Reference
Guide | Reference

30  Somatic Distress and Interoception

30.1 Summary

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

30.2 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.”

30.3 Core Features

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

30.4 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.

30.5 Variants / Spectrum

  • Pain-dominant presentations.
  • Fatigue or low-energy syndromes.
  • Functional neurologic symptoms (weakness, tremor, nonepileptic events).
  • Health anxiety overlap.

30.6 Severity Anchors (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.

30.7 Time-Course Patterns

  • Chronic persistence with flares.
  • Trigger-linked or stress-linked spikes.

30.8 Functional Impact

  • Work/school: reduced stamina or attendance.
  • Relationships: increased reassurance seeking or withdrawal.
  • Self-care: disrupted routines, healthcare overuse or avoidance.

30.9 Common Mimics / Differential

  • Medical conditions with clear etiology.
  • Trauma-related somatic hyperarousal.
  • Anxiety-driven bodily alarm.

30.10 Medical / Substance Rule-Outs

  • Endocrine, autoimmune, neurologic, or infectious contributors.
  • Medication effects or withdrawal.

30.11 Developmental Expression

  • Childhood: somatic complaints or school avoidance.
  • Adolescence: fatigue, pain, or health anxiety.
  • Late life: symptom focus with medical overlap.

30.12 Cultural / Context Notes

  • Somatic framing of distress may be culturally normative.
  • Access to care shapes symptom interpretation.

30.13 Measurement Prompts

  • Brief somatic symptom measure.
  • Pain/fatigue tracking.

30.15 Documentation Snippet (1-2 lines)

  • “Persistent bodily distress with high interoceptive focus; Somatic 3; chronic course with flares.”