8 Psychotherapy8.7 Psychotherapeutic psychiatry
8.7.5 Psychological distress and bodily health
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
Mind and body affect each other
Distress affects the body. It can change sleep, appetite, autonomic arousal (such as a racing heart), activity and attention to bodily sensations.
Physical illness affects the mind. It can increase distress and disrupt a person's identity or relationships.
Symptoms are real even when tests find no disease that fully explains them. A psychological mechanism does not mean the person is producing them on purpose.
Assessment
An integrated assessment considers physical causes, medication effects, mental disorder, function and how the person understands their symptoms.
What keeps symptoms going
Process | Possible consequence | What it means for treatment |
|---|---|---|
Threatening interpretation | Ordinary sensations are read as signs of danger | Explore meanings and test predictions together |
Repeated checking or reassurance | Brief relief makes further checking more likely | Agree a consistent response and planned reviews |
Avoidance | Function and confidence fall | Build an activity plan that suits the individual |
Restriction, bingeing or purging | Medical risk and psychological preoccupation feed each other | Coordinate nutritional, physical and psychological care |
Invalidating encounters | Mistrust and repeated help-seeking increase | Acknowledge the person's experience and offer a shared explanation |
Management
Give a positive explanation. Describe plausible interacting mechanisms and agree a plan, rather than just saying the tests are normal.
Reassess new or changing symptoms appropriately, even when a functional or bodily distress formulation is already in place.
Eating disorders: manage physical risk and nutrition alongside disorder-focused psychological treatment. Do not wait for one to settle before considering the other.
Chronic primary pain: acceptance and commitment therapy or cognitive behavioural therapy may be used, delivered by appropriately trained staff.
Set realistic goals, such as more activity, more participation and less distress, rather than removing every bodily sensation.
Coordinate care to avoid contradictory explanations and needless duplication, while keeping access to medical review when needed.