Somatic Complaints

Mind and body appear to be more related than previously thought. What affects the mind and psychological health will often have a significant impact on the body and physical health, and vice versa. Traumatic stress often results in psychological symptoms, such as those that compose posttraumatic stress disorder (PTSD) and other psychological disorders. In addition, somatic complaints are also associated with traumatic stress. In this context, somatic complaints are defined as symptoms that are experienced as physical sensations in the body. Examples include pain, headaches, muscle tension, gastrointestinal discomfort, heart palpitations, or fatigue. Medically unexplained somatic syndromes have also been described, such as fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome, somatization, and conversion disorder. Although somatic complaints are common in the general population, they are frequently experienced by individuals suffering from traumatic stressors such as military combat, sexual assault, child abuse, natural disasters, or torture. This entry discusses PTSD and somatic complaints, commonly reported somatic symptoms, and functional somatic syndromes.

Not every individual who undergoes a trauma develops such symptomatology, so certain risk or vulnerability factors have been explored. Research has demonstrated that genetic predispositions and adverse early childhood experiences represent vulnerability factors. It has also been suggested that unhealthy attachment to caretakers in early childhood may influence the developing nervous system, which would represent a risk factor.

A number of researchers have examined the relationship between psychological and somatic symptoms in trauma survivors. Evidence from such studies indicates that symptoms of PTSD mediate the relationship between trauma exposure and number and intensity of somatic complaints. For example, a greater number of PTSD symptoms predicted a greater number of somatic complaints, particularly cardiovascular, gastrointestinal, dermatological, neurological, and chronic pain symptoms in combat veterans and refugee torture survivors. Evidence suggests that this relationship between PTSD and somatic complaints is mediated still further by symptoms of depression. Furthermore, somatic health complaints have been demonstrated to predict more symptoms of depression years after the initial assessment. Individuals complaining of somatic symptoms often seek medical care, so research studies have generally used self-reports of physical health problems as well as frequency of utilization of health care services when measuring somatic symptoms. Although trauma survivors often report more somatic symptoms than do individuals who have not experienced trauma, trauma survivors often do not have more physical health problems. This suggests a heightened vigilance against and reduced tolerance for general physical discomfort.

It is hypothesized that for individuals predisposed to developing somatic and psychological symptoms following a trauma, the traumatic experiences will [Page 644]often contribute to a dysregulation of the autonomic nervous system, which is responsible for the fight-or-flight response, and the hypothalamic-pituitary-adrenal (HPA) axis, which is responsible for releasing stress hormones into the bloodstream. Dysregulation of these systems may result in cardiovascular or gastrointestinal dysfunctions, muscle tension, and fatigue, as well as reduced pain tolerance. Furthermore, those who have difficulty coping with the aftermath of trauma may have increased states of emotional arousal, such as anger and anxiety, which can negatively affect cardiovascular and gastrointestinal health. They may also develop unhealthy lifestyle habits, including smoking, substance abuse, and poor diet, which can also have adverse effects on physical health.

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