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Somatic Health Issues in Trauma-Related Disorders: Effects on Psychobiological Axes Affecting Mental and Physical Health

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Person Centered Approach to Recovery in Medicine

Part of the book series: Integrating Psychiatry and Primary Care ((IPPC))

Abstract

Psychological trauma is common and can have long-lasting deleterious effects on mental and physical health. Childhood adversity and maltreatment, as well as adult exposures to interpersonal violence, accidents and disasters, and other life-threatening medical events, such as myocardial infarcts can all be associated with psychological trauma, as can even lifesaving medical procedures such as surgeries and intensive care unit stays. Exposure to trauma in childhood and as adults is associated with increased risk for psychiatric morbidity, in particular posttraumatic stress disorder (PTSD), but also increased rates of depression and anxiety disorders. It has long been appreciated that PTSD has substantial comorbidity with other psychiatric disorders, including in depression and substance use disorders, and there is also accumulating evidence that childhood adversity, adult trauma exposure, and PTSD all have considerable somatic health consequences and are associated with increased disease risk and increased medical morbidity and mortality. These include conditions often associated with somatization and psychiatric morbidity, such as irritable bowel disorder, fibromyalgia, and other chronic pain disorders, but also more common medical disorders such as coronary artery disorder, atherosclerosis, cancer, and stroke. Trauma exposure and PTSD are associated with increased levels of health risk behaviors, such as smoking, alcohol and drug use, poor diet, and physical activity, as well as increased body mass index (BMI) and rates of obesity; PTSD is also associated with poorer medical compliance and healthcare utilization. All of these at-risk health behaviors likely contribute to the increased morbidity and mortality associated with trauma exposure and PTSD. It is possible that, in addition, specific physiological processes related to trauma exposure and PTSD may also contribute to disease processes and increase morbidity. This chapter will review evidence linking trauma and PTSD to several psychobiological processes or “axes” that may contribute and/or mediate increased morbidity. Long-term effects of trauma and PTSD are presumably mediated and maintained by alterations on the brain/central nervous system (CNS) that then lead to alterations in output and activity of peripheral nervous system and autonomic as well as neuroendocrine systems that then effect changes on peripheral physiological processes such as cardiovascular function, immune function, and metabolism that lead to increased pathophysiological processes and disease risk. This chapter will review evidence of effects of trauma and PTSD on specific CNS functions that may be associated with “downstream” pathological processes, as well as evidence of effects of trauma and PTSD on the sympathetic autonomic system, the hypothalamic-pituitary-adrenal (HPA) axis, and immune function (in particular, inflammatory processes), all of which could contribute and/or mediate effects of trauma and PTSD on medical morbidity.

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  1. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA

    Anthony P. King

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  1. Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy

    Luigi Grassi

  2. University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA

    Michelle B. Riba

  3. Inova Fairfax Hospital, Johns Hopkins University Inova Fairfax Hospital, Falls Church, VA, USA

    Thomas Wise

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King, A.P. (2019). Somatic Health Issues in Trauma-Related Disorders: Effects on Psychobiological Axes Affecting Mental and Physical Health. In: Grassi, L., Riba, M., Wise, T. (eds) Person Centered Approach to Recovery in Medicine. Integrating Psychiatry and Primary Care. Springer, Cham. https://doi.org/10.1007/978-3-319-74736-1_10

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