Guide
Guide | Reference

20  Somatic Distress and Interoception

20.1 Summary

  • Distressing bodily sensations, pain, or fatigue with heightened attention to internal cues and uncertainty about what they mean.

20.2 Patient-Language Phrases

  • “My body feels off all the time.”
  • “I notice every sensation and worry about it.”
  • “I’m exhausted no matter how much I rest.”
  • “The pain feels overwhelming.”

20.3 Core Features

  • Persistent or intense bodily discomfort.
  • Heightened interoceptive focus or scanning.
  • Distress or worry about symptoms.

20.4 Boundary Markers

  • What it is: bodily distress with attention amplification or uncertainty intolerance.
  • What it is not: clear, fully explained medical conditions without distress amplification.

20.5 Quick Structure

  • Variants / Spectrum
    • Pain-dominant presentations.
    • Fatigue or low-energy syndromes.
    • Functional neurologic symptoms (weakness, tremor, nonepileptic events).
    • Health anxiety overlap.
  • Severity (0-4)
    • 0: No significant somatic distress.
    • 1: Mild, intermittent, manageable.
    • 2: Moderate, persistent, impacts function.
    • 3: Severe, frequent, with significant distress or impairment.
    • 4: Extreme, disabling or unsafe.
  • Time-course
    • Chronic persistence with flares.
    • Trigger-linked or stress-linked spikes.
  • Functional impact
    • Work/school: reduced stamina or attendance.
    • Relationships: increased reassurance seeking or withdrawal.
    • Self-care: disrupted routines, healthcare overuse or avoidance.
  • Developmental expression
    • Childhood: somatic complaints or school avoidance.
    • Adolescence: fatigue, pain, or health anxiety.
    • Late life: symptom focus with medical overlap.
  • Cultural/context notes
    • Somatic framing of distress may be culturally normative.
    • Access to care shapes symptom interpretation.