The onset and maintenance of eating disorder are deeply related to psychosocial stress, which includes interpersonal difficulty, abuse, and loss experience. These are well known as a risk factor of eating disorders.

Recent studies in these days have shown that patients with anorexia nervosa (AN) have excessive cognitive control and suppressed emotional processing. A previous fMRI study on the processing of negative words concerning interpersonal relationships showed the hyperactivity of brain regions related to cognitive control such as dorsolateral prefrontal cortex (DLPFC). On the other hand, the regions concerning emotional processing such as amygdala were negatively correlated to alexithymia.

We reported that AN patients showed hypoactivity of ventrolateral prefrontal cortex during cognitive flexibility task using fMRI. Decision making is a brain function integrating cognitive control and emotional processing. We found that the hyperactive DLPFC during decision making in AN patients and the patients did not show significant activity in ventromedial prefrontal cortex which is a key region of decision making. These results may support the hypothesis of excessive cognitive control and disturbed emotional processing. Altered neural circuits may be responsible for stress coping problems in patients with eating disorders.

Because eating disorders have an onset and clinical course that are closely related to psychosocial factors, they can be broadly regarded as psychosomatic diseases. Most patients with eating disorders experience distress, loneliness, and a tendency for low self-esteem. As a result, it is believed that they cope with various psychological problems through behaviors such as over-eating or under-eating. Furthermore, many patients experience transient self-esteem if they are praised by others for being thin or experience success in dieting through their own efforts.

Chronic starvation also has negative effects on brain functions such as elevation of obsessive-compulsive behaviors. Moreover, previous reports suggest that epigenetic alterations might occur among patients with anorexia nervosa during chronic starvation.

Treatment of eating disorders is often difficult, and integrated treatment of both the mind and body is necessary.

In the current report, we discuss eating disorders as stress-related diseases and introduce our therapy through the presentation of a case of anorexia nervosa.

Eating disorder (ED) is one of the stress related diseases. Often life events can be its trigger factors, and psycho-social stresses influence both its improvement and exacerbation.

Body weight gain is very important for the patients with anorexia nervosa (AN). However, when the therapist focuses too much on the improvement of their physical state, they often say “Do not focus only on my weight gain, please.” If I could approach in some other ways beside body weight gain, what would be important for the treatment of AN? In my opinion, therapist should establish a good relationship with patient at first. In the next stage, we should deal with both weight gain and patient’s mind growth. Getting self-acceptance is also an important stage in the treatment of AN. In order to break through a lot of their life experiences, they need to arrive at the improvement in self-acceptance and self-efficacy through counseling with therapists. In these stages, therapists have to focus on effects of stressors and exacerbating factors on patients with ED. We should also continue to evaluate their positive side, which induces their self-efficacy.

Although ED may be one of the intractable diseases and its treatment contains many difficult tasks, we should not give it up.

Eating disorders are not mere abnormalities of appetite and eating behaviors, but severe disorders of eating behaviors based on psychological factors such as excessive attention to body weight and excessive influence of body shape and weight on self-evaluation. Eating disorders are mainly classified as anorexia nervosa (AN) and bulimia nervosa (BN). Regarding AN, there are reports that social appearance anxiety is associated with anorexia nervosa symptomology. In case of BN, studies using momentary assessments show that binges and vomiting episodes are more likely to occur on days with lower positive affect, higher negative affect, anger/hostility and stress. As described above, there are many reports showing that stress including psychosocial factors is related to symptoms and courses of eating disorders. There is no doubt that eating disorders are included in stress-related diseases. In this article, we also introduce data on psychosocial factors of eating disorder patients treated in our hospital and overview the relationship between eating disorders and stress.

The theme of this workshop was the “history and findings of psychosomatic therapy” and my presentation focused on “Morita therapy.” I spoke about Dr. Shoma Morita’s contribution to the history and findings of psychosomatic therapy and Dr. Yujiro Ikemi’s contribution to psychosomatics, and explained the actual state of Morita therapy while quoting my own and patients’ experiences.

Morita therapy was developed by Morita (1874-1938) for patients with Morita neurosis. Although this is an excellent therapy, it is not popular in Japan. However, Morita therapy is applicable to many patients in psychosomatics and psychosomatic internal medicine.

