RDoC Mechanisms Underlying Bodily Symptoms in Psychiatry: A Scoping Review

Somatic or bodily symptoms are ubiquitous in medicine 1 and represent a massive burden of disease and disability worldwide. 2 , 3 When bodily symptoms are causally associated with a treatable mental or physical disorder, it is imperative to implement a comprehensive diagnostic and therapeutic clinical plan. 4 However, somatic symptoms can chronically persist without a clear etiology, resulting in a diverse spectrum of symptoms characterized as “functional”. 5–7 The ICD-11 recently progressed toward a more integrative view of this health issue, introducing the notion of Bodily Distress Disorder (BDD), 8 which no longer requires these symptoms to be “unexplained by another condition” for a formal diagnosis. 9 , 10 Furthermore, this nosological entity encompasses a previously diverse range of functional somatic symptoms and somatoform disorders. 11 There is considerable heterogeneity in the literature concerning the terminology used by researchers to describe somatic expression within psychosomatic medicine. This encompasses, but is not limited to, ICD-based psychosomatic disorders, 12 functional syndromes, 13 and specific somatic symptoms. 14 Many psychiatric conditions are associated with somatic symptoms, 15–17 adding complexity to their treatment. 18 Results from the last decades in psychiatry research have highlighted neurobiological underpinnings of many psychiatric disorders 19 , 20 and since 2009, the Research Domain Criteria (RDoC) initiative has supported novel ways of studying mental disorders via focusing on disruptions of normal body functions. 21 , 22 As a translational framework for research, it encompasses a matrix that classifies units of analysis (eg genes, behaviors and experimental paradigms) into constructs and subcontstructs (eg loss, perception, attention) that relates to six broader domains (eg cognitive systems, negative valence systems, social processes). Intrinsically, the RDoC framework is predominantly structured around top-down cerebral processes, while bottom-up processes involving extra-cerebral structures - such as the perception of internal stimuli - remain underrepresented among its components. Individually, the mechanisms underlying certain somatic symptoms are starting to be unraveled. For example, chronic pain most probably results from the integration of different processes 23 including interoception. 24 Similarly, psychiatric disorders are increasingly being associated with endophenotypes indicative of neurobiological dysfunctions. 19 , 25 However, evidence regarding the intersection between somatic symptoms and psychiatric disorder is not clearly available. Here, we propose to summarize the available literature at the crossroads between bodily symptoms, psychiatric disorders and their underlying neurobiological mechanisms. This scoping review aims to highlight key findings and potential knowledge gaps in this field, providing a comprehensive overview of how somatic symptoms may influence or be influenced by psychiatric conditions.

Our methodology workflow follows the PRISMA-ScR Checklist 26 and is summarized in Figure 1 . Figure 1 Methodology workflow. This diagram summarizes the methodology of this scoping review, according to the PRISMA-ScR checklist. Scoping review flowchart: neurobiology and symptoms in psychiatric disorders. A flowchart explores the link between neurobiological factors and bodily symptoms in psychiatric disorders. Objectives include describing evidence and identifying related neurobiological factors. Eligibility criteria cover original research and observational studies in English or French, published from 2025, involving adults over 18 with at least one bodily symptom, one psychiatric disorder and one RDoC construct. Information is sourced from Medline, Embase and psycINFO. Search criteria involve three sections connected by AND, with OR options: bodily symptoms, psychiatric disorders and neurobiological factors. Data charting includes independent entry into a calibrated table. Critical appraisal involves semi-automatic duplicate removal, foreign language exclusion, abstract reading by two reviewers and full text reading by one reviewer. Results are synthesized into summary