The emotion regulation process in somatic symptom disorders and related conditions - A systematic narrative review

Somatic symptom disorders and related conditions (SSD-RC), along with depression and anxiety disorders, are among the most common mental disorders. Disturbances in emotion regulation (ER) are considered a key factor in the etiology and pathogenesis of SSD-RC. The present review aims to summarize relevant research on ER in SSD-RC and integrate results in the extended process model of ER. We conducted a systematic literature search in PubMed, PsycInfo, Psyndex, and Web of Science. After screening and systematic quality appraisal, 105 (n = 29332 participants) out of 2118 identified studies were included. Correlations with somatic symptoms in general and clinical populations as well as group comparisons with non-SSD-RC groups were included to summarize effects. We found evidence for deficits in the identification process of ER, especially reduced emotional clarity and ER self-efficacy, in patients with SSD-RC. SSD-RC were also significantly associated with a deviant pattern of habitual strategies (selection process) including a more frequent use of expressive suppression and a less frequent use of cognitive reappraisal. However, for both the identification and selection stages, there were many studies that did not find evidence for alterations in SSD-RC. Furthermore, self-report data suggests impairments in implementing ER. Experimental studies are scarce and have not found conclusive evidence for ER implementation deficits in SSD-RC. In addition to experimental studies, particularly ecological momentary assessments are needed to better understand potential alterations regarding ER in SSD-RC. Clinical interventions that target the identification of the need for ER, self-efficacy, and the repertoire of different strategies currently appear most promising.