Unit 4 (Part 2): Impact on Body Systems and Physical Health

Part II builds on

Unit 2's review of the ACE study

Trauma and health conditions (Sowder, Knight & Fishalow, 2018)

A wide variety of health conditions have been linked to trauma

Healthcare use with a trauma history

Healthcare costs and utilization are higher among US adults with trauma histories

Adult trauma survivors' health

More physical symptoms of concern, poorer overall health, lower health-related quality of life

Amount of trauma and health outcomes

The greater the number and/or severity of traumatic experiences, the more significant the negative health outcomes

Two pathways from trauma to poor health

Lifestyle factors (behavioral pathway) and direct physical effects (biological pathway)

Behavioral pathway

Coping attempts lead to "maladaptive" strategies: alcohol and other substances, smoking, overeating or unhealthy diet, other high-risk behaviors

Biological pathway

Chronic hyperarousal of the stress-response system damages the brain and other body systems

Chronic stress hormones

Taxing to the body; suppress immune functioning and cause chronic inflammation

Inflammation is associated with

A wide range of physical health problems, including cardiovascular and autoimmune diseases

Gabor Maté

Local influence: expert on addiction, stress and childhood development; worked 12 years in Vancouver's Downtown Eastside

Trauma and pain comorbidity

High rate of PTSD and physical pain comorbidity; high comorbidity between adult chronic pain and childhood abuse or maltreatment

Comorbid PTSD and pain

May be resistant to PTSD treatment

Is the trauma–pain relationship well understood?

No

Pain as a trauma reminder

Pain can serve as a reminder of the traumatic event and worsen reexperiencing symptoms

Bartoszek et al. (2017)

Only pain caused by the traumatic event itself triggered reexperiencing symptoms

Shared vulnerability model (Asmundson et al., 2002)

Psychological and biological vulnerabilities interact with trauma to produce hypervigilance, cognitive biases and avoidance

Shared cognitive vulnerability for PTSD and chronic pain

Attentional bias for threat: the person is more likely to attend to threat (i.e., pain)

Somatization

Development of somatic (body-based) symptoms for which no organic cause is found

Trauma victims and somatic complaints

Score higher on self-reports of somatic complaints than controls

Possible influences on somatization after trauma (Elklit & Christiansen, 2009)

Neurobiological changes, increased physiological arousal, poorer health behavior

Other trauma consequences linked to somatization

Depression, anxiety, dissociation, PTSD

PTSD–somatization explanation

Lowered responsiveness to external stimuli plus increased awareness of internal stimuli

Proposed mediator of the PTSD–somatization relationship

Dissociation

Patients with more somatoform symptoms than other psychiatric patients

Patients with dissociative disorders and PTSD

Somatization's impact on patients

Can be very invalidating and cause mistrust of healthcare providers

GI complaints linked to physical and/or sexual abuse

Abdominal pain, nausea and vomiting, pelvic pain, ulcers

Functional gastrointestinal disorders

Chronic or recurrent GI symptoms not explained by structural or organic abnormalities; correlated with maltreatment

Common functional GI disorder

Irritable bowel syndrome

Stress and the brain–gut connection

Stress may over-activate the nerves that connect the brain and the gut

Basis for trauma-related digestive problems

Chronic sympathetic nervous system arousal

Vagus nerve / parasympathetic nervous system

Connected to the face, heart and gut; keeps the gut working to digest

Amygdala alarm and digestion

Muscle tension clamps down on the vagus nerve; blood pumps out of the gut for fight or flight, stopping digestion

Chronic stress and food

The body responds to anything as a threat, including food; all phases of digestion are interrupted or altered

ACE study and the cardiovascular system

Linked childhood abuse, neglect and household dysfunction to ischemic heart disease

Later cardiovascular studies

Replicated the ACE–heart disease link even when controlling for lifestyle factors

Childhood maltreatment and cardiovascular disorders by sex

Stronger relationship for women than men