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Interoceptive processing and difficulty identifying feelings are proposed candidate processes for BFRBs and SSDBody sensations may link repetitive behaviors and physical symptoms

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Key Takeaway
Note that interoceptive processing is a proposed but tentative hypothesis for understanding BFRB mechanisms.

This hypothesis-generating mini review explores the conceptual links between body-focused repetitive behaviors (BFRBs) and somatic symptom disorder (SSD). The authors synthesize current literature to investigate whether interoceptive processing and difficulties in identifying feelings serve as common underlying processes for both conditions.

For SSD, the review notes that interoceptive response bias has been examined using objective and signal-detection-based paradigms. In contrast, direct objective evidence regarding interoceptive processing in BFRBs is currently limited. The authors propose the interoceptive pathway in BFRBs as a tentative hypothesis rather than an established mechanism.

Several limitations hinder current synthesis, including a lack of direct comparative studies between BFRBs and SSD due to diagnostic separation, divergent research paradigms, and inconsistent terminology. Because of these factors, the findings are currently intended for hypothesis generation rather than establishing definitive clinical pathways. The review suggests this framework may guide future comparative studies to clarify the relationship between these conditions.

Have you ever wondered why some people struggle with repetitive physical habits or feel constant physical symptoms that have no clear medical cause? Researchers are looking into a common thread between these two different experiences: how our brains process internal sensations, known as interoceptive processing.

The review suggests that difficulty identifying feelings and processing body signals could be a shared factor in both body-focused repetitive behaviors (BFRBs) and somatic symptom disorder (SSD). While the link for those with physical symptoms is being studied through specific tests, the connection to repetitive behaviors is still a tentative theory.

Because these two conditions are often treated separately, it is hard to compare them directly right now. The research currently lacks enough direct comparisons and consistent terms to be certain. However, this work provides a new framework for future studies to see if improving how we process body signals could help people with both conditions.

What this means for you:
Difficulty processing internal body signals may link repetitive behaviors and physical symptom disorders.

Common questions

What is interoceptive processing?

Interoceptive processing is how your brain receives and understands signals from inside your body. This includes things like your heartbeat, breathing, and feelings of physical discomfort. The study suggests that difficulty with this process might be a shared factor for people who have both somatic symptom disorder and body-focused repetitive behaviors.

Is the link between these conditions proven?

Not yet. Because these two conditions are diagnosed differently and use different research methods, there is currently a lack of direct comparative studies. The connection to body-focused repetitive behaviors is specifically described as a tentative hypothesis rather than an established fact.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedAug 2026
View Original Abstract ↓
Body-focused repetitive behaviors (BFRBs) and somatic symptom disorder (SSD) are classified in different chapters in DSM-5. The former is characterized by repetitive body-focused actions, whereas the latter is characterized by distressing somatic symptoms accompanied by excessive thoughts, feelings, or behaviors related to those symptoms. Although parallel evidence has accumulated in each domain, direct comparative studies between BFRBs and SSD remain lacking. This gap arises partly from diagnostic separation, divergent research paradigms, and inconsistent terminology. The present mini review therefore proposes a hypothesis-generating conceptual framework in which difficulty identifying feelings and altered interoceptive processing may represent candidate processes relevant to both conditions. However, the strength of evidence is asymmetric. In SSD, interoceptive response bias has been examined using objective and signal-detection-based paradigms, whereas in BFRBs direct objective evidence remains limited. Accordingly, the proposed BFRB pathway should be regarded as a tentative hypothesis rather than an established mechanism. We further outline operational definitions, methodological considerations, and exploratory research questions for future comparative studies.
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