Trauma-Related Physical Symptoms and Illnesses

People often have physical symptoms that are stress induced: the failed stockbroker nursing an ulcer, the overwhelmed housewife having chronic nausea, the hardworking teacher having a late-day tension headache, the businessman having a stress-induced heart attack. These examples illustrate that stress affects our bodies and organs, but how and to what degree? During the last 30 years, stress has been raised in the public's mind as a major contributor to illness. This notion has been reflected in articles published in mainstream magazines such as Time and Newsweek as well as in such health-focused television programs as Dr. Phil and Dr. Oz. Both the U.S. Public Health Service and the World Health Organization's Global Burden of Disease Study have confirmed that stress and mental illness have serious implications for physical health. Mental illness has risen to the second most burdensome disease process, second only to cardiovascular disease. In addition, in the early 2000s, physicians began to use depression and anxiety as independent risk factors for developing coronary artery disease, giving them as much weight as diabetes mellitus, tobacco use, obesity, and hyper-cholesterolemia. The evidence that psychological stress contributes to physical problems is intuitive, yet the link remains somewhat murky.

This entry explains how psychological stress contributes to physical symptoms and illness. Severe psychological stress in particular provides us an opportunity to examine how our bodies respond to extreme situations. For the purposes of this entry, stress will be defined as the impact of acute and chronic traumatic stimuli. Acute traumatic events include natural disasters, war, rape, or physical injury (through violent crime or vehicular accident). Chronic traumatic events may encompass years of sexual or emotional abuse, divorce, and relational or occupational problems. Furthermore, this entry will consider the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) descriptions of Posttraumatic Stress Disorder, Acute Stress Disorder, Adjustment Disorder with Anxiety, and Generalized Anxiety Disorder as stress syndromes, which may lead to physical illness. This acute and chronic definition is broad but will help isolate those unquestionably traumatic incidents (e.g., car crash) that can then be extrapolated back to more social stressors (e.g., divorce) that may be lower on the spectrum of traumatic stimuli. Notably, we appreciate that stress is personal and depends on one's cognitive interpretation of an event (e.g., divorce can be traumatic too).

What follows, then, is a description of the complex sequence of the human stress response from brain to end organ. Next, we will discuss the various physical ailments more commonly affected by stress and their respective mechanisms. Finally, we will discuss how trauma contributes to somatoform disorders and how these differ from psychosomatic illnesses.