Psychosomatic Mechanisms of Fear’s Impact on Human Functioning

The study is devoted to the psychosomatic mechanisms of fear’s influence on human vital activity. The aim was to systematize the neurobiological, psychological, and physiological links in the transformation of fear emotion into bodily dysfunctions, as well as to identify unresolved problems in this area. Using theoretical analysis and systematization of scientific publications (PubMed, Scopus, Russian journals, 2018‒2025), four neurobiological levels of the fear response organization were identified: cortical, limbic, brainstem, and endocrine. It was revealed that alexithymia (inability to verbalize emotions) acts as a key mediator of fear somatization, with its level being significantly higher in somatoform disorders (47.54±5.20 on TAS-20) compared to anxiety-phobic disorders (34.69±10.69). Two types of psychosomatic response to fear were established: the sympatho-adrenal type (characteristic of most anxiety disorders, with tachycardia and hypertension) and the parasympathetic/vasovagal type (in specific phobias, with bradycardia and hypotension). Comparative analysis showed that anxiety levels are higher in anxiety-phobic disorders (11.79±3.07 on HADS), whereas depression (8.07±1.98) and alexithymia dominate in somatoform disorders. The effectiveness of therapeutic approaches was analyzed: cognitive-behavioral therapy remains the gold standard, while unconscious exposure methods show preliminary evidence of reducing behavioral avoidance (d=0.77). Gaps in the study of the problem were identified: a lack of longitudinal studies, an absence of integrative models of systemic organ interaction in chronic fear, and the underdevelopment of personalized algorithms for therapy selection. The findings highlight the need to implement screening for anxiety and alexithymia in patients with somatic complaints of unclear genesis, to use HADS and TAS-20 scales for differential diagnosis of anxiety-phobic and somatoform disorders, and to provide psychoeducation in cases of pronounced alexithymia. Recommendations for clinical practice were developed: training primary care physicians to recognize psychosomatic masks of fear and prioritizing longitudinal studies to establish causal relationships.