tables and a Sankey diagram. Methodology workflow. This diagram summarizes the methodology of this scoping review, according to the PRISMA-ScR checklist. Three different information sources were screened (Medline, Embase, psycINFO), using the search queries that are available on SearchRxiv (links are provided below). Databases were first accessed on the 27 th of May 2022 and an update search using the same search strings on the same information sources was performed on the 7 th of May 2025, covering the period between May 2022 and May 2025. Briefly, the search strategy was to include articles whose titles incorporate terms that refer to a somatic symptom (items from the BDS checklist 14 and from relevant litterature 13 , 27 as well as somatoform disorders from ICD-10 12 ), a psychiatric disorder based on items from the ICD-10 12 and items from the RDoC matrix, 28 version 5, accessed in May 2022. Search strings are available on searchRxiv. Duplicates were excluded using automatic detection features from Mendeley Reference Manager (Elsevier) and Rayyan, 29 while remaining duplicates were excluded by manual removal based on abstract screening. Inclusion and exclusion criteria were checked by abstract screening performed by two independent reviewers. Consensus about discordant articles was obtained by discussion between reviewers. Full text screening and data charting was performed by a single reviewer. The RDoC matrix, version 5, accessed between 2022 and 2026 was used for this analysis. When an article addressed multiple bodily symptoms, psychiatric disorders, or RDoC constructs, they were all recorded in the data table Studies focusing on a psychosomatic disorder where a somatic symptom and a psychiatric disorder overlap (eg somatoform disorder, conversion disorder) as the only psychiatric disorder were excluded, because our goal was to specifically investigate somatic symptoms as comorbidities to traditional psychiatric disorders rather than primary functional diagnoses Pain located in more than one location, fibromyalgia and unspecific pain were grouped as “pain” and mentions of general somatic symptoms were classified as “somatic symptoms (unspecified)”. Outcome measures were classified based on the ISPOR Clinical Outcome Assessment framework. 30 Data tables were collected and analyzed using Microsoft Excel. The Sankey diagram was generated in Jupyter Notebook. 31 The corresponding python code, as well as all data tables are available upon request to the authors. Graphical adaptations of the figures were done using Microsoft Powerpoint or Inkscape.

After a thorough selection process, 73 articles were included in the study. The study flowchart is summarized in Figure 2 . The list of included articles, 32–104 along with their extracted content, is provided in Supplementary File 1A–I . Most articles were observational cross-sectional prospective studies (n=69), but 2 retrospective studies and 2 case reports were also included. 55 articles studied unspecified adult populations, but studies on gender-specific somatic symptoms such as endometriosis or premature ejaculation included only females in the former (n=14) or males in the latter (n=2). Germany was the leading country where studied populations were recruited (n=19), followed by the USA (n=15) and Turkey (n=6). Included articles were published between 1989 and 2025, while 70% of the included articles (n=51) were published after 2010. Figure 2 Study flowchart. This flow chart reports the number of excluded articles at each stage of the selection process, leading to a total of 73 included articles. A flowchart showing article selection process with exclusion steps leading to 73 included articles. The flowchart illustrates the process of article identification and selection through database searching. It begins with ′Articles identification through database searching′ leading to ′Duplication removal′ with 2,228 articles, excluding 1,191 studies. Next is ′Foreign language automatic removal′ with 1,037 articles, excluding 40 studies. This is followed by ′Abstract screening′ with 997 articles, excluding 867 studies. Then, ′Full text screening′ with 130 articles, excluding 57 studies. The process concludes with a ′Total number of included articles′ being 73. Study