Although it is difficult to treat eating disorders, appropriate psychotherapy can be administered for each patient by understanding and assessing the psychopathology of the disease. The essence of the symptoms of eating disorders is “adherence,” which derives from “perfectionism” based on the uncertainty of self-existence. Symptoms tend to be chronic owing to “addiction,” as one side of the eating disorder, and “hypersensitivity to oneself,” as the other. Assessment is important across the three axes of stages of disease, types of personality, and levels of motivation. We can assess the depth of psychopathology of each patient based on the early, lasting, and chronic stages of disease; reactive/conflictive, adherent, and impulsive types of personality; and recovery, fear, and denial levels of motivation. For ambulant treatment, we should approach patients with eating disorders according to the depth of their psychopathology, mainly through using a simple version of cognitive-behavioral therapy. It is important that therapist to share an image of recovery with patients.

1. When evaluating a person from the perspective of “mind,” “body,” and “behavior,” behavior needs to be carefully assessed.

2. Behavior is usually attributed to mental symptoms such as thinking and intellectual ability.

3. Behaviors seen in dementia patients that seem strange to others are called behavioral and psychological symptoms of dementia (BPSD). This is an example of inappropriate conceptualization of behavioral problems.

4. The severity of depression needs to be assessed comprehensively including mood, thoughts, and behavior.

5. Behavioral problems may provide useful information when depression is suspected.

6. In the treatment of depression, comprehensive evaluation is necessary of inborn factors, environmental factors during personality development, environmental stress, and physical factors.

In recent years, “interoception” has attracted attention as a cognitive science background for psychosomatic correlations. Interoception refers to the sensation of physiological states inside the body, such as breathing, heartbeat, and movement of the intestinal tract, and is considered a necessary function for maintaining homeostasis. In addition, interoceptive dysfunction has been observed in various stress-related disorders (e.g., PTSD, depression, anxiety disorders, psychosomatic disorders, and eating disorders).

Interoceptive dysfunction has been widely studied in neuroscience and psychology. Interoceptive signals are believed to be concentrated in the insular cortex of the brain and projected to the amygdala, which is responsible for various emotional experiences. In addition, Damasio et al. showed that people with low interoceptive sensation are highly likely to engage in high-risk behaviors. These findings suggest that behavioral change is influenced by internal receptive sensations, which can be considered a factor that defines behavior. In our study, we observed a decrease in anxiety, a change in behavior, and a change in brain circuitry in the insular cortex when implementing a cognitive training task that directly strengthened the internal receptive sense.

In this paper, we introduce the findings on abnormalities in interoceptive sensation as a model of psychosomatic correlations, and present the results of our intervention experiment that examined the relationship between interoceptive sensation and behavioral change.

Eating disorders include “mental,” “physical,” and “behavioral” components in their diagnostic criteria, and their pathology changes in a psychosomatic correlation from onset to recovery. The pathology of the “mind,” such as perfectionism, low self-esteem, and emotional intolerance, is recognized across subtypes. Low body weight caused by anorexia often results in “physical” symptoms, such as lethargy, edema, hormonal abnormalities, and metabolic disorders, which can be life-threatening. Binge eating/purging and laxative abuse can lead to physical complications, such as reflux esophagitis and electrolyte abnormalities, which if prolonged, can lead to chronic renal dysfunction. These “mental” and “physical” symptoms greatly influence the “behavior” of the patient. Low self-esteem, abnormal eating behavior, and interpersonal irritability can lead to the avoidance of welfare services for social reintegration. In treatment, it is necessary to comprehend the level of the condition from each of these aspects of “mind,” “body,” and “behavior” and to provide comprehensive intervention.

