Expectations and expectancies as a core principle in functional somatic symptoms: Evidence and clinical implications 2025 Hausteiner-Wiehle et al

[Andy]

Abstract

Expectation and expectancies play a central role in current etiological models of functional somatic symptoms and their clinical manifestations as functional disorders, bodily distress disorder and somatic symptom disorder. Their effects have been shown with respect to symptom development, symptom persistence and treatment outcomes. Handling expectations and expectancies is therefore an important task in their prevention and management, from primary care to psychotherapy. This review presents current evidence concerning the role of expectation and expectancies in the etiology and maintenance of functional somatic symptoms, and how to address them in transdisciplinary treatment.

Paywall, https://www.thieme-connect.de/products/ejournals/abstract/10.1055/a-2564-6206

 

[Trish]

Anyone have any idea what they are talking about?

 

[Utsikt]

Anyone have any idea what they are talking about?

My guess is that it has something to do with predictive coding?

 

[Trish]

My guess is that it has something to do with predictive coding?

Maybe. I suspect it's something more simplistic like we feel ill because we expect to feel ill, so we need psychotherapy to do some cognitive restructuring, or whatever the fashionable jargon is at the moment.

 

[Arvo]

Maybe. I suspect it's something more simplistic like we feel ill because we expect to feel ill, so we need psychotherapy to do some cognitive restructuring, or whatever the fashionable jargon is at the moment.

Same.


GT translation of the German summary:

Expectations play a central role in current etiological models of functional physical complaints and their clinical manifestations as functional or somatic stress disorders. Expectation effects can be demonstrated with regard to the development and maintenance of complaints, as well as the effectiveness of treatments. Therefore, expectation management is a central element of their prevention and care, from the initial contact, which usually takes place in somatic medicine, through to psychotherapy. This review summarizes the evidence on the role of expectation effects in the development and maintenance of functional physical complaints. It also explains various transdisciplinary techniques of expectation management.

So basically it sounds like: "Expectations" are at the center of our etiological model of your illness. That your illness is the result of "expectation" is demonstrated by you having illness symptoms and because the treatments work. [err...]
Therefore expectation management is key from the moment you step into the drs office. We will summarize the evidence that your illness is the result of expectation. You can contact us at our psychosomatic medicine clinic.

 

[rvallee]

Putting aside that those are models, and models can say anything, and all they have is models, this model actually explains them very well. Not the patients. Them. They have very explicit and specific expectations of what diseases are known and described, specifically how they are known and described, and the symptoms they can and do cause. And those expectations break, predictably, for all the things they don't know to expect, all the things they don't know.

'Tis is a really silly case of people who have erected glass houses surrounded by glass walls throwing stones all day at people they force to live out in the open. Of course no such effect has been shown, rather because of their weird fantasy models, they expect certain things, mostly common things, and when they find those things they simply assert the model, throwing away their training and all reason aside, on the simple mindless argument that "it could be this model we invented for this purpose, entirely out of ignorance". It could be, it's not possible to say for certain that it isn't god's will / mind-body-spiritual-mumbo-jumbo, therefore it must be, because the model compels it.

What's extra funny is that they invented those models this way. It's not as if they sprung out of evidence, or were found through scientific means, certainly not unexpected. No, rather it's simply expectations they have about what they know and what they believe to be possible, based on limited models, such as current medical knowledge, and about the whole pantheon of logical fallacies.

This works exactly like flat earth. Flat earth is a model built out of nothing, not scientific research or real life data. It creates expectations, suggests things that could be found and things that shouldn't be found, and proponents look for anything that will confirm those, while ignoring anything that contradicts it. Exactly like psychosomatic ideology. It works exactly as mindlessly and with as excessively biased intent. About the only difference is the crowd of believers and their influence on society. Delusional fantasies become disastrous when they are given real life power.