flowchart. This flow chart reports the number of excluded articles at each stage of the selection process, leading to a total of 73 included articles. In total, 75 somatic symptoms were reported, most of them referring to general symptoms such as pain (n=33) or broad somatic symptoms (n=34). These symptoms were assessed by heterogeneous scales or sometimes a subscale of a clinical scale that was not designed to assess somatic symptoms. However, few studies were examining gastro-intestinal system symptoms (n=4) and genito-urinary system symptoms (n=4) ( Table 1 ). Table 1 Bodily Symptoms Represented in the Included Articles Bodily Symptom Number of Occurrences % Pain 33 44.0 Somatic symptoms (unspecified) 34 45.3 Gastro-Intestinal system symptoms 4 5.3 Genito-urinary system symptoms 4 5.3 Total 75 100.0 Notes : The 73 included articles covered 75 bodily symptoms, grouped into 4 main categories: pain, unspecific somatic symptoms, gastro-intestinal system symptoms and genito-urinary system symptoms. Bodily Symptoms Represented in the Included Articles Notes : The 73 included articles covered 75 bodily symptoms, grouped into 4 main categories: pain, unspecific somatic symptoms, gastro-intestinal system symptoms and genito-urinary system symptoms. 105 psychiatric conditions were identified in our sample ( Table 2 ), anxiety and fear-related disorders being the most studied psychiatric disorders (n=40), followed by mood disorders (n=27), personality disorders (n=14) and psychotic disorders (n=9). Other psychiatric disorders were also mentioned in some articles, such as stress-related disorders (n=6), eating disorders (n=4), depersonalization derealization disorder (n=1), substance use disorders (n=3) and autism (n=1). Table 2 Psychiatric Disorders Represented in the Included Articles Psychiatric Disorder (ICD-11) Number of Occurrences % Anxiety or fear-related disorders Generalized Anxiety Disorder 9 8.6 Panic Disorder 5 4.8 Illness anxiety 1 1.0 Agoraphobia 1 1.0 Anxiety Disorders (unspecified) 23 21.9 Obsessive compulsive disorder 1 1.0 Subtotal 40 38.1 Mood disorders Depressive disorders 23 21.9 Bipolar disorder 1 1.0 Mood disorders (unspecified) 3 2.9 Subtotal 27 25.7 Personality disorders Borderline Personality Disorder 11 10.5 Personality disorders (unspecified) 3 2.9 Subtotal 14 13.3 Psychotic disorders Schizophrenia 8 7.6 Psychotic disorders (unspecified) 1 1.0 Subtotal 9 8.6 Stress-related disorders Post-traumatic stress disorder 4 3.8 Complex Post-Traumatic disorder 1 1.0 Adjustment disorder 1 1.0 Subtotal 6 5.7 Eating disorders Bulimia Nervosa 2 1.9 Anorexia Nervosa 1 0.9 Eating disorders (unspecified) 1 0.9 Subtotal 4 3.8 Other Substance use disorders 3 1.0 Depersonalization derealisation disorder 1 2.9 Autism 1 1.0 Subtotal 5 4.8 Total 105 100.0 Notes : The 73 included articles covered 105 psychiatric disorders, distributed across different ICD-11 categories for psychiatric disorders. Psychiatric Disorders Represented in the Included Articles Notes : The 73 included articles covered 105 psychiatric disorders, distributed across different ICD-11 categories for psychiatric disorders. Clinical cases were defined by ClinRO (57.5%) and PRO (42.5%) for psychiatric disorders, whereas for bodily symptoms, most clinical cases were defined by PRO (86.3%). Neurobiological processes were assessed by PRO (55.4%), PerfO (31.1%), Biomarkers (10.8%) and ClinRO (2.7%). fMRI was the most used biomarker, used in 5 articles. Detailed results about the types of measurements are available in Supplementary File 1I . Regarding neurobiological processes, somatosensory perception was the most studied RDoC subconstruct (n=25), followed by self-knowledge (n=13) and potential threat (n=10). Other RDoC constructs and subconstructs are detailed in Table 3 . Table 3 Neurobiological Processes Represented in the Included Articles RDoC Domains RDoC Constructs RDoC Subconstructs Number of Occurrences % Cognitive systems Perception Somatosensory Perception 26 29.5 Attention NA 5 5.7 Declarative memory NA 2 2.3 Working memory NA 1 1.1 Language NA 1 1.1   Subtotal 34 39.1 Negative Valence Systems Potential Threat (“Anxiety”) NA 10 11.5 Sustained Threat NA 8 9.2 Acute Threat (“Fear”) NA 4 4.6 Loss NA 2 2.3   Subtotal 24 27.6 Social processes