Stress, distress, and bodytalk: co-constructing formulations with patients who present with somatic symptoms

In the context of stress-internal or external events that threaten the individual's physical or psychological well-being-the human body signals distress along with disruptions in physiological regulation. When stress-related disruptions are extreme or are not limited in time, they may result in a broad range of somatic, behavioral, and cognitive symptoms. This article aims to (1) provide clinicians with a theoretical framework for understanding the body systems that mediate stress-induced somatic symptoms, and (2) illustrate how this framework can be applied clinically. The article begins with a brief overview of the key body systems involved in homeostasis, paying special attention to how those systems take on self-protective functions in the face of stress. Against that background, the focus then turns to a discussion of commonly occurring somatic symptoms and their probable neurophysiological underpinnings. Short vignettes illustrate typical presentations and how potential etiologies can be discussed with patients, be used to co-construct formulations, and be integrated into jointly determined treatment plans.