Can Trauma Manifest in the Physical Body?
When I learned about post-traumatic stress disorder (PTSD) in medical school, it was usually confined to my psychiatry courses. Because why else would it be anywhere else…it only affects the mind, right? I never really questioned this paradigm as I had no reason to until I started to see some particular diseases happen predominantly in patients with a significant trauma background. These anecdotal cases motivated me to see what the scientific literature suggested, and to my surprise maybe the mind was not the only place a trauma lives.
My first introduction to trauma’s effect on the body came to me as I learned about adverse childhood experiences (ACEs). ACEs are traumatic events that occur in childhood that could include experiencing violence, abuse and neglect. These could include having a family member attempt or die by suicide, growing up in a household with substance use, mental health problems or instability due to parental separation. ACEs are linked to chronic health problems and there is a direct correlation with someone’s ACEs score (there is a quiz available on the CDC website to calculate one’s ACE score) and becoming affected by chronic diseases in the future.
Toxic stress from ACEs can change brain development and affect learning, response to stress, decision-making, and attention. According to the CDC’s website, up to 1.9 million cases of heart disease and 21 million cases of depression could have been potentially avoided by preventing ACEs or by providing expert therapy. Adverse childhood experiences are common; about 61% of adults surveyed across 25 states reported that they had experienced at least one type of ACE and nearly 1 in 6 reported they had experienced four or more types of ACEs. According to the research, dysfunctional households and childhood abuse can increase the risk of chronic physical disease by up to 81%.
As I learned more about this phenomenon, I wondered what other diseases may have a root cause of trauma. Looking deeper into a common ailment presenting with chronically recurring belly pain and altered bowel habits, a disorder called irritable bowel syndrome or IBS, I realized that there is a strong psychological component associated with it. IBS has been known as a “functional” disorder, meaning there is no detectable structural or biochemical cause responsible for the symptoms. Instead, the issues lie more in how the digestive tract functions- there can be too much, or too little activity of the gut – contractions, secretions – at inappropriate times. Knowing that the gut has a “second brain” or “enteric nervous system” (referring to the 150 million nerve cells or neurons sandwiched between the muscle layers of the intestine, could trauma that affects the neurons of the brain also affect the neurons of the gut?
Researchers at Mayo Clinic interviewed nearly 2,600 people regarding psychological, emotional, and other life traumas as well as if they suffered from IBS. The research showed that people with IBS had a much higher likelihood of having experienced trauma (emotional/physical abuse, death of a loved one, divorce, accident, etc.) than people without IBS.
A new field of science called psychoneuroimmunology studies the effect of the mind on physical health and looks at the interaction between psychological processes and the nervous and immune systems of the human body. The majority of both nerve and immune cells are located in the gut, and numerous studies have demonstrated strong modulatory effects of psychological stress and trauma on these cells.
So it shouldn’t come as a big surprise that PTSD is not just a psychiatric diagnosis, but is associated with compromised functions of the gut and digestive symptoms, and that more effective treatments for PTSD have beneficial effects not only for the mind, but also the body, in particular the digestive system.
Sarah Abedi, MD is an emergency medicine doctor practicing in Southern California. She completed her medical school at UC Irvine and finished her emergency medicine residency at Harbor UCLA. Her medical interests lie in the science of disease prevention which motivated her to create The Hidden Body Podcast.