Ethics code: IR.US.PSYEDU.REC.1403.117
1- Islamic Azad University, Science and Research Branch, Tehran, Iran
2- University of Shiraz, Shiraz, Iran
3- , Tehran University of Medical Sciences Branch, Tehran, Iran
2- University of Shiraz, Shiraz, Iran
3- , Tehran University of Medical Sciences Branch, Tehran, Iran
Abstract: (7 Views)
Background:
Psychophysiologic or psychosomatic disorders represent one of the most complex diagnostic and therapeutic areas in behavioral medicine, situated at the intersection of biomedical conceptualizations and emotion-focused psychotherapeutic models. Patients frequently navigate long cycles of medical consultations, repeated diagnostic procedures, and inconclusive test results before receiving an accurate understanding of the emotional mechanisms contributing to their persistent somatic symptoms. Despite growing empirical evidence supporting the role of unconscious emotional processes, attachment patterns, and defensive functioning in the manifestation of bodily symptoms, the lived experience of these patients particularly their transition from biomedical to psychotherapeutic care remains underexplored.
The present study aimed to develop a conceptual model explaining the lived experience of individuals with psychosomatic symptoms during their pathway from medical treatment to psychological therapy, with a focus on identifying structural, emotional, and relational factors that either maintain or reduce symptom persistence.
Methods:
This qualitative study employed a grounded theory approach to explore the dynamic processes shaping patients’ experiences. Twelve individuals with persistent somatic symptoms without identifiable organic pathology, all of whom had participated in psychotherapy, were recruited using purposive theoretical sampling. Data were collected through in-depth semi-structured interviews focusing on patients’ diagnostic journeys, encounters with medical professionals, emotional meaning-making of symptoms, and experiences in psychodynamic or emotion-focused therapy.
Interviews were audio-recorded, transcribed verbatim, and analyzed using the constant comparative method across three stages: open, axial, and selective coding. Memos and analytic notes were used throughout the process to refine categories and explore emerging relationships. Ethical principles were fully observed, including informed consent and approval from the institutional ethics committee.
Results:
Three core thematic axes emerged from the analysis:
(1) Healthcare System Dynamics: Participants described contradictory diagnoses, fragmented care, and emotionally detached communication from providers as key contributors to confusion, anxiety, and diminished trust. Conversely, clear explanations, coordinated multidisciplinary care, and emotionally attuned interactions facilitated hope and engagement.
(2) Individual Emotional–Personality Factors: Chronic anxiety, insecure attachment patterns, fear of psychiatric medication, limited emotional awareness, and reliance on inhibitory defenses were frequently linked to exacerbation of symptoms. Meaning-making how patients interpreted the bodily manifestations of their internal conflict played a central role in symptom intensity and their readiness for psychological treatment.
(3) Social and Familial Support: Supportive family involvement reduced distress and fostered treatment engagement, while invalidation, stigma, or blame heightened symptom severity and reinforced feelings of helplessness.
Overall, symptom persistence was shaped by the interaction of structural barriers in the healthcare system, unresolved internal conflicts, and the availability or absence of empathic relational support.
Conclusion:
Patients’ experiences of psychosomatic symptoms cannot be understood through biomedical or psychological frameworks alone. Rather, they reflect a dynamic interplay of bodily processes, unconscious emotional activations, interpersonal patterns, and the structural affordances of the healthcare system. Effective care for these patients requires an integrative model that combines biomedical assessment, deep psychodynamic or emotion-focused therapy, culturally sensitive communication, and supportive relational networks. The findings highlight the critical importance of bridging the gap between physicians’ biomedical models and patients’ meaning-based interpretations, emphasizing that sustained improvement emerges when patients feel heard, validated, and guided in understanding the emotional roots of their physical distress.
Psychophysiologic or psychosomatic disorders represent one of the most complex diagnostic and therapeutic areas in behavioral medicine, situated at the intersection of biomedical conceptualizations and emotion-focused psychotherapeutic models. Patients frequently navigate long cycles of medical consultations, repeated diagnostic procedures, and inconclusive test results before receiving an accurate understanding of the emotional mechanisms contributing to their persistent somatic symptoms. Despite growing empirical evidence supporting the role of unconscious emotional processes, attachment patterns, and defensive functioning in the manifestation of bodily symptoms, the lived experience of these patients particularly their transition from biomedical to psychotherapeutic care remains underexplored.
The present study aimed to develop a conceptual model explaining the lived experience of individuals with psychosomatic symptoms during their pathway from medical treatment to psychological therapy, with a focus on identifying structural, emotional, and relational factors that either maintain or reduce symptom persistence.
Methods:
This qualitative study employed a grounded theory approach to explore the dynamic processes shaping patients’ experiences. Twelve individuals with persistent somatic symptoms without identifiable organic pathology, all of whom had participated in psychotherapy, were recruited using purposive theoretical sampling. Data were collected through in-depth semi-structured interviews focusing on patients’ diagnostic journeys, encounters with medical professionals, emotional meaning-making of symptoms, and experiences in psychodynamic or emotion-focused therapy.
Interviews were audio-recorded, transcribed verbatim, and analyzed using the constant comparative method across three stages: open, axial, and selective coding. Memos and analytic notes were used throughout the process to refine categories and explore emerging relationships. Ethical principles were fully observed, including informed consent and approval from the institutional ethics committee.
Results:
Three core thematic axes emerged from the analysis:
(1) Healthcare System Dynamics: Participants described contradictory diagnoses, fragmented care, and emotionally detached communication from providers as key contributors to confusion, anxiety, and diminished trust. Conversely, clear explanations, coordinated multidisciplinary care, and emotionally attuned interactions facilitated hope and engagement.
(2) Individual Emotional–Personality Factors: Chronic anxiety, insecure attachment patterns, fear of psychiatric medication, limited emotional awareness, and reliance on inhibitory defenses were frequently linked to exacerbation of symptoms. Meaning-making how patients interpreted the bodily manifestations of their internal conflict played a central role in symptom intensity and their readiness for psychological treatment.
(3) Social and Familial Support: Supportive family involvement reduced distress and fostered treatment engagement, while invalidation, stigma, or blame heightened symptom severity and reinforced feelings of helplessness.
Overall, symptom persistence was shaped by the interaction of structural barriers in the healthcare system, unresolved internal conflicts, and the availability or absence of empathic relational support.
Conclusion:
Patients’ experiences of psychosomatic symptoms cannot be understood through biomedical or psychological frameworks alone. Rather, they reflect a dynamic interplay of bodily processes, unconscious emotional activations, interpersonal patterns, and the structural affordances of the healthcare system. Effective care for these patients requires an integrative model that combines biomedical assessment, deep psychodynamic or emotion-focused therapy, culturally sensitive communication, and supportive relational networks. The findings highlight the critical importance of bridging the gap between physicians’ biomedical models and patients’ meaning-based interpretations, emphasizing that sustained improvement emerges when patients feel heard, validated, and guided in understanding the emotional roots of their physical distress.
Keywords: Psychophysiologic Disorders, Somatic Symptom Disorders, Lived Experience, Grounded Theory, Psychodynamic Psychotherapy, Emotion Regulation, Patient Experience, Social support.
Type of Study: Original Research Article |
Subject:
Psychology
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
