Autonomic symptoms as a window into mental and physical health: Insights from the Serbian validation of the Body Perception Questionnaire-Short Form (BPQ-SF)

Autonomic nervous system (ANS) dysregulation has been widely examined in relation to various mental and physical symptoms, often revealing similar patterns. This study explored these associations within the framework of polyvagal theory using the Body Perception Questionnaire-Short Form (BPQ-SF), a widely used instrument for assessing autonomic symptoms and body awareness, not yet validated in Serbian. Accordingly, our study had two main goals: to validate the Serbian BPQ-SF and to examine whether ANS dysregulation is similarly associated with depression, anxiety, and stress symptoms, as well as with chronic physical diseases. We also validated the Body Awareness Very Short Form (BA-VSF), whose 12 items are incorporated into the BPQ-SF. In our sample (N = 795), the proposed factor structure was confirmed, with one factor for Body Awareness and two for Autonomic Symptoms (supra- and sub-diaphragmatic). Both BPQ body awareness and autonomic symptom scores were related to symptoms of depression, anxiety, and stress, as well as to physical disease status; however, further analysis showed that anxiety was the only significant predictor, highlighting a particularly strong link between autonomic dysregulation and anxiety and the broader relevance of ANS dysregulation across mental and physical symptoms. Correlations with Multidimensional Assessment of Interoceptive Awareness (MAIA) dimensions, particularly Noticing, further support conceptual overlaps in interoceptive awareness despite differences between the MAIA and polyvagal models. The BA-VSF also showed good internal consistency and produced comparable results, discussed in relation to previous findings.