Objective: This study aims to verify whether mental dysfunctions can be a risk factor differentiable from organic causes in somatization.
Background: A popular hypothesis in psychosomatic medicine posits that psychosocial factors including childhood relational trauma, dissociation, and alexithymia may play a central role in the pathogenesis of somatization. Empirical studies have reported a reliable correlation between mental dysfunctions and functional somatic syndromes (FSSs), such as interstitial cystitis/bladder pain syndrome (IC/BPS). Yet, it remains unknown whether mental dysfunctions can be a separate risk factor from organic defects in FSSs, such as a smaller bladder capacity for the persistent urge to void and frequent urination of IC/BPS.
Methods: Ninety-four IC/BPS patients were recruited to test the hypothesis. Forty-seven patients with acute cystitis served as clinical controls. Psychosocial and psychiatric variables including potentially traumatizing events, anxiety, depression, dissociation, and alexithymia were assessed with validated scales. Anesthetic bladder capacity, a state-of-the-art bladder-centric etiological factor in IC/BPS, was examined by cystoscopic hydrodistention.
Results and Discussion: Among traumatizing events, those perpetrated by close others in childhood were found to be the most salient features discriminating the IC/BPS group from the control group. More importantly, positive correlations were found in the IC/BPS group between childhood relational trauma, mental dysfunctions, and anesthetic bladder capacity. IC/BPS patients who had higher scores on childhood relational trauma as well as anxiety, dissociation, and alexithymia were found to have a larger bladder capacity. Our results suggest that mental dysfunctions may constitute a pathogenic pathway that differs from bladder-centric defects in IC/BPS.

Childhood relational trauma, dissociation, and alexithymia in interstitial cystitis/bladder pain syndrome: Evidence for a psychosocial subtype in functional somatic syndromes