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Health Matters 8/30: Undiagnosed physical complaints may be linked to emotional trauma 

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By Susanne Steinberg, M.D. 

In many cases, the scars of past trauma extend beyond emotional pain and physical injury, manifesting as distinct physical symptoms or disorders. 

Chronic pain, excessive fatigue, stomach and bowel problems, headaches, palpitations and dizziness are often associated with trauma, and routine tests and physical exams typically fail to provide an explanation. 

These symptoms, however, are significant and require a comprehensive evaluation. In fact, failure to address and treat symptoms can lead to feelings of hopelessness, depression and anxiety. Persistent symptoms can be so debilitating the patient may self-medicate and be at risk for substance dependence.  

Penn Medicine Princeton House Behavioral Health provides treatment for trauma and its related physical manifestations through its partial hospital and intensive outpatient programs designed specifically for both men and women. 

Mind Body Connection 

In the United States, 61% of men and 51% of women report exposure to at least one traumatic event in their lifetime, according to the U.S. Department of Health and Human Services. 

Common examples of a traumatic event include natural disasters, serious accidents, acts of war or terrorism, sexual and physical assault, and emotional abuse. Yet trauma can also be caused by other highly stressful situations, such as divorce, job loss, financial insecurity, taking care of a sick loved one or the untimely death of a friend or family member. 

In fact, some people don’t recognize their experiences as trauma, but rather as part of their normal existence. 

The majority of people faced with a traumatic event may experience a range of reactions and symptoms afterward, but often recover with time. If symptoms worsen, persist and interfere with day-to-day functioning, it might be post traumatic stress disorder (PTSD). PTSD is more prevalent among women and more chronic when compared to men in the general population. 

Symptoms associated with PTSD typically fall into four general categories: 

  • Increased arousal, including intrusive memories, flashbacks (re-experiencing trauma), nightmares, exaggerated startle response, extreme vigilance about ones’ safety. 
  • Avoidance behaviors, such as staying away from places, events or objects that are reminders of the traumatic event and avoiding thoughts or feelings related to the traumatic event. 
  • Negative changes in thinking and mood, including trouble remembering key features of the traumatic event, distorted feelings of guilt or blame, loss of interest in enjoyable activities, negative thought about yourself or the world. 
  • Changes in emotional reactions, such as feeling tense or on-edge, difficulty sleeping, angry outbursts or irritability or being emotionally numb (unable to experience happiness, satisfaction or love). 

In addition, a link exists between undiagnosed physical complaints and PTSD, as well as depression. Researchers are diligently at work trying to clarify the mechanism(s) that explain the connection between the mind and body when managing stress. 

During trauma, the body goes into survival mode, and later may have difficulty stabilizing. As a result, stress hormones are released, raising blood pressure, blood sugar and causing inflammation which, over time, causes physical damage. Additionally, a constant state of stress may cause muscle tension, leading to additional pain and fatigue. 

Trauma may have an even longer-term impact as medical practice and researchers uncover a number of neurological, gastrointestinal, cardiovascular, autoimmune and endocrine diseases that are associated with PTSD.

A Collaborative Approach

In mental health, it is especially important to take a holistic view of each patient. Patients often present with a multitude of problems. In some cases, treating a physical problem first (e.g. pain) can permit the patient to address emotional symptoms more effectively in therapy. In other cases, the reverse is true.

Lab work and physician assessments can be critical to identify or rule out health conditions and provide clues that help define treatment priorities. 

Once priorities are identified, a collaborative approach to care is essential. Psychoeducation and psychotherapy, psychiatrist and primary care physician or specialist oversight, nursing care and medications can all play a role. The patient is the center of the team and family engagement can make a meaningful difference.

Penn Medicine Princeton House Behavioral Health offers a Men’s Trauma Program and a Women’s Trauma Program specifically designed to meet the unique needs of each population. 

Participants in both programs develop the skill sets to ease distress and emotionally regulate, improve interpersonal effectiveness and practice mindfulness meditation.

Often, feeling better emotionally can begin to help someone feel better physically. 

The Men’s Trauma Program and the Women’s Program are offered in Princeton, North Brunswick, Moorestown and Eatontown. The Women’s Program is also available in Hamilton.

For more information about Princeton House Behavioral Health’s trauma programs for men and for women, call 888-437-1610 or visit princetonhouse.org. 

Susanne Steinberg, M.D., is the medical director of the Moorestown Outpatient Program of Penn Medicine Princeton House Behavioral Health.

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