Perception and understanding of self Agency 1 1.1 Self-knowledge 13 14.9 Affiliation and Attachment NA 7 8.0 Social Communication NA 1 1.1 Perception and Understanding of Others Understanding Mental States 2 2.3   Subtotal 24 27.6 Arousal and Regulatory Systems Arousal NA 3 3.4 Sleep-Wakefulness NA 1 1.1 Circadian Rhythms NA 1 1.1 Subtotal 5 5.7 Total 87 100.0 Notes : The 73 included articles covered 87 RDoC constructs and subconstructs, distributed across 4 domains. Neurobiological Processes Represented in the Included Articles Notes : The 73 included articles covered 87 RDoC constructs and subconstructs, distributed across 4 domains. Figure 3 is a Sankey diagram illustrating how bodily symptoms, RDoC constructs and psychiatric disorders are interconnected within the analyzed articles. The underlying data are available in Supplementary File 1J . The most common triad was pain-perception-borderline personality disorder, occurring in 10 articles, followed by pain-perception-schizophrenia, occurring in 7 articles. Most neurobiological mechanisms were common to various bodily symptoms and psychiatric disorders, whereas “perception” was specifically associated with pain as a bodily symptom, but it was associated with many psychiatric disorders. Only one article focused on a specific type of pain (chest pain) and was then individualized for the visualization. Interestingly, it is the only bodily symptom that is associated to the RDoC construct “loss”. Some papers included information on more than one bodily symptom, psychiatric disorder or RDoC construct/subconstruct, hence there are more associations than the total number of included articles. Figure 3 Triads of bodily symptom – RDoC construct/subconstruct – psychiatric disorder in the included articles. Sankey diagram illustrating the connections between bodily symptoms and psychiatric disorders through RDoC constructs and subconstructs in the included articles. A Sankey infographic mapping bodily symptoms to RDoC constructs and psychiatric disorders via weighted links. A Sankey infographic showing triads of bodily symptom, RDoC construct or subconstruct and psychiatric disorder. The layout reads in three vertical columns: Bodily symptoms, RDoC constructs subconstructs and Psychiatric disorders, with connecting bands whose thickness varies to indicate larger or smaller connections; exact numbers are not shown. Top labels list categories. Under Bodily symptoms: Pain, Somatic symptoms, Genito urinary system symptoms, Gastro intestinal system symptoms. Under RDoC constructs subconstructs: Cognitive systems, Negative valence systems, Social processes, Arousal and regulatory systems. Under Psychiatric disorders: Anxiety or fear related disorders, Mood disorders, Personality disorders, Psychotic disorders, Eating disorders, Stress related disorders, Other. Bodily symptom labels include Somatic symptoms unspecified, Emesis, Dyspeptic symptoms, Overactive bladder Syndrome, Premature ejaculation, IBS symptoms, Chest pain, Pain, Clitoris hypersensitivity. RDoC labels include Perception and understanding of others, Language, Sustained threat, Affiliation and attachment, Perception and understanding of self, Declarative memory, Sleep Wakefulness, Attention, Social communication, Potential threat Anxiety, Acute threat Fear, Loss, Working memory, Arousal, Perception, Circadian rhythms. Psychiatric disorder labels include Depersonalization derealization disorder, Anxiety disorders unspecified, Depressive disorders, Substance use disorders, Post traumatic stress disorder, Obsessive compulsive disorder, Psychotic disorders unspecified, Complex post traumatic disorder, Personality disorders unspecified, Illness anxiety, Agoraphobia, Generalized anxiety disorder, Panic disorder, Mood disorders unspecified, Schizophrenia, Borderline personality disorder, Bulimia nervosa, Autism, Bipolar disorder, Adjustment disorder, Eating disorders unspecified. Abbreviations : RDoC, Research Domain Criteria, IBS, Irritable bowel syndrome. Triads of bodily symptom – RDoC construct/subconstruct – psychiatric disorder in the included articles. Sankey diagram illustrating the connections between bodily symptoms and psychiatric disorders through RDoC constructs and subconstructs in the included articles.

