How to Improve Your Physical Health While Still Struggling With “Somatic Tolerance”


What is “somatic tolerance”?  It is a therapy term that is used when you find it either unpleasant or just plain difficult to be present in your body.  You could be unable to answer a question like “When you are scared, where do you feel it in your body?” or you could not know that you are dehydrated until you almost pass out.  When you try to use a relaxation strategy such as progressive relaxation technique, you want to vomit because of how being connected to your physical body makes you feel.  You don’t care about your body, don’t want to be more “in it” if you can help it, and certainly don’t enjoy it.


Your doctors and dentists won’t fully appreciate this combo of emotions about your body and your active ignoring or your passive inability to know what your body is communicating.  Your trauma therapist might not either.  This is one of those things that providers think is hard-wired.  They often think that everyone that hasn’t had a stroke or head trauma should be able to sense their body’s signals.  Everyone that is over 5 should be motivated to optimize their physical health.  Everyone wants a better mind-body connection.

NOPE.  Not “everybody”.

Not for people who endured ongoing horrific abuse.

The body was the scene of many crimes, much pain, and lots of stress.  It is hard to imagine that anyone with DID is good at somatic tolerance.  This includes dancers and other kinds of physical performers.  You could be able to control the body but not be connected emotionally to it.  You could manage it like a separate being;  feeding and caring for it, but not realize that “it”is exhausted or hungry, or full.  And that your body is the only one all of you have to bring into a therapy session and into life.


So how can you get better at caring for your body when your somatic tolerance is low?

By understanding why that makes complete sense, having no shame about it, and taking small steps that do not scare you or your system.

  • This is tough stuff.  But it really does make sense that people with DID have low somatic tolerance until they do a lot of healing.  We don’t know everything about how DID alters interoception as well as continuous identity and consciousness (although the ads I get for courses make it seem like I could learn it all in a 4-hour online course!!).  We DO know that DID allows people who experience early severe and prolonged abuse to survive.  It comes at a cost, and this is one of those costs.
  • You didn’t cause the abuse you experienced or perpetuate it.  The responsibility for THAT falls on your abusers and those that did not see and report the abuse.
  • While you didn’t initially create low somatic tolerance through self-harm, substance abuse, or through any other action you took or are presently taking,  those actions may be making it harder to build your somatic tolerance. They are desperate survival strategies that have cost you dearly.
  • You can begin to care for the body by taking small steps.  Your system may have ideas, so ask inside.  If you are drawn to a type of toothpaste or a healthy food, try it out.  If you need to drink more water, see if a particular type of water or a water bottle appeals to you.  Make it easy by automating healthy actions.  Pair taking a walk with something you already do.  Ask a trusted person to go with you.  Draw or paint or craft something connected with healthy actions.  Make-your-own-pottery places could be fun for child parts, and you might make something related to dental care, healthy meals, exercise, or sleep.  All good for the body, your body.
  • If any parts get scared, review the goal, reassure that there is no reason to go any faster than needed, and that everyone gets a vote.  Even flossing one tooth is a move in the right direction.  Promising tiny actions instead of huge plans works for so many people.  It can reduce the fear.  If you think that flossing that one tooth in your therapy session is a good idea, ask your therapist to support you.  It could be the best session you have this month!

I invite you to comment and share your healthy ideas on building somatic tolerance here !!


Published by Cathy Collyer

I am a licensed occupational therapist and a licensed massage therapist, in private practice in the NYC area. I have over 25 years of professional experience in adult and pediatric treatment, with a focus on sensory processing issues and treating the consequences of complex trauma. I am the author of four books, including "Staying In The Room: Managing Medical And Dental Care When You Have DID" and "The Practical Guide To Toilet Training Your Child With Low Muscle Tone". Over the years I have lectured about trauma treatment and pediatric development.

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