Guide
Guide | Reference

35  Predominant Somatic and Interoceptive Prototypes

35.1 Summary

  • Prototypes dominated by bodily distress, symptom focus, or functional neurologic presentations.

35.2 Included Prototypes (Guide exemplars)

  • Functional Neurologic Symptom Prototype (exemplar).
  • Somatic Symptom Burden Prototype (exemplar).
  • Full catalog appears in the Clean Reference.

35.3 How to Use This Cluster

  • Start with the Atlas entry for somatic distress and interoception.
  • Rate the Somatic Distress and Interoception domain.
  • Apply a prototype label only when it improves communication or documentation.

35.4 Boundary Markers

  • What it is: persistent bodily distress or functional symptoms with high impact.
  • What it is not: fully explained medical illness without distress amplification.

35.5 Common Overlap

  • Anxiety and threat sensitivity.
  • Sleep and arousal dysregulation.

35.6 Functional Neurologic Symptom Prototype (Exemplar)

35.6.1 Summary

  • A pattern of neurologic symptoms (e.g., weakness, tremor, non-epileptic events) not fully explained by structural disease and linked to functional disruption.

35.6.2 Prototype Features

  • Neurologic-type symptoms with inconsistent or variable findings.
  • Symptoms fluctuate with attention, stress, or context.
  • Significant distress or functional impairment.

35.6.3 Threshold Guidance

  • Use when functional neurologic symptoms are prominent and impairing after medical evaluation.

35.6.4 Expected Domain Profile

  • Somatic Distress and Interoception: moderate to high.
  • Anxiety and Threat Sensitivity: variable.

35.6.5 Time-Course and Trajectory

  • Fluctuating with stress or context.
  • May be episodic or persistent.

35.6.6 Differential and Red Flags

  • Neurologic disease requiring workup.
  • Substance or medication effects.
  • Seizure disorders or syncope.

35.6.7 Specifiers

Specifiers: course + contributors + risk, as relevant; see Reference for full.

35.7 Somatic Symptom Burden Prototype (Exemplar)

35.7.1 Summary

  • A pattern of multiple or persistent bodily symptoms with high distress and functional impact.

35.7.2 Prototype Features

  • Ongoing pain, fatigue, or multisystem symptoms.
  • High symptom-related distress or preoccupation.
  • Functional impairment and healthcare use.

35.7.3 Threshold Guidance

  • Use when symptom burden is persistent and impairing after evaluation.

35.7.4 Expected Domain Profile

  • Somatic Distress and Interoception: moderate to high.
  • Anxiety and Threat Sensitivity: variable.

35.7.5 Time-Course and Trajectory

  • Chronic with episodic flares.

35.7.6 Differential and Red Flags

  • Medical conditions with clear etiology.
  • Substance or medication effects.
  • Trauma-related somatic hyperarousal.

35.7.7 Specifiers

Specifiers: course + contributors + risk, as relevant; see Reference for full.