Interoceptive Accuracy and Bias in Somatic Symptom Disorder, Illness Anxiety Disorder, and Functional Syndromes: A Systematic Review and Meta-analysis

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2022 Aug 18

PMID 35980959

Authors

Carolin Wolters

Alexander L Gerlach

Anna Pohl

Affiliations

Soon will be listed here.

Abstract

Somatic symptom disorder, illness anxiety disorder, and functional syndromes are characterized by burdensome preoccupation with somatic symptoms. Etiological models propose either increased interoceptive accuracy through hypervigilance to the body, or decreased and biased interoception through top-down predictions about sensory events. This systematic review and meta-analysis summarizes findings of 68 studies examining interoceptive accuracy and 8 studies examining response biases in clinical or non-clinical groups. Analyses yielded a medium population effect size for decreased interoceptive accuracy in functional syndromes, but no observable effect in somatic symptom disorder and illness anxiety disorder. The overall effect size was highly heterogeneous. Regarding response bias, there was a small significant effect in somatic symptom disorder and illness anxiety disorder. Our findings strengthen the notion of top-down factors that result in biased rather than accurate perception of body signals in somatic symptom disorder and illness anxiety disorder.

Citing Articles

Global research status and trends of somatic symptom disorder: A bibliometric study.

Yang C, Zhang K, Wang Q, Wang S, Li H, Zhang K World J Psychiatry. 2025; 15(1):100730.

PMID: 39831025 PMC: 11684216. DOI: 10.5498/wjp.v15.i1.100730.

Exploring the Link Between Interoception and Symptom Severity in Premature Ventricular Contractions.

Limonova A, Minenko I, Sukmanova A, Kutsenko V, Kulikova S, Nazarova M J Clin Med. 2025; 13(24.

PMID: 39768680 PMC: 11676546. DOI: 10.3390/jcm13247756.

A systematic review and meta-analysis of the relationship between subjective interoception and alexithymia: Implications for construct definitions and measurement.

Van Bael K, Scarfo J, Suleyman E, Katherveloo J, Grimble N, Ball M PLoS One. 2024; 19(11):e0310411.

PMID: 39509403 PMC: 11542822. DOI: 10.1371/journal.pone.0310411.

The Relationship Between Interoceptive Awareness, Emotion Regulation and Clinical Symptoms Severity of Depression, Anxiety and Somatization.

Lee S, Lee M, Kim H, Huh H Psychiatry Investig. 2024; 21(3):255-264.

PMID: 38569583 PMC: 10990629. DOI: 10.30773/pi.2023.0221.

Progress in understanding functional somatic symptoms and syndromes in light of the ICD-11 and DSM-5.

Creed F World Psychiatry. 2023; 22(3):474-475.

PMID: 37713560 PMC: 10503926. DOI: 10.1002/wps.21118.

References

Borchers A, Gershwin M . Fibromyalgia: A Critical and Comprehensive Review. Clin Rev Allergy Immunol. 2015; 49(2):100-51. DOI: 10.1007/s12016-015-8509-4. View

Fiorio M, Gambarin M, Valente E, Liberini P, Loi M, Cossu G . Defective temporal processing of sensory stimuli in DYT1 mutation carriers: a new endophenotype of dystonia?. Brain. 2006; 130(Pt 1):134-42. DOI: 10.1093/brain/awl283. View

Rief W, Martin A . How to use the new DSM-5 somatic symptom disorder diagnosis in research and practice: a critical evaluation and a proposal for modifications. Annu Rev Clin Psychol. 2014; 10:339-67. DOI: 10.1146/annurev-clinpsy-032813-153745. View

Tinazzi M, Frasson E, Bertolasi L, Fiaschi A, Aglioti S . Temporal discrimination of somesthetic stimuli is impaired in dystonic patients. Neuroreport. 1999; 10(7):1547-50. DOI: 10.1097/00001756-199905140-00028. View

