Somatization of emotional experience in patients with temporomandibular disorders: the role of mentalized affectivity and interoceptive awareness

Temporomandibular disorders (TMDs) are a set of clinical conditions involving the masticatory muscles, the temporomandibular joint, and related orofacial structures, which produce (even chronic) pain in the mouth and face. Research has largely investigated the psychological factors associated with TMDs, providing robust evidence of the tendency of TMD patients to experience psychological distress as somatic symptoms. Despite the extensive research conducted in this field, no study has yet explored the role of mentalized affectivity and interoceptive awareness in predicting somatic symptoms in TMD patients. The aim of this study was, therefore, to fill this gap. Methods: Fifty patients with TMDs completed standardized surveys, including: the Graded Chronic Pain Scale (GCPS-2.0), the Patient Health Questionnaire-15 (PHQ-15), the Multidimensional Assessment of Interoceptive Awareness (MAIA), and the Mentalized Affectivity Scale (MAS). One hierarchical multiple linear regression was run to determine the role of the factors that were significant at a 0.05 significance level in Pearson correlations in predicting somatic symptoms in TMD patients; a mediation analysis was then conducted, entering the eligible variables. Results: Somatic symptoms were uniquely predicted by the MAS “Expressing Emotions” subscale, and this relationship was mediated by the MAIA “Not-Worrying” and “Trusting” subscales. Discussion: These findings – albeit preliminary – show that patients with TMDs are inadequately conscious that their-own physical stimuli can be the somatic expressions of their-own emotions. As a result, these patients are susceptible to worry excessively when perceiving pain and experience their body as unsafe and untrustworthy: this may lead them to falsely attributing (even innocent) physical signs to physical illness. These results may have significant implications for clinical practice, guiding (in parallel to medical treatments) psychological intervention programs aimed at supporting TMD patients to express emotions and interpret correctly the signals originating from their body.