Beyond Categorical Diagnosis and Therapies: Toward Dimensional, Process-Based, and Personalized Psychosomatic Medicine

This editorial argues for a necessary reorientation in psychosomatic medicine: moving beyond categorical diagnosis and disorder-specific treatment toward dimensional, process-based, and personalized models of assessment and intervention. Rather than reporting new empirical findings, the article develops a conceptual and theoretical synthesis informed by dimensional approaches to psychopathology, the Hierarchical Taxonomy of Psychopathology, Research Domain Criteria, process-based therapy, homeostasis, allostasis, predictive regulation, biosemiotics, and personalized medicine. Together, these perspectives provide the basis for a regulatory model of psychosomatic care. Although categorical diagnostic systems remain valuable for clinical communication, epidemiological classification, and the organization of health-care services, they do not adequately account for the heterogeneity, comorbidity, shared mechanisms, and variability in treatment response that frequently characterize psychosomatic conditions. Dimensional and process-based approaches offer a more clinically useful framework by directing attention to regulatory processes that operate across diagnostic boundaries. Within this framework, adaptive regulation is proposed as a core clinical unit that connects biological, psychological, behavioral, interpersonal, and social domains. Biosemiotics adds further depth to this perspective by framing symptoms not merely as isolated markers of pathology, but as meaningful regulatory signs embedded within the person’s broader bodily, emotional, relational, and cultural context. On this basis, the editorial supports the use of multidimensional regulatory profiling in psychosomatic medicine. Such profiling would guide treatment selection according to the specific mechanisms that are disrupted, including threat–safety regulation, interoception, emotional flexibility, executive control, attachment, motivation, social functioning, and meaning construction. Psychosomatic medicine should therefore complement categorical diagnosis with individualized regulatory profiles. This shift would allow care to become more flexible, mechanism-based, and personally responsive by asking which regulatory dimensions are impaired and which combination of interventions is most likely to restore adaptive functioning.