Autism spectrum disorder (ASD), as the name implies, is currently regarded as a continuously transitioning spectrum rather than a categorical one. Recently, a large-scale epidemiological survey reported that the disorder is seen in approximately 2% of cases and tends to be regarded as a common disease. It is easy to have various problems, such as lack of socialization, ease of isolation because of difficulty in communication, difficulty in adapting to environmental changes owing to a lack of flexibility, and ease of being accompanied by comorbidities. Not all ASDs require treatment or support. Patients who appeared in our clinical setting were those with comorbidities.

In this paper, we discuss the “mind,” “body,” and “behavior” of ASD, comorbidities, physical symptoms including psychosomatic disorders and suicidal behavior, as well as their mutual relevance and how support should be provided.

Objectives : This study aimed to investigate coping self-efficacy (CSE) in patients undergoing cardiac rehabilitation.

Subjects : The patient group (n=122) comprised hospitalized patients participating in cardiac rehabilitation, and the control group (n=115) comprised community-dwelling elderly people.

Method : Participants completed a questionnaire on CSE and affective states.

Results : Factor analysis of the 24 items of the CSE questionnaire revealed the following four major factors : cognition, avoidance, problem solving, and distractive acting. The patient group showed lower levels of cognition than the control group did. Among female participants, patient group exhibited lower levels of problem solving and distractive acting compared to the control group. Cognition, problem solving, and distractive acting were positively associated with good mental health, whereas avoidance and distractive acting in female patients were positively associated with anger-hostility.

Conclusion : This study revealed that the patient group, especially women, tended to display lower CSE levels than those of the control group. For an effective intervention, the CSE tendencies observed in this study should be considered.

Background : Breast cancer often affects women in their 30s and 40s. Owing to the increase in maternal age in recent years, the timing and provision of treatment overlaps with the period of child-rearing in patients. Child-rearing patients with cancer likely experience significant psychological distress, but the impacts of child-rearing-related anxiety and depression in these patients have not been adequately investigated in Japan. The aims of this study were to determine the levels of anxiety and depression among child-rearing patients with cancer and to investigate impacts of child-rearing-related factors, including concerns about parental roles and parent-child relationships.

Subjects : Subjects were patients with breast cancer aged 20 years or older who were diagnosed within the past 10 years and who were living with at least one child aged 18 years or younger. All subjects were native Japanese speakers. Data were collected via self-administered questionnaires composed of the following items : general information about the subjects and their children ; basic clinical information ; an original scale on parental interactions with children ; and the FACT-G, BCWI, and HADS scales for assessing quality of life (QOL), concerns, anxiety, and depression. Between-group comparisons, multiple regression and factor analysis were used to model factors affecting anxiety and depression. This study was approved by the institutional review board at Tohoku University School of Medicine (2019-1-785).

Results : We obtained 63 valid responses. Compared with the low-anxiety group, the high-anxiety group showed significantly higher levels of concerns about the “future,” their “physical body,” and “interpersonal and societal relations” (all p<.001). Compared with low-anxiety and low-depression groups, “psychological aspects” and “functional aspects” of QOL were significantly lower in the respective high-anxiety (p<.001) and high-depression (p<.05) groups. “Societal and familial aspects” of QOL were also significantly lower in the high-depression group than in the low-depression group (p<.05). The following two items were identified as factors contributing to anxiety : “it’ s hard to talk about the future” and “my child and I understand each other’ s intentions and thoughts” (both p<.05). The following three items were identified as factors in depression : “presence or absence of recurrence,” “I tend to avoid topics related to my illness,” and “my child and I understand each other’ s intentions and thoughts” (all p<.01). Factor analysis revealed the following three factors as concerns related to the child-rearing : “fearing negative effects of my illness on my child,” “parent-child relationships,” and “hoping to be a good parent.”

Conclusion : In addition to their anxiety about their illness, child-rearing patients with breast cancer appeared to worry about their children as mothers, thereby affecting their overall levels of anxiety and depression. Greater understanding about the psychological support necessary for child-rearing patients with cancer is required to reduce their anxiety and provide appropriate care accordingly.