Atomistic spin models have found enormous success in addressing the properties of magnetic materials, grounded on the identification of the relevant underlying magnetic interactions. For instance, the huge development in the field of magnetic skyrmions and other noncollinear magnetic structures is largely due to our understanding of the chiral Dzyaloshinskii-Moriya interaction. Recently, various works have proposed new types of chiral interactions, with seemingly different forms, but the big picture is still missing. Here, we present a systematic construction of a generalized spin model containing isotropic and chiral multisite interactions. These are motivated by a microscopic model that incorporates local spin moments and the spin-orbit interaction, and their symmetry properties are established. We show that the chiral interactions arise solely from the spin-orbit interaction and that the multisite interactions do not have to follow Moriya's rules, unlike the Dzyaloshinskii-Moriya and chiral biquadratic interactions. The chiral multisite interactions do not vanish as a result of inversion symmetry and comply with a generalized Moriya rule: If all sites connected by the interaction lie in the same mirror plane, the chiral interaction vector must be perpendicular to this plane. We then illustrate our theoretical considerations with density functional theory calculations for prototypical magnetic systems. These are triangular trimers built out of Cr, Mn, Fe, and Co adatoms on the Re(0001), Pt(111), and Au(111) surfaces, for which C 3v symmetry applies, and Cr and Fe square tetramers on Pt(001) with C 4v symmetry. The multisite interactions are substantial in magnitude and cannot be neglected when comparing the energy of different magnetic structures. Finally, we discuss the recent literature in light of our findings and clarify several unclear or confusing points.