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Somatic Effects

It is difficult to believe that the stress system itself would be the only portion of the body to bear the impact of war-zone trauma.  Researchers are finding a number of somatic effects—seemingly unrelated diseases and symptoms—that seem to occur more frequently in people who have been exposed to traumatic stress.  In one study, female veterans who screened positive for PTSD also reported more physical health challenges, including obesity, smoking, irritable bowel syndrome, fibromyalgia, chronic pelvic pain, polycystic ovarian disease, asthma, cervical cancer, and stroke (SoRelle, 2004).

Some veterans, after spending months or years in a constant high-adrenaline fight-or-flight state, find their bodies exhausted and unable to summon enough adrenaline to feel excited or respond appropriately to present-day stress.  Hypoadrenia is the name for a mild or partial form of Addison’s disease, which includes an underproduction of adrenaline and an overproduction of cortisol, after the adrenal gland has been overused in response to stress and threat.  Some effects of this condition include lack of energy and motivation, low levels of both adrenaline and cortisol, hypoglycemia, weakness, confusion, insomnia, dizziness.  People with moderate levels of hypoadrenia might become adrenaline junkies, taking risks in order to get any arousal (Tattersall, 1999).

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Scaer (2005) divides the somatic effects of trauma into five categories, based on the physical characteristics of the body’s response to stress and trauma:

• Diseases of abnormal autonomic regulation, the results of having the sympathetic and parasympathetic chemicals surge and clash during hyperarousal, dissociation, and the freeze response.  These include diseases of fatigue and weakness (e.g., fibromyalgia and chronic fatigue syndrome), diseases that reflect hyperactive digestive processes (e.g., irritable bowel syndrome, gastroesophageal reflux disease), mitral valve prolapse, and migraine headaches (which have sympathetic and parasympathetic phases, first constricting then dilating the blood vessels in the head and the brain)
• Syndromes of procedural memory, in which numbness, spasms, clumsiness, pain, tics, tremors, twitches, dizziness, or other somatic symptoms are often misinterpreted as “psychosomatic” problems, but they actually represent physical changes in the brain areas that stored the traumatic experience in procedural memory
• Diseases of somatic dissociation, which may be characterized by pain, numbness, tingling, or a feeling of “differentness” in a region or regions of the body that may have received inadequate blood flow and oxygen during traumatic experiences
• Disorders of endocrine and immune system regulation (e.g., hyperthyroidism—chronic overactivity of the thyroid gland—increased vulnerability to diabetes, and increased vulnerability to autoimmune diseases such as lupus or multiple sclerosis), direct results of the involvement of these systems in the body’s sympathetic and parasympathetic responses to stress and threat
• Disorders of cognition and sleep, including attention deficit/hyperactivity disorder (which is characterized by impaired control by the prefrontal cortex and tends to appear more often in people who have been exposed to trauma), sleep-disordered breathing, sleep apnea, and increased vulnerability to narcolepsy (a complex disorder that disturbs night-time sleep and compels sleep during the day)

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One cluster of somatic symptoms is captured under the term “somatoform dissociation,” which refers to the condition traditionally labeled “conversion disorder” or “conversion hysteria.”  Its symptoms include a lack of awareness or control of movement or sensation.  van der Hart and colleagues (2000) describe somatoform dissociation as “a lack of the normal integration of sensorimotor components of experience, e.g., hearing, seeing, feeling speaking, moving, etc.” (van der Hart et al., 2000, p. 33). 

Next: Co-Occurring Traumatic Brain Injuries

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The material on all of the Clinical Pages is taken directly from the draft version of Finding Balance After the War Zone:  Considerations in the Treatment of Post-Deployment Stress Effects, a manual under development for the Great Lakes Addiction Technology Transfer Center and Human Priorities.  This draft is copyright © 2008, Pamela Woll.  Reprint permission is universally granted, but attribution is requested.
Click here for References and Other Resources.
Click here to link to a PDF file of the current version of the clinician’s manual draft.
Click here to link to a PDF file of the accompanying booklet for veterans.