The most common triad associating somatic symptom, RDoC construct and psychiatric disorder was pain-perception-borderline personality disorder, followed by pain-perception-schizophrenia. Altogether, this scoping review sheds light to a growing area of research characterized by its diverse and scattered nature, highlighting the critical need for interdisciplinary research in psychosomatic medicine. There is especially need for a shift from cross-sectional associative studies toward longitudinal cohorts or neurobiologically informed experimental/interventional designs. More coordinated efforts could help to better understand the complex interactions between psychological and bodily symptoms, ultimately aiming to improve diagnostic approaches and treatment strategies.

This scoping review identified a growing body of research examining the interplay between bodily symptoms and psychiatric disorders through mechanistic processes that were mapped on the RDoC matrix. While some systematic reviews were focusing on specific links between bodily symptoms, neurobiological processes and psychiatric disorders, 105–109 to our knowledge we present here the first trial to compile primary literature on this broad topic in a single scoping review. Most studies were referring to general somatic symptoms instead of specific syndromes or symptoms. This phenomenon could be partially explained by our search methodology -principally based on general symptoms from the BDS checklist - but it is worth noting that common psychosomatic syndromes included in our search strategy (eg fatigue syndromes, hyperventilation syndrome or multiple chemical sensitivity) did not yield any publication. However, it is now debated whether these syndromes should still be separated rather than grouped into one diagnostic entity: BDD. 13 Given the hypothesis that bodily perceptions of emotions are conserved throughout populations, 110 future studies should aim to delineate more specific somatic patterns that are associated with different psychiatric disorders. Our results demonstrate that anxiety and mood disorders account for more than 50% of studied psychiatric disorders in the context of a mechanistic study related to somatic symptoms. Noticeably, few studies cover neurodevelopmental disorders, although mind–body interactions are emerging as novel mechanisms in these conditions. 111 Dissociative symptoms are shared by various nosologic entities and commonly associated with bodily distress disorder. 112 In our corpus, disorders typically presenting with dissociative symptoms such as PTSD-related disorders and depersonalization-derealization disorder only account for 6/105 psychiatric disorders, highlighting the need to further explore neurobiological underpinnings of somatic manifestations of dissociative disorders. Also characterized by dissociative symptoms, borderline personality disorder is well represented in our corpus, studied in association with pain and perception. Given the fact that self-harming behavior is a core-symptom of borderline personality disorder, it is not surprising that this triad emerges as the most frequently studied in our review. In line with this finding, specific literature reviews are emerging on this topic, 113–115 suggesting an interesting subject to be covered by a meta-analysis or a broader topic review. RDoC is a widely used framework that systematically catalogues neurobiological constructs in the context of mental health. It has been actively promoted by governmental health agencies, such as the National Institute of Mental Health (NIMH) in the United States, which have made the allocation of research grants conditional upon the integration of projects within the RDoC framework. The observed increase in the number of included publications since 2010 may partly be explained by this prioritization of mechanistically driven research in psychiatry, but it also reflects a broader trend observed across scientific literature over the past decades. 116 The RDoC matrix was chosen to map neurobiological mechanisms using a reductionist strategy. However, it has not been updated since 2019 and it excludes interesting processes such as gut–brain interactions 117 that could be covered by a complementary review. “Somatosensory perception” and “perception and understanding of self” represent almost half of the neurobiological constructs that have been correlated to psychiatric disorders and somatic symptoms in our sample. Unsurprisingly, somatosensory perception was exclusively related to pain as a somatic symptom, whereas self-perception is a more heterogeneous concept that incorporates well-known concepts in psychosomatic medicine such as alexithymia and interoception. 