• Inge Sengelmann

Complex Trauma & Medical Syndromes: Using Somatic Psychotherapy to Heal

In the last decade, the medical community has begun incorporating trauma-informed medical care by administering something called the ACE test. ACE stands for adverse childhood experiences, and research shows that higher ACE scores result in poorer health outcomes over a lifetime. According to the Centers for Disease Control, a high ACE score makes you five times as likely to be depressed and experience chronic medical conditions, a risk that can cut your overall life expectancy by as much as twenty years.

Most recently, in a 2018 episode of 60 Minutes on CBS, Oprah Winfrey popularized the notion that what happens to us in early life can impact our health and mental health later in life. Dr. Bruce Perry, an American psychiatrist and Senior Fellow of the Child Trauma Academy in Houston, Texas, concurs. In the 60 Minutes interview, he stated: “If you have developmental trauma, the truth is you're going to be at risk for almost any kind of physical health, mental health, and social health problem that you can think of.”

Trauma, first and foremost, robs us of our innate, organic capacity to self-regulate. The autonomic nervous system, which impacts most bodily functions, begins to operate in a chaotic fashion – either getting stuck on high arousal, creating tension and constriction in the musculature, cardiovascular system, and viscera; or dropping into states of shutdown and energy conservation, where little energy is reaching organ systems; or both in a chaotic alternating pattern, which is most common in syndromes.

These somatic reactions and medical conditions may relate directly to the type of trauma suffered, and any physical damage that was caused, or they may be more diffuse. They have been found, nonetheless, to involve all major body systems. According to Christine Heim, PhD, from the CDC and Emory University School of Medicine: "A growing literature suggests that early adverse experience increases the risk for a range of negative health outcomes, including fatiguing illnesses. Identification of developmental risk factors for chronic fatigue syndrome is critical to inform pathophysiological research and devise targets for primary prevention."

Children exposed to traumatic events or long-standing stressors are 2.7 times more likely to experience functional somatic conditions (functionally debilitating conditions for which no distinct cause can be determined), such as fibromyalgia, chronic fatigue syndrome, chronic pain, irritable bowel syndrome and others. Exposure to childhood trauma was associated with a 3- to 8-fold increased risk for chronic fatigue syndrome. “Stress has exogenous, direct effects on the occurrence of chronic fatigue," a research study concludes.

A 2014 study in the Journal of Psychosomatic Research showed higher rates of childhood emotional abuse in patients with migraine. Another study published in 2015 in the journal Neurology found a correlation between adverse childhood experiences (ACE) and migraine. Rates of ACEs were higher in people who got migraines versus regular headaches and the odds of migraine reportedly went up when more than one form of ACE occurred in a person.

Other studies have concluded that 25-50% of fibromyalgia and chronic pain patients reported a history of trauma that preceded the onset of their symptoms by several weeks to several months. In addition to fibromyalgia, chronic fatigue and migraines, other trauma-mediated syndromes may include irritable bowel syndrome, premenstrual syndrome, restless legs syndrome, myofascial pain syndrome, chemical sensitivities, autonomic dysfunction (orthostatic hypotension and postural orthostatic tachycardia), possibly hyper extensibility of joints, acne rosacea and psoriasis, Raynaud's phenomenon, sicca complex (dry eyes and mouth) and vasomotor rhinitis (constant runny nose and congestion).

Additionally, these conditions commonly co-exist with psychiatric conditions such as anxiety and depression. There may be emotional numbing and a lack of ability to experience pleasure or positive emotions. Self-disturbances may be characterized by a negative self-concept, marked by persistent beliefs about oneself as diminished, defeated, or worthless, and possibly accompanied by deep and pervasive feelings of shame or guilt. Interpersonal disturbances may include persistent difficulties in sustaining relationships due to a tendency to either avoid, deride, or have little interest in relationships, or occasionally experiencing close or intense relationships but having difficulty maintaining emotional engagement.

The somatic presentations of trauma are difficult to reach with traditional cognitive psychotherapy, primarily because they are implicitly embedded in the neurophysiology as mostly non-conscious responses. They are best addressed by a combination of body-based, somatic psychotherapy, healing touch therapies, restorative yoga, and a multidisciplinary approach that bridges Western medicine with Eastern healing strategies. Somatic Experiencing® (SE), a form of trauma therapy that emphasizes guiding the client's attention to interoceptive, kinesthetic and proprioceptive experience is particularly well-suited to address syndromes. Its style of inner attention, in addition to the use of kinesthetic and interoceptive imagery, as well as the deliberate use of touch to increase the body’s coherent self-regulation, can lead to the resolution of symptoms resulting from chronic and traumatic stress.

Afari, N., Ahumada, S. M., Wright, L. J., Mostoufi, S., Golnari, G., Reis, V., & Cuneo, J. G. (2014). Psychological Trauma and Functional Somatic Syndromes: A Systematic Review and Meta-Analysis. Psychosomatic Medicine, 76(1), 2–11. http://doi.org/10.1097/PSY.0000000000000010

Burke, N.N., Finn, D.P., McGuire, B.E., & Roche, M. (2016). Psychological stress in early life as a predisposing factor for the development of chronic pain: Clinical and preclinical evidence and neurobiological mechanisms. Journal of Neuroscience Research. DOI: 10.1002/jnr.23802.

Payne, P., Levine, P.A., Crane-Godreau, M.A. (2015). Somatic experiencing: using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology, 6, 93. https://www.frontiersin.org/article/10.3389/fpsyg.2015.00093 DOI=10.3389/fpsyg.2015.00093 Zouikr, I.,

Bartholomeusz, M. D., & Hodgson, D. M. (2016). Early life programming of pain: focus on neuroimmune to endocrine communication. Journal of Translational Medicine, 14, 123. http://doi.org/10.1186/s12967-016-0879-8

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