Review Mentalising impairments in somatic symptom and functional neurological disorders: A systematic review 2026 Stagaki et al

[Andy]

Highlights​

• First systematic review of mentalizing in SSD & FND.
• SSD & FND (esp. PNES) show potential other-focused cognitive mentalizing deficits.
• Self-focused mentalizing was rarely examined.
• Diagnostic and measurement heterogeneity limits conclusions.
• Findings offer preliminary support for mentalization-informed approaches in SSD & FND.

Abstract​

Somatic Symptom Disorder (SSD) and Functional Neurological Disorder (FND) are among the most prevalent conditions within the DSM-5 category of somatic symptom and related disorders (SSRD) and are associated with substantial psychological distress and functional impairment. Although the aetiology of SSRD is multifactorial and remains uncertain, emerging evidence suggests that impairments in mentalizing – the capacity to understand one's own and others' mental states - may contribute to the development and persistence of functional somatic symptoms. Despite growing research interest, no systematic review has synthesised the evidence comparing mentalizing abilities in individuals with SSD or FND to those without these diagnoses.

The present systematic review addressed this gap by examining whether individuals with SSD and FND differ in mentalizing relative to healthy and clinical control groups, focusing on studies explicitly assessing mentalizing-related constructs. A comprehensive search of three electronic databases identified 18 eligible studies, comprising 1801 participants. Methodological quality was appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Tool for case-control studies, and the psychometric robustness of mentalizing measures was critically evaluated.

Overall, adults with SSD and FND – particularly those with psychogenic non-epileptic seizures (PNES) - demonstrated impairments in other-focused cognitive mentalizing compared to control groups. In contrast, self-focused mentalizing was rarely assessed, precluding firm conclusions. Findings suggest that mentalizing may be clinically relevant in SSD and FND and support further investigation of mentalization-informed assessment and intervention. However, substantial diagnostic and measurement heterogeneity underscores the need for high-quality, adequately powered studies employing validated, multidimensional assessments of mentalizing.

Open access

 

[Hoopoe]

A boring, common sense explanation for this could be that patients are too impaired to have a normal social life and therefore lose some of the pertinent skills.

 

[rvallee]

See, you can tell they're witches because when you dunk them in water they scream and insist they're not witches. That's how you know. Well, that's how we do it anyway.

Despite growing research interest, no systematic review has synthesised the evidence comparing mentalizing abilities in individuals with SSD or FND to those without these diagnoses.

Possibly not by calling it "mentalizing", by which they obviously sort of mean somatizing, but other than that this is a very dishonest premise. It's been checked, over-checked, again and again. It's probably the most over-checked thing in the entire history of medical, uh, mentalizing.

Overall, adults with SSD and FND – particularly those with psychogenic non-epileptic seizures (PNES) - demonstrated impairments in other-focused cognitive mentalizing compared to control groups.

Oh, do people experiencing symptoms experience symptoms? How bold and groundbreaking. How could we possibly understand more about those illnesses without genius insights like this? It's clearly vital to keep funding this never-ending gravy trolley loop.

The two FND studies with the highest quality ratings (7/9 and 6.5/9) yielded contradictory results despite both investigating PNES using similar affective mentalizing measures (RMET) and additional cognitive tasks (SST and HT or MET). Gürsoy et al.

Diagnostic heterogeneity was pervasive. In SSD studies, participants were variably classified as SSD, SFD, or PSPD using differing frameworks (DSM-5, DSM-IV, ICD-10, CBCL), while FND studies included PNES, FMD, and mixed samples, with PNES criteria varying notably (e.g., seizure frequency thresholds from ≥1/year to ≥2/month). This variability limits comparability and interpretation of findings.

It's almost like all of this is made up and all they're doing is throwing stuff at the wall and only working from whatever sticks, mostly because of the small shelves they placed on the wall to conveniently catch things that don't actually stick but will be recorded as such anyway because what are you going to do about it?

A further methodological concern in Seitz et al. [10] was the unexpected finding that healthy controls reported significantly higher levels of childhood trauma across all domains than the SSD group. Given established links between childhood trauma and mentalizing impairments [[54], [55], [56]], this confound complicates interpretation of null findings.

Such complications. Making stuff up is easy. Making sense of made up stuff becomes problematic quickly.

mentalizing – the capacity to understand one's own and others' mental states

It's pretty clear who has mentalizing issues here.

 

[Sean]

A further methodological concern in Seitz et al. [10] was the unexpected finding that healthy controls reported significantly higher levels of childhood trauma across all domains than the SSD group. Given established links between childhood trauma and mentalizing impairments [[54], [55], [56]], this confound complicates interpretation of null findings.​

Or it disproves a link between childhood trauma and SSDs, and does not exactly provide any support for the whole concept of SSD itself.

It is staring them right in the face, and they still will not see it. It is a level of intellectual and ethical failure that is off the charts.