Understanding through experience is the most important aspect of this therapy, and we cannot understand everything based on theories. We can understand a matter through experience after constantly pondering about it. Morita worried about cardiac neurosis during his school days, and developed Morita therapy after overcoming it. Ikemi worried about various neuroses and psychosomatic disorders during his puberty and laid the foundation of psychosomatics and psychosomatic internal medicine. Ikemi received Morita therapy from Morita, and I also personally underwent this therapy. Based on my experience, it can be said that Ikemi could openly confess his worry, and this made him grow stronger. I also suffered from similar neurosis. After receiving Morita therapy, I frankly confessed my worries and was cured completely. A woman, who had not been able to go out alone for 20 years, received walking training therapy (modification of Morita therapy), in which operations in occupational therapy were replaced by walking, and she understood her neurosis through experience ; consequently, she could go anywhere alone. This woman and I have overcome neurosis by understanding it through experience. In Morita therapy, a patient’s anxiety and tension are not eradicated ; rather, the patient is cured although they still exist (Morita said as they are). This is the uniqueness of Morita therapy. Ikemi said that psychosomatics was not applicable to neuroses. If so, problems with physical diseases must be examined for psychosomatics. Many patients with physical diseases are physically and mentally unconscious of any symptom and exhibit so-called alexithymia and alexisomia. Almost all diabetic patients are physically and mentally insensitive to their disease, unlike patients with Morita neurosis. Therefore, different physical and mental therapies, including biofeedback of blood sugar, are required for diabetic patients. Training to increase sensitivity is required, unlike Morita therapy. Therapies suitable for psychosomatic disorders must be applied to the patients.

The applications of the major theories of transactional analysis (TA) to the treatment of psychosomatic patients were discussed through the specific cases. Four main theories of traditional TA i. e. ego-states analysis, transactional analysis proper, racket and game analysis, script analysis, and eight therapeutic operations which E. Berne has presented provide the grounds for all assessments and interventions. The Redecision Therapy which R&M Goulding have developed requires the commitment of patients to the therapies and cathects their ‘Child’ ego-states, and consequently the patients would be changed dramatically. If you are familiar to Personality Adaptations Theory which V. Joines et. al. have completed, you can understand the patients’ personality traits clearly and construct the therapy plan based on the theory. The Relational Perspective which H. Hargaden et. al. have proposed, would give you insights and guidance in the relationship with the patients who are not aware of their own wounds because their ‘self’ that is ‘Child’ ego-state has been confused since their infancy.

Currently, there is a major change in the way of scientific research and applied practice, beginning with the field of artificial intelligence. It is a paradigm shift from a top-down methodology that examines general hypotheses and applies the results to reality, to a bottom-up methodology that individually builds an optimal model that predicts outcomes based on a large amount of actual data. In the near future, a bottom-up approach based on the vast data of the each patient may be indispensable for chronic diseases and psychosomatic problems where the mechanism is complicated and individual differences are large. A similar paradigm shift has also occurred when practicing methods such as sports and education, and further clinically utilizing psychosomatic therapy such as Autogenic Training. Differences between the two approaches can produce a decisive difference in effect. In this paper, we will explain what these are, and concretely present the difference between the two types of approaches in research and practice, taking the Autogenic Training as an example.

Among several types of therapy included in psychosomatic treatment, general psychotherapy is the basis in providing these types of treatment. For medical doctors engaged in clinical psychosomatic medicine, learning general psychotherapy, in the course of internship is essential, and will affect the nature of therapeutic self in their approach to patients as therapist. In general psychotherapy, which consists of acceptance, support, reassurance, and listening, patients feel their thoughts and feelings being accepted by therapist as they are. Morita therapy is a psychotherapy Masatake Morita established in the 1920s. While traditional Morita therapy prioritized human understanding and the attitude based on treatment theory, it had less emphasis on acceptable attitude toward patients. In today’s Morita therapy, however, therapists accept patients’ symptoms as the basis of treatment, and support patients to lead their everyday lives actively in own ways by leaving those symptoms and associated emotions as they are.

Sitting a university admissions exam is a major life event, but many students experience physical and mental imbalance from the attendant stress. Over a four-year period, the author surveyed ten university students who underwent psychosomatic screenings for bodily imbalance. The sample consisted of 90% high school students (70% were female). Half reported headaches, and 80% were found to have anxiety on a psychological screening. Subjects were briefed on the fact that when the admission testing period concluded before treatment began, their symptoms would lessen, and that understanding the characteristics of stress symptoms they experienced when undertaking tests was crucial. Following this, subjects took a more receptive and closely attentive stance and utilized the ventilation of stressful issues as a coping mechanism ; the majority experienced an alleviation of symptoms following the conclusion of admissions exams. The mechanisms of stress implicated with taking admissions exams were precisely correlated with mental and physical wellbeing, and a psychosomatic form of medicine that fostered an awareness of this helped subjects appreciate current conditions, prevent their worsening, and achieve their goals. As with past research findings on “jyukensei syndrome,” in which prep school students exhaust their energy, we discuss herein the characteristics and attitudinal changes of a student population that have developed physical and mental imbalance during university admissions exams and undergone psychosomatic treatment thereafter.