Somatic symptom burden, PTSD, and dissociation: Cross-sectional findings from 995 international female mental health service users
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Somatic symptom burden, PTSD, and dissociation: Cross-sectional findings from 995 international female mental health service users
Highlights
- Large global study of PTSD/CPTSD and somatic symptoms in 995 female participants.
- Dissociation showed the strongest association with somatic symptom severity.
- Trauma symptoms accounted for an additional 32 % of the variance in somatic burden.
- PTSD, DSO, and dissociation symptoms jointly classified elevated somatic burden
- Results support trauma-informed screening for somatic symptoms in clinical settings.
Abstract
Objective
Methods
Results
Conclusion
Background
Somatic symptoms—such as chronic pain, fatigue, dizziness, and gastrointestinal disturbances—are highly prevalent among individuals with mental health disorders, particularly those with histories of trauma. These symptoms often present in primary care or psychiatric settings, sometimes overshadowing the underlying psychological distress and complicating diagnosis and treatment.
Research over the past two decades has consistently demonstrated links between trauma exposure and physical symptomatology, particularly in populations with post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). Trauma-related dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, autonomic nervous system hyperarousal, and inflammatory processes have been proposed as biological pathways that amplify physical distress.
In addition to PTSD, disturbances in self-organization (DSO)—a core feature of CPTSD—encompass symptoms like affective dysregulation, negative self-concept, and interpersonal difficulties. These symptoms may exacerbate bodily stress responses and contribute to the development or maintenance of somatic complaints.
Dissociation is another key trauma-related process that warrants attention. Dissociation involves disruptions in consciousness, memory, identity, or perception and is often a coping mechanism for overwhelming trauma. However, chronic dissociation can impair emotional processing and bodily awareness, potentially intensifying or perpetuating somatic symptom burden.
Despite these well-established associations, the unique and combined contributions of PTSD, DSO, and dissociation to somatic symptom burden remain underexplored, particularly in international, clinically diverse populations. Moreover, most studies have been limited to smaller samples or specific geographic or clinical contexts, limiting generalizability.
Given these gaps, large-scale, cross-cultural investigations are essential to clarify how trauma-related symptoms interact with somatic distress and to inform trauma-informed care models. Understanding these relationships can improve screening, early intervention, and treatment approaches, especially for populations such as women, who may be disproportionately affected by trauma-related somatic symptoms due to gender-based violence and other vulnerabilities.
High prevalence of somatic symptom burden
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More than half of the female participants (54.9%) reported elevated somatic symptoms.
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This indicates that physical symptoms (such as pain, fatigue, or gastrointestinal problems) are extremely common in female mental health service users worldwide.
Trauma symptoms explain significant variance
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The regression model showed that PTSD, DSO, and dissociation explained an additional 32% of variance in somatic symptoms beyond demographics and childhood trauma history.
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This means current trauma-related symptoms—not just past trauma exposure—play a crucial role in ongoing somatic distress.
Summary
This study provides strong evidence that somatic symptom burden in female clinical populations is deeply intertwined with trauma-related psychopathology, especially dissociation. The findings argue for routine trauma-informed assessments and interventions in both mental health and medical settings, aiming for holistic care that addresses both psychological and physical sequelae of trauma.
Limitations
Despite the strengths of this large, international sample and use of validated assessment tools, several limitations should be considered when interpreting the findings:
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Cross-sectional design
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The study design prevents determination of causality.
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It remains unclear whether trauma-related symptoms lead to increased somatic burden, whether somatic distress exacerbates trauma symptoms, or if a bidirectional relationship exists.
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Self-report measures
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Data were based on self-reported questionnaires, which are subject to recall bias, social desirability bias, and subjective interpretation of symptoms.
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Objective clinical evaluations or structured diagnostic interviews could provide more accurate assessments.
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Sample characteristics
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The sample included female mental health service users, limiting generalizability to males, non-binary individuals, or community populations.
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Cultural differences across international sites were not deeply examined, which could influence how trauma and somatic symptoms are experienced and reported.
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Unmeasured variables
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Other factors such as comorbid physical health conditions, medication use, socioeconomic status, or cultural stigma were not systematically assessed, yet may significantly impact somatic symptom expression.
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Potential for symptom overlap
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Symptoms of PTSD, dissociation, and somatic disorders can overlap (e.g., hyperarousal, fatigue, sleep problems), making it challenging to fully disentangle their unique contributions.
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Clinical setting bias
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As participants were recruited from clinical settings, findings may overrepresent individuals with more severe psychopathology and may not reflect patterns in non-clinical or subclinical populations.
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