It is well-known that emotional and psychological trauma can have a lasting impact on those affected. Much attention has been given to the psychological health effects of trauma, such as the onset and development of depression, anxiety, obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD)[1]. Growing research considers the connection between trauma, particularly childhood trauma, and the onset of chronic physical illness in adult life.
There is consistent evidence to show that trauma and chronic illness are connected. In 1998, Kaiser Permanente published the ACE study – an in-depth study looking at adverse childhood experiences and how they impact survivors’ health in later life.[2] The study showed that people with ACEs were more likely than the general population to develop chronic illnesses such as heart disease, lung disease, and cancer.
Another study published in the American Journal of Preventive Medicine found that people with high scores on the ACE questionnaire are at a higher risk of autoimmune diseases, depression, anxiety, insomnia, and frequent headaches.[3] It is believed that prolonged emotional stress, as experienced by many trauma survivors, creates a number of physical changes in the body that lead to illness and disease.
Understanding Trauma
Trauma is defined by SAMHSA as ‘an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life-threatening with lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.’[4]
All of us may experience a potentially traumatic event at one point or another over the lifespan.[5] Such an event could be anything from a car crash, to exposure, to combat in war, to sexual abuse. These are some of the more obvious cases of traumatic events. These events can overwhelm us and cause us to have adverse reactions for a long time after the event has happened. Common trauma symptoms include:
- Insomnia
- Re-experiencing (re-living the event, flashbacks)
- Anxiety
- Depression
- Hypervigilance
- Social withdrawal
- Fear
- Low self-esteem
If these symptoms persist for more than a month, a person can be said to have post-traumatic stress disorder (PTSD). If a person experiences trauma in childhood, such as sexual abuse or neglect, or witnessing violence in the home, they may also develop PTSD. In cases where a child has been abused by a close family member, they may be diagnosed with complex PTSD (C-PTSD).
Types of Chronic Illness associated with Trauma
In 1993, researchers McEwan and Stellar published an article in Archives of Internal Medicine outlining a strong correlation between PTSD and physical illness.[6] Based on this study, the National Centre for PTSD explains that ‘psychological trauma and subsequent, repeated reminders of traumatic events trigger a cascade of neuronal, hormonal, and immunologic effects that damage the body over time.’[7]
A 2013 study reported that people who have PTSD are more likely than those without PTSD to report serious illness such as cardiovascular disease, respiratory disease, and other physical health conditions.[8]
The Impact of Childhood Trauma on Health
Research published in Frontiers in Psychology supports the ACE study findings; those who have experienced one or multiple ACEs are at a greater risk of mental and physical health conditions as they enter adulthood. The research, carried out by Stephen E. Mock and Susan M. Arai, suggests that mental health issues and socioeconomic status (SES) play a role in the onset and development of chronic illness.
The researchers found that those who have been through trauma in childhood, particularly abuse and neglect, may be at a ‘cumulative disadvantage’[9] when it comes to health. According to Mock and Arai, ‘cumulative disadvantage is the notion that early disadvantage or negative experiences are linked to a cascade of adverse events throughout life that have long-term negative consequences.’[10]
According to the study, lower socioeconomic status may act as a buffer for chronic illness in those who have experienced an ACE. Those with lower socioeconomic status may have less access to comprehensive mental health support systems. Trauma is known to lead to mental health issues. If a person experiences trauma-related mental health issues and is unable to attain the help and treatment they need due to socioeconomic barriers, their likelihood of developing further illness is increased.
Lower SES is linked to trauma and poor health outcomes. According to research published in the journal Child Abuse & Neglect, ‘low SES among parents was also identified as a risk factor for the perpetration of maltreatment suggesting a potential mechanism in the intergenerational transmission of violence.’[11]
Stress and Illness
Trauma is a stress-related condition. When the body remains under stress for an extended time, neurochemicals and hormones associated with stress are released in abnormally large amounts. Though these chemicals occur naturally and are an important part of normal functioning, their extended release can be toxic to the brain and body.
Stress hormones are used by the body to prepare it for action in the face of threat. Typical to PTSD is a distorted threat response system, where threat is perceived even though there is no real threat in the environment. People with PTSD typically experience hypervigilance, where the body is more often than not on high alert. This constant lookout for danger is mentally and physically exhausting for the person suffering.
