Proof-of-concept study of association of dietary sensitivities, inflammatory, and cognitive markers with psychosomatic distress in bodily distress disorder: A cross-sectional study

ABSTRACT Background: Bodily Distress Disorder (BDD) presents a significant challenge in clinical practice due to the persistence of symptoms despite psychopharmacological and nonpharmacological treatment and repeated patient visits to multiple health facilities. The etiology of BDD is postulated to involve a complex interplay of psychoimmunological factors, dietary sensitivities, and attentional biases, leading to somatosensory amplifications. Materials and Methods: A cross-sectional study was conducted to explore the association between psychoimmunological and electrophysiological parameters with the clinical profile of patients with BDD. Results: ANOVA revealed significant associations between BDD severity and N100, N200, and P200. Individuals with higher Type A behavior exhibited elevated soluble tumor necrosis factor receptor 1 (sTNF-R1) ( t = 2.603, P = 0.023) and monocyte chemotactic protein-1 (MCP-1) levels ( t = 2.353, P = 0.037). In contrast, health anxiety was associated with increased alpha-melanocyte-stimulating hormone (α-MSH) levels ( t = 3.581, P = 0.004). Lactose-sensitive individuals showed higher anxiety and pain scores, while sleep disturbance was significantly higher in the gluten-sensitive group compared with those without such sensitivity. Individuals with higher International Classification of Diseases severity showed distinct differences in event-related potential latencies and amplitudes, particularly within N200 and P200 components. Conclusion: The multidimensional interplay exists between psychopathology, immune dysregulation, electrophysiological alterations, and dietary sensitivities in individuals with bodily distress. The associations between neurocognitive processing, illness severity, elevated sTNF-R1, α-MSH, and MCP-1 levels with Type A behavior and health anxiety require longitudinal observations in a large sample. Dietary sensitivity in BDD could trigger higher anxiety, somatic distress, and sleep disturbances, and may require screening routinely.