PERSPECTIVE article
Front. Psychiatry
Sec. Psychological Therapy and Psychosomatics
Embracing the Psychological Complexity of Tinnitus-Correlated Distress: From Descriptive Nosologies to Explanatory, Person-Centred Models
Provisionally accepted
- Charité University Medicine Berlin, Berlin, Germany
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Chronic tinnitus presents a psychosomatic paradox: while the perceptual features of the sound are often similar across individuals and frequently linked to hearing loss, the levels of evoked distress differ substantially. This distress predicts the experiential quality, persistence, and chronification of tinnitus perception, thereby shaping what is recognized as chronic tinnitus or tinnitus disorder in clinical practice. Two interconnected processes of medicalization can be observed: first, the framing of distressing tinnitus as a medical disorder in its own right; and second, the framing of the distress itself as a psychiatric “comorbidity.” Dominant medical-descriptive frameworks in psychiatry classify distress using atheoretical, categorical systems; these face well-documented limits in reliability, validity, and clinical utility, and often privilege biomedical over psychosocial context. Placed at this junction, the current paper examines three conceptual approaches to distress: (1) medical-descriptive-nomothetic, (2) psychological-descriptive-nomothetic, and (3) psychological-descriptive-idiographic — which becomes explanatory upon considering individuals' life context, meaning-based appraisals and symptom function. For both clinical and research practice in chronic tinnitus, we argue for a shift towards psychological-explanatory-idiographic models that account for person-specific interactions of vulnerability, stress (including relational and contextual factors), emotional nuance, and coping (VSEC), linked through personal meaning. This aligns with a broader momentum towards idiographic, process-based therapies as the future of psychological intervention. Although meaning-centred formulations challenge nomothetic research methodologies, they offer clearer clinical reasoning and help avoid unhelpful medicalization beyond somatic factors which contribute to initial symptom onset.
Keywords: chronic tinnitus, HITOP, Clinical psychology and health, Diagnosis criticism, psychological formulation
Received: 13 Oct 2025; Accepted: 03 Nov 2025.
Copyright: © 2025 Boecking, Rose, Steinmetzger, Brueggemann and Mazurek. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Benjamin Boecking, benjamin.boecking@charite.de
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