Psikosomatik Tıpta Aleksisomi: Bir Gözden Geçirme

Abstract

Psikosomatik tıp, bedensel hastalıkların oluşumu ve seyrinde psikososyal faktörlerin rolünü inceleyen disiplinler arası bir alandır. Bu alanda uzun yıllardır duyguları ifade etme güçlüğü olarak bilinen aleksitimi üzerine yoğunlaşılmış olsa da, son yıllarda araştırmacıların dikkati "bedensel duyumları fark etme ve ifade etme güçlüğü" olarak tanımlanan "Aleksisomi" (Shitsu-taikan-sho) kavramına yönelmiştir. Dr. Ikemi, 1973 yılında P. E. Sifneos tarafından ortaya atılan aleksitimi kavramını Japonya'ya tanıttıktan kısa bir süre sonra, psikosomatik hastalıkları olan hastaların sadece duygularını değil, aynı zamanda bedensel hislerini ve duyumlarını da tanımlamakta zorluk çektiklerini fark etti. Dr. Ikemi, bedensel farkındalık eksikliği özelliğinin kavramına Japonca'da “shitsu-taikan-sho” (İngilizce'de “alexisomia”) adını vermeyi önerdi; burada “shitsu” eksiklik, “taikan” bedensel hisler/duyumlar ve “sho” durum/semptomlar anlamına gelmektedir. Japon psikosomatik tıbbının kurucusu Yujiro Ikemi tarafından ortaya atılan bu kavram, hastaların yalnızca duygularını değil, homeostatik dengenin korunması için hayati olan açlık, tokluk, yorgunluk ve gerginlik gibi bedensel sinyalleri de okuyamadıklarını öne sürer. İnterosepsiyon ile ilişkisi üzerinden değerlendirildiğinde, özellikle insular korteks ve anterior singulat korteksin bedensel farkındalığın oluşumunda merkezi rol oynadığı görülmektedir. Aleksisominin bu beyin ağlarındaki işlevsel bağlantı bozukluklarıyla ilişkili olabileceği düşünülmektedir. Bu derleme, aleksisomi kavramının tarihsel gelişimini, nörobiyolojik altyapısını, ölçüm araçlarını ve klinik yansımalarını literatür bulguları eşliğinde ayrıntılı bir şekilde ele almaktadır.

Keywords

• Aleksisomi
• Shitsu-taikan-sho
• Psikosomatik Tıp
• İnterosepsiyon
• Aleksitimi

Alexisomia in Psychosomatic Medicine: A Review

Abstract

Psychosomatic medicine is an interdisciplinary field that examines the role of psychosocial factors in the development and course of bodily illnesses. While this field has focused for many years on alexithymia, known as difficulty in expressing emotions, in recent years researchers have turned their attention to the concept of "Alexisomia" (Shitsu-taikan-sho), defined as "difficulty in recognizing and expressing bodily sensations." Soon after Dr. Ikemi introduced to Japan the concept of alexithymia, coined by P. E. Sifneos in 1973, he noticed that patients with psychosomatic diseases have difficulty in describing not only their emotions, but also somatic feelings and sensations. Dr. Ikemi proposed naming the concept of the trait of lacking somatic awareness “shitsu-taikan-sho” in Japanese (“alexisomia” in English), meaning “shitsu” a lack, “taikan” bodily feelings/sensations, and “sho” condition/symptoms. This concept, introduced by Yujiro Ikemi, the founder of Japanese psychosomatic medicine, suggests that patients cannot read not only their emotions but also bodily signals vital for maintaining homeostatic balance, such as hunger, satiety, fatigue, and tension. When evaluated in terms of its relationship with interoception, it is seen that the insular cortex and anterior cingulate cortex, in particular, play a central role in the formation of bodily awareness. It is thought that alexisomia may be associated with functional connectivity disorders in these brain networks. This review examines the historical development, neurobiological basis, measurement tools, and clinical implications of the alexisomia in detail, accompanied by literature findings.

