A taxonomy of the components of body-oriented mentalization in somatic-symptom and related disorders as perceived by experienced clinicians: a concept-mapping study

Abstract

Background: Somatic-symptom and related disorders are considered to be maintained by reduced skills in body-oriented mentalization. This refers to the capacity to observe and to be open to bodily experiences in the self and others, and to connect these to mental states. In order to get a grip on the construct of body-oriented mentalization, valid assessment is essential. Objective: To yield an overview of the observable components of body-oriented mentalization and to structure these components. Methods: A concept-mapping procedure was used. Participants were clinicians with experience in working with body-oriented mentalization. Eleven in-depth interviews yielded a comprehensive overview of 55 observable components of body mentalization. These components were sorted by 46 clinicians in one sorting task based on content and in another on perceived importance. Hierarchical cluster analysis (squared Euclidean distances, Ward’s method) was used to obtain a structured overview of the first sorting. Results: The hierarchical structure showed eight clusters of observable components, classified in four main categories: psychosomatic congruency, verbalizations (exploring, expressing and connecting), body-mind relatedness (awareness, accepting and perspective taking) and relational context. The perceived importance ratings showed individual differences between clinicians. Clusters were on average rated equally important. Conclusion: The overview of observable components of body-oriented mentalization in eight clusters is a starting point for the development of an assessment tool for body mentalization. This is essential in research to elucidate how body-oriented mentalization relates to somatic-symptom disorder and can be used to examine whether interventions directed at improvement of body-oriented mentalization really improve body-oriented mentalization skills and whether these improved skills mediate other outcomes.