Physical Health Problems After Single Trauma Exposure

Physical Health Problems After Single Trauma Exposure.

Research has established that chronic stress, including traumatic events, leads to adverse health outcomes. The literature has primarily used two approaches: examining the effect of acute stress in a laboratory setting and examining the link between chronic stress and negative health outcomes. However, the potential health impact of a single or acute traumatic event is less clear. The authors review studies on health, including cardiovascular, immune, gastrointestinal, neurohormonal, and musculoskeletal outcomes; describe potential pathways through which single, acute trauma exposure could adversely affect health; and consider research and clinical implications.

The question of how trauma affects health is highly salient, given the prevalence of trauma in our society. Estimates vary, but the most comprehensive and nationally representative prevalence study to date indicates that at least 60% of men and 51% of women in the general population report experiencing at least one traumatic event in their lives (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). In Kessler et al.’s study, the three most commonly experienced types of trauma were witnessing someone being badly injured or killed; being involved in a fire, flood, or natural disaster; and being involved in a life-threatening accident. In addition to single-incident or acute trauma exposure, chronic or complex trauma exposure is prevalent in our culture. Exposure to early life adversity, such as physical abuse, sexual abuse, and neglect are common: approximately one third of children are estimated to experience physical abuse (Anda et al., 1999); approximately one in four girls and one in five boys experience sexual victimization during childhood (Finkelhor, Hotaling, Lewis, & Smith, 1990). Other forms of non-abuse trauma, such as exposure to community violence, are also common (Bell & Jenkins, 1993). Such forms of trauma are notable because they occur repeatedly over key developmental periods, thereby increasing the likelihood of negative outcomes via chronic activation of stress response systems.

Trauma sets the stage for ongoing psychological and physical distress, which can mutually affect one another, possibly for the duration of the survivor’s life span, leading to negative physical health consequences. These consequences increase with chronicity of environmental exposure as well as with psychiatric distress. The majority of the body’s systems are adversely affected by trauma. Specifically, there is a significant disruption to gastrointestinal functioning, the cardiovascular system, immunological functioning, the reproductive system, the musculoskeletal system, neuroendocrine functioning, and finally brain structure and functioning. Not only are these systems broadly affected by symptoms, but the risk factors for development of future medical disease are exponentially greater following exposure to trauma.

To add to the physical impact of trauma, the psychological consequences are equally devastating. It is noted throughout the literature that individuals exposed to trauma frequently experience comorbid disorders, such as anxiety, depression, and PTSD. The psychological impacts of trauma are long term and treatment resistant. Furthermore, the psychological impact of trauma imparts further risk and exacerbation of physical illness. Functioning is significantly impaired because of the increased physiological arousal with external and internal cues or triggers. Thus, it is frequently difficult for an individual to return to baseline activities (including social and occupational functioning). Taken together, the extant literature demonstrates that trauma leads to chronic impairment in one’s psychological and physical functioning. The data reviewed here suggest several pathways to health problems following exposure to trauma: (1) Conscious or nonconscious reactivity to triggered reminders chronically elevates the body’s stress response and (2) suppressive emotion management techniques generate a physical strain that chronically elevates the body’s stress response.

Credit: Wendy D’Andrea, Ritu Sharma, Amanda D. Zelechoski, and Joseph Spinazzola. 2011.