Keywords

• Alexisomia
• Shitsu-taikan-sho
• Psychosomatic Medicine
• Interoception
• Alexithymia

References

1. Aksu MH, Baltacı NN, Ekmekçi Ertek İ, Coşar B (2023) Turkish adaptation, validity, and reliability study of Shitsu-Taikan-Sho (Alexisomia) Scale. Psychiatry Clin Psychopharmacol, 33:134-142.
2. Arimura T, Oka T, Matsushita T (2012) Development of the Shitsu-taikan-sho scale. Jpn J Psychosom Med, 52:745-754.
3. Bagby RM, Parker JD, Taylor GJ (1994) The twenty-item Toronto alexithymia scale—I. Item selection and cross-validation of the factor structure. J Psychosom Res, 38:23-32.
4. Cauda F, Geminiani GC, Vercelli A (2014) Evolutionary appearance of von Economo’s neurons in the mammalian cerebral cortex. Front Hum Neurosci, 8:104.
5. Cannon WB (1932) The Wisdom of the Body. New York, WW Norton.
6. Craig AD (2002) How do you feel? Interoception: The sense of the physiological condition of the body. Nat Rev Neurosci, 3:655-666.
7. Craig AD (2009) How do you feel—now? The anterior insula and human awareness. Nat Rev Neurosci, 10:59-70.
8. Critchley HD, Garfinkel SN (2017) Interoception and emotion. Curr Opin Psychol, 17:7-14.

9. Di Bello M, Carnevali L, Petrocchi N (2023) Modulatory effects of transcranial direct current stimulation of right insula on compassion motivation. Int J Clin Health Psychol, 23:100362.
10. Hasuo H, Sakai K (2021) Clinical characteristics of alexisomia in patients with incurable cancer. Ann Palliat Med, 10:10244-10252.
11. Ikemi Y (1963) Shinryo Naika. Tokyo, Chukoshinsho.
12. Ikemi Y (1977) Psychosomatic medicine. Jpn Med J, 2755:49-54.
13. Ikemi Y (1979) Psychophysiology as the starting point of education. Jpn J Transact Anal, 4:1-10.
14. Ikemi Y, Ikemi A (1983) Psychosomatic medicine: A meeting ground of Eastern and Western medicine. J Am Soc Psychosom Dent Med, 30:3-16.
15. Ikemi Y, Ishikawa H (1979) Integration of occidental and oriental psychosomatic treatments. Psychother Psychosom, 31:324-333.
16. Kabir RS, Oka T, Chapagain D (2018) Self-Active Relaxation Therapy (SART) and self-regulation: a comprehensive review and comparison of the Japanese body movement approach. Front Hum Neurosci, 12:21.
17. Kurokawa N (1991) Alexithymia and alexisomia in diabetes mellitus. Diabetes J, 19:111-114.
18. Lipowski ZJ (1988) Somatization: the concept and its clinical application. Am J Psychiatry, 145:1358-1368.
19. Lopez-Ojeda W, Hurley RA (2022) Von Economo neuron involvement in social cognitive and emotional impairments in neuropsychiatric disorders. J Neuropsychiatry Clin Neurosci, 34:302-306.
20. Oka T (2020) Shitsu-taikan-sho (alexisomia): A historical review and its clinical importance. BioPsychoSocial Med, 14:23.
21. Oka T, Lkhagvasuren B, Yamada Y (2025) Effects of recumbent isometric yoga on the daily functioning level of patients with myalgic encephalomyelitis/chronic fatigue syndrome: A randomized controlled trial. BioPsychoSocial Med, 19:19.
22. Sifneos PE (1973) The prevalence of alexithymic characteristics in psychosomatic patients. Psychother Psychosom, 22:255-262.
23. Sugita M, Ikemi Y, Nakai Y (1977) The disturbance of sensory awareness in alexithymia. In Proceedings of the 4th International College of Psychosomatic Medicine, Tokyo, Japan, 45-49.