Communication, somatisation and alexithymia. The impact of alexithymia for the process of somatisation in context of clinical communication

Background: Chronic health complaints are prevalent in general practice and in psychiatry and are often labelled as medically unexplained symptoms (MUS). Sensitisation has been proposed as an underlying neurobiological substrate for MUS. We suggest that a deficit in affect regulation, operationalized as alexithymia, represents a vulnerability factor for the development and sustainment of MUS and propose a model for a process of somatisation, in which emotionally relevant and stressful stimulation may trig ger sensitisation mechanisms, which again contribute to uphold and reinforce subjective symptoms in vulnerable individuals. The two hypotheses of the study are presented under "Principal objectives and sub-goals". Two experimental series will be conducte d, one for each hypothesis. Series I: fMRI study of the Frontal Down-Regulation Hypothesis. The fMRI paradigm includes the presentation of stories with personal relevance and content typical of clinical communication, presented in blocks of 30-60 seconds . Two experiments will be conducted, one with healthy individuals with and without alexithymia (8-12 subjects in each cell), and one with MUS patients with and without alexithymia. (8-12 subjects in each cell). Series II: Distress, rumination and sustain ed arousal after arranged consultations A series of arranged consultations in which specific communication elements are systematically presented to four sub-samples: one with healthy individuals with and without alexithymia, and one with MUS patients with and without alexithymia, 20 subjects in each of four cells. Subjects will be presented with specified physician behaviours, such as many vs. few psychosocial questions. We propose that emotionally activating physician behaviour will be associated with in creased rumination, negative affect and subsequent increased stress activation, as measured by cortisol in saliva and other psychophysiological measures.