Stress, Distress, and Bodytalk: Co-constructing Formulations with Patients Who Present with Somatic Symptoms
Abstract
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.
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In high arousal, all muscles, both smooth and striated, increase in tone; heart rate and respiration become more rapid; and posture is stabilized.
“In brief, all muscles, both smooth and striated, increase in tone;41,43 heart rate and respiration become more rapid; and posture is stabilized.”
From Fear and the Defense Cascade (2015) · cites this paper as [41]
In some species or strains within species, tonic immobility may be the front-line defense response to extreme threat, even when the animal is not restrained.
“In some species or strains within species, however, tonic immobility may be the front-line defense response to extreme threat, even when the animal is not restrained.8,26,86”
From Fear and the Defense Cascade (2015) · cites this paper as [26]
Because the HPA axis, sympathetic system, and immune system interact reciprocally as part of a larger stress-regulation system, downregulation of one system will have a correlative impact on the functioning of the other systems.
“Importantly, because the HPA axis, sympathetic system, and immune system interact reciprocally as part of a larger stress-regulation system, downregulation of one system will have a correlative impact on the functioning of the other systems.41,181”
From Fear and the Defense Cascade (2015) · cites this paper as [41]
Controlling hyperventilation episodes via body scans and breath techniques may indirectly decrease the frequency of collapsed immobility episodes.
“Controlling hyperventilation episodes via body scans212 and the use of breath techniques41 may indirectly decrease the frequency of collapsed immobility episodes.”
From Fear and the Defense Cascade (2015) · cites this paper as [41]
Cites
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Kozlowska, K., Walker, P., McLean, L., & Carrive, P. (2015) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000065 · Cited by 468 · see citing works
“system interact reciprocally as part of a larger stress-regulation system, downregulation of one system will have a correlative impact on the functioning of the other systems.(41,181)”
BackgroundSelf-citationReduction of autonomic regulation in children and adolescents with conversion disorders
Kozlowska, K., Palmer, D. M., Brown, K. J., McLean, L., Scher, S., Gevirtz, R., Chudleigh, C., & Williams, L. M. (2015) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000184 · Cited by 82 · see citing works
Self-citationKozlowska, K., Rampersad, R., Cruz, C., Shah, U., Chudleigh, C., Soe, S., Gill, D., Scher, S., & Carrive, P. (2017) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-017-0976-0 · Cited by 48 · see citing works
Self-citationKozlowska, K., Cruz, C., Davies, F., Brown, K. J., Palmer, D. M., McLean, L., Scher, S., & Williams, L. M. (2016) · Australian and New Zealand Journal of Family Therapy · doi:10.1002/anzf.1187 · Cited by 16 · see citing works
Self-citationKozlowska, K., Schollar-Root, O., Savage, B., Hawkes, C., Chudleigh, C., Raghunandan, J., Scher, S., & Helgeland, H. (2023) · Children · doi:10.3390/children10111724 · Cited by 14 · see citing works
“Reproduced with permission © Kasia Kozlowska 2013 [36].”
MethodInfluentialSelf-citation
- Authors
- Kozlowska, K.
- Affiliations
- The University of Sydney (AU)
- Corresponding author
- Kozlowska, Kasia
- ORCID
- Kozlowska, Kasia
- Venue
- Harvard Review of Psychiatry
- Published
- 2013-11
- Volume
- 21
- Issue
- 6
- Pages
- 314-333
- ISSN
- 1067-3229 (ISSN-L)
- OpenAlex
- W2023294279
- Cited by
- 40
- References
- 5
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1 · 2023: 3 · 2022: 3 · 2021: 1 · 2020: 4 · 2019: 3 · 2018: 1 · 2017: 5 · 2016: 5 · 2015: 5 · 2014: 3
- FWCI
- 0.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Harvard Review of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Health Professions › General Health Professions › Health, psychology, and well-being
- Keywords
- stress, distress, somatic symptoms, homeostasis, physiological regulation, self-protection, body systems, somatic symptom disorder, clinical formulation, treatment planning
- MeSH terms
- Diagnosis, Differential, Homeostasis, Humans, Somatoform Disorders, Stress, Physiological, Stress, Psychological
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