for psychosomatic disorders requires a multifaceted ap-proach. CBT and hypnosis have shown significant effectiveness in managing these conditions. Furthermore, SSRIs have demonstrated positive effects, although their efficacy varies among patients. The MindChat dehypnotization technique has also shown promise in addressing cognitive-emotional distortions, but further cohort studies are needed to fully assess its efficacy.

For clinical practice, these findings highlight the importance of an integrated treatment approach that combines psychological therapies, pharmacological interventions, and potentially microbiota-targeted therapies. Future research should focus on comparative analyses of different therapeutic strategies, utilizing advanced imaging techniques such as EEG and magnetic resonance imaging (MRI) to monitor treatment effects. Clinical trials should be designed to stratify patients by gender, age, and symptom type to better understand the nuances of psychosomatic disorders. Interdisciplinary studies involving neurologists, psychiatrists, gastroenterologists, and immunologists could further advance the field, providing a comprehensive understanding of the pathophysiological mechanisms and improving patient outcomes in psychosomatic medicine.

Funding Statement

Funding None.