Higgins J, Thompson S . Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21(11):1539-58. DOI: 10.1002/sim.1186. View

Van den Bergh O, Stegen K, Van de Woestijne K . Learning to have psychosomatic complaints: conditioning of respiratory behavior and somatic complaints in psychosomatic patients. Psychosom Med. 1997; 59(1):13-23. DOI: 10.1097/00006842-199701000-00003. View

Lonn J, Crenshaw A, Djupsjobacka M, Johansson H . Reliability of position sense testing assessed with a fully automated system. Clin Physiol. 2000; 20(1):30-7. DOI: 10.1046/j.1365-2281.2000.00218.x. View

Barsky A, Orav E, Bates D . Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005; 62(8):903-10. DOI: 10.1001/archpsyc.62.8.903. View

Krautwurst S, Gerlach A, Gomille L, Hiller W, Witthoft M . Health anxiety--an indicator of higher interoceptive sensitivity?. J Behav Ther Exp Psychiatry. 2014; 45(2):303-9. DOI: 10.1016/j.jbtep.2014.02.001. View

10.

Gavaghan D, Moore A, McQuay H . An evaluation of homogeneity tests in meta-analyses in pain using simulations of individual patient data. Pain. 2000; 85(3):415-424. DOI: 10.1016/S0304-3959(99)00302-4. View

11.

Kroenke K . A practical and evidence-based approach to common symptoms: a narrative review. Ann Intern Med. 2014; 161(8):579-86. DOI: 10.7326/M14-0461. View

12.

Hanback J, Revelle W . Arousal and perceptual sensitivity in hypochondriacs. J Abnorm Psychol. 1978; 87(5):523-30. DOI: 10.1037//0021-843x.87.5.523. View

13.

Pollatos O, Dietel A, Herbert B, Wankner S, Wachsmuth C, Henningsen P . Blunted autonomic reactivity and increased pain tolerance in somatoform patients. Pain. 2011; 152(9):2157-2164. DOI: 10.1016/j.pain.2011.05.024. View

14.

Brown R, Skehan D, Chapman A, Perry E, McKenzie K, Lloyd D . Physical symptom reporting is associated with a tendency to experience somatosensory distortion. Psychosom Med. 2012; 74(6):648-55. DOI: 10.1097/PSY.0b013e3182595358. View

15.

Cella M, White P, Sharpe M, Chalder T . Cognitions, behaviours and co-morbid psychiatric diagnoses in patients with chronic fatigue syndrome. Psychol Med. 2012; 43(2):375-80. DOI: 10.1017/S0033291712000979. View

16.

Perepelkina O, Romanov D, Arina G, Volel B, Nikolaeva V . Multisensory mechanisms of body perception in somatoform disorders. J Psychosom Res. 2019; 127:109837. DOI: 10.1016/j.jpsychores.2019.109837. View

17.

Di Lernia D, Serino S, Riva G . Pain in the body. Altered interoception in chronic pain conditions: A systematic review. Neurosci Biobehav Rev. 2016; 71:328-341. DOI: 10.1016/j.neubiorev.2016.09.015. View

18.

Corneille O, Klein O, Lambert S, Judd C . On the role of familiarity with units of measurement in categorical accentuation: Tajfel and Wilkes (1963) revisited and replicated. Psychol Sci. 2002; 13(4):380-3. DOI: 10.1111/1467-9280.00468. View

19.

Tinazzi M, Fiaschi A, Frasson E, Fiorio M, Cortese F, Aglioti S . Deficits of temporal discrimination in dystonia are independent from the spatial distance between the loci of tactile stimulation. Mov Disord. 2002; 17(2):333-8. DOI: 10.1002/mds.10019. View

20.

Anastasopoulos D, Bhatia K, Bisdorff A, Bronstein A, Gresty M, Marsden C . Perception of spatial orientation in spasmodic torticollis. Part I: The postural vertical. Mov Disord. 1997; 12(4):561-9. DOI: 10.1002/mds.870120413. View