AUTHOR=Ezra Yacov , Hammerman Oded , Shahar Golan 

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

JOURNAL=Frontiers in Psychiatry

VOLUME=Volume 10 - 2019

YEAR=2019

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2019.00039

DOI=10.3389/fpsyt.2019.00039

ISSN=1664-0640

ABSTRACT=Despite the shift towards a biopsychosocial paradigm of medicine, many physicians and Mental Health Professional (MHPs) find it difficult to treat patients with psycho-somatic disorders. This situation is particularly troublesome due to the high prevalence of these conditions.  Despite progress made over the last few decades in understanding mechanisms underlying the mind-body relationship, a disparity remains between the research and its clinical implementation. One possible reason for this is the lack of a comprehensive agreed upon model, incorporating a biopsychosocial framework and rooted in an understanding of the various psychobiological pathways. Such a model would enable better communication between physicians and MHPs, allowing them to deliver coordinated and stratified treatments. 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 then 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 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. Finally, treatment of the aforementioned case studies is seen through the lens of the Four-Cluster model and a proposed integration of our model with existing theories is discussed. 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 accuracy and efficacy of treatment.