Stress chemicals cause high levels of activation in the body. Over time, this activation can wear away at muscles and tissues and lead to inflammation. Inflammation is closely linked to the development of disease. Prolonged stress is known to cause inflammation in the body, which sets the stage for disease or illness to develop.
Chronic Illness as a Cause of Psychological Trauma
PTSD can lead to the onset of physical illness and disease. Similarly, medical diagnosis of illness or disease, such as cardiovascular issues, lung disease, cancer, or autoimmune diseases, can be traumatic and lead to PTSD. Research published by Donald Emerson in 2014 highlights that an estimated 12 – 25 percent of people diagnosed with a life-threatening illness go on to develop PTSD.[12]
In Conclusion
Research is continuing into the effects of childhood trauma on chronic illness later in life. Approaches to treatment for co-occurring trauma and chronic illness focus symptoms management in combination with mind-body therapies. The mind-body connection is a significant point of focus in trauma treatment.[13] When we are traumatised, our self-relationship is compromised. Not just emotionally, but also physically. Many trauma survivors report feelings of dissociation and disconnection from their bodies, which could relate to the onset of psychosomatic issues manifesting as illness and disease.
If you have a client, or know of someone who is struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).
[1] Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/
[2] Felitti, Vincent J et al. “Relationship Of Childhood Abuse And Household Dysfunction To Many Of The Leading Causes Of Death In Adults”. American Journal Of Preventive Medicine, vol 14, no. 4, 1998, pp. 245-258. Elsevier BV, doi:10.1016/s0749-3797(98)00017-8. Accessed 31 Dec 2020.
[3] Anda, Robert F et al. “Adverse childhood experiences and chronic obstructive pulmonary disease in adults.” American journal of preventive medicine vol. 34,5 (2008): 396-403. doi:10.1016/j.amepre.2008.02.002
[4] Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014
[5] Shrira, Amit et al. “Potentially traumatic events at different points in the life span and mental health: findings from SHARE-Israel.” The American journal of orthopsychiatry vol. 82,2 (2012): 251-9. doi:10.1111/j.1939-0025.2012.01149.x
[6] McEwen, B S, and E Stellar. “Stress and the individual. Mechanisms leading to disease.” Archives of internal medicine vol. 153,18 (1993): 2093-101.
[7] McEwen, Bruce S. “Stress And The Individual”. Archives Of Internal Medicine, vol 153, no. 18, 1993, p. 2093. American Medical Association (AMA), doi:10.1001/archinte.1993.00410180039004. Accessed 31 Dec 2020.
[8] Scott, Kate M. et al. “Associations Between Lifetime Traumatic Events And Subsequent Chronic Physical Conditions: A Cross-National, Cross-Sectional Study”. Plos ONE, vol 8, no. 11, 2013, p. e80573. Public Library Of Science (Plos), doi:10.1371/journal.pone.0080573. Accessed 31 Dec 2020.
[9] Mock, Steven E, and Susan M Arai. “Childhood trauma and chronic illness in adulthood: mental health and socioeconomic status as explanatory factors and buffers.” Frontiers in psychology vol. 1 246. 31 Jan. 2011, doi:10.3389/fpsyg.2010.00246
[10] Mock, Steven E, and Susan M Arai. “Childhood trauma and chronic illness in adulthood: mental health and socioeconomic status as explanatory factors and buffers.” Frontiers in psychology vol. 1 246. 31 Jan. 2011, doi:10.3389/fpsyg.2010.00246
[11] Zielinski, David S. “Child maltreatment and adult socioeconomic well-being.” Child abuse & neglect vol. 33,10 (2009): 666-78. doi:10.1016/j.chiabu.2009.09.001
[12] Edmondson, Donald. “An Enduring Somatic Threat Model of Posttraumatic Stress Disorder Due to Acute Life-Threatening Medical Events.” Social and personality psychology compass vol. 8,3 (2014): 118-134. doi:10.1111/spc3.12089
[13] Burnett-Zeigler, Inger et al. “Mind-Body Approaches to Treating Mental Health Symptoms Among Disadvantaged Populations: A Comprehensive Review.” Journal of alternative and complementary medicine (New York, N.Y.) vol. 22,2 (2016): 115-24. doi:10.1089/acm.2015.0038