108 , 109 , 118 Further primary research should indeed take advantage of the increasing knowledge about interoceptive processes, 119 in order to characterize more precisely its implication in specific psychosomatic interactions. Moreover, a recent review also suggests that interoceptive technologies should be studied as therapeutic interventions in psychiatric conditions. 120 Taking a broader view, computational psychiatry and psychosomatics 121 stands as a promising integrative discipline, uniquely positioned to inform and stimulate primary research through computational modeling approaches. On the other side, affiliation and attachment represents an understudied (n = 7/87) psychological mechanism in the context of borderline personality disorder and somatic symptoms, given that dysfunctional attachment styles are known to contribute to the emergence of this disorder. 122 Attentional processes should also raise more concern in the interface between psychiatric disorders and somatic symptoms, representing only 8/87 RDoC constructs in our review. Interestingly, sensorimotor systems are not represented in our corpus, whereas it is known to be affected in functional neurological syndrome. 123 This may partly reflect the domain’s novelty within the framework, as it represents the most recent addition to the RDoC matrix, integrated in 2019, 124 leaving comparatively less time for a body of research to accumulate. In summary, our scoping review identifies interesting knowledge gaps that need to be addressed by further specific primary research about potential mechanisms mediating the interaction between somatic symptoms and psychiatric disorders ( Table 4 ). Furthermore, it recognizes areas of inquiry that possess a sufficient body of literature to warrant systematic reviews. Table 4 Knowledge Gaps Bodily Symptoms RDoC Constucts/Subconstructs Psychiatric Disorders – Fatigue syndromes (chronic fatigue syndrome, postviral chronic fatigue syndrome) – Globus syndrome – Multiple chemical sensitivity – Interoception – Affiliation and attachment – Attention – Sensorimotor systems – Neurodevelopmental disorders (eg autism spectrum disorder) – Disorders associated with dissociative symptoms (PTSDs, depersonalination-derealization disorder) Notes : This table summarizes research areas that were not adequately covered, according to the results of this scoping review, indicating knowledge gaps that future research should address. Knowledge Gaps Fatigue syndromes (chronic fatigue syndrome, postviral chronic fatigue syndrome) Globus syndrome Multiple chemical sensitivity Interoception Affiliation and attachment Attention Sensorimotor systems Neurodevelopmental disorders (eg autism spectrum disorder) Disorders associated with dissociative symptoms (PTSDs, depersonalination-derealization disorder) Notes : This table summarizes research areas that were not adequately covered, according to the results of this scoping review, indicating knowledge gaps that future research should address. Further investigation into these subjects and their interactions could reveal important insights into how neurobiological processes influence both psychiatric and somatic symptomatology. Our findings also reveal a significant gap concerning the populations examined. Further research should prioritize older adults, as somatic symptoms frequently co-occur with psychiatric conditions in this demographic category. 125 Specifically, a recent review 126 highlights how risk factors accumulate across the lifespan in the context of nociplastic pain, paving the way for future studies about the relationship between mental disorders and nociplastic pain in older adults. It is a recognized issue that older adults are not sufficiently represented in clinical research. 127 Furthermore, the intricate and multifaceted characteristics of geriatric conditions might not fully fit within the RDoC framework, which emphasizes the developmental trajectories of mental health conditions. 22 In addition to the previously mentioned limitations regarding the RDoC matrix’s reductionist impact on the identification of neurobiological processes, our study has further constraints. Firstly, even if each included article focused on specific psychiatric conditions, it is important to acknowledge the variability in how these conditions are evaluated across studies. Some studies use definitive diagnoses according to international standards and clinician evaluations, while others rely on self-reported questionnaires for psychiatric symptoms. This variability may compromise the reliability of mechanistic associations with RDoC constructs by conflating properly diagnosed patients with individuals presenting with psychological symptoms. However, in the context of somatic complaints, embracing patient subjectivity by collecting PROs seems paramount. Secondly, each article that was included in this review identifies a relationship between somatic symptoms, psychiatric disorders, and RDoC constructs; however, this does not necessarily imply a causal relationship or a robust statistical association.