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Somatization: How Trauma Impacts Your Body
(Complex PTSD, Category 3)
The third system category of complex PTSD is somatization, or the ways the body remembers trauma. Survivors of long-term trauma frequently have problems with their digestive systems; they also often have chronic pain, cardiopulmonary symptoms, and sexual symptoms. Some of these may be conversion symptoms, where problems related to trauma and abuse attach to the parts of the body that were hurt during trauma. Body memory (also called somatic memory) is part of what is known as implicit memory. Rothschild notes that persons with PTSD suffer many “images, sensations, and behavior impulses…disconnected from [the] context, concepts, and understanding” (2000, 37) of the trauma. These contextual cues, understandings, and concepts are parts of the explicit memory of the trauma (implicit and explicit memory are discussed in chapter 1).
The nervous system communicates somatic memories of trauma between the brain and all other parts of the body. When the memories of trauma are stored as sensations, similar sensations can trigger the memories, causing what is known as state-dependent recall of the trauma. Your body can “remember” a trauma that your conscious mind is not remembering. So you’re experiencing an implicit (body) memory or trauma without the explicit (thought) memory needed to make sense of it. Various body parts may hurt or have symptoms that are in some way trauma-connected, and you have no knowledge of how those parts of the body were involved in trauma.
Emotions that are connected to trauma also may be carried in the body. Rothschild writes that “emotions, though interpreted and named by the mind, are integrally an experience of the body,” and that emotions “feel different on the inside of the body” or each individual” (2000, 56). She further explains that there are many phrases in the English language to express the links between emotions and the body (2000, 57):
If you have turned some of your symptoms of trauma back onto your body, it is important that you allow those symptoms to speak: that you identify their origin and their relationship to what happened to you. It is also important for you to learn to develop a baseline state of calm by working on the exercises in chapter 2. Additionally, it is important that you have one good medical doctor who understands trauma and the impacts of trauma, rather than a number of different doctors who treat you for the trees without seeing the forest. Trauma can cause you to amplify and generalize your physiologic symptoms. The best course of action is to make sure that you have no serious medical condition and then look to the trauma basis of your symptoms, working on the memories from which they come. You can use the techniques in chapter 4 to do this work.
Chronic Pain
What is pain? Generally, when you have a pain in your body you immediately think that something is wrong medically, and you want to fix it. However, with survivors of ongoing, complex trauma, there may be no physical cause for the pain they feel, or the amount of pain you feel is not necessarily in direct proportion to the physical injury you have. Pain is a psychological problem as well as a medical or physical problem. Curro (1987) found that pain had four dimensions: motivational (your desire to avoid or escape from pain), cognitive (your experience with and memory of pain), affective (the feelings you associate with pain, including fear, anxiety, stress), and discriminative (your nervous system’s response to what causes the pain and its onset, duration, intensity, quality, and location).
What do you do if you have chronic pain that is not based in a medical condition? How do you get relief when the tendency of the medical community is not to prescribe enough pain medication to control the pain stimulus? One way to work with pain is to use what are known as cognitive behavior techniques or cognitive behavior therapy (CBT). The adherents of cognitive behaviorism say that your thoughts influence your feelings and behavior, and your feelings and behavior influence your thoughts. If patterns of thinking and behaving are destructive or maladaptive, they can be challenged and changed. CBT teaches persons with pain to question and challenge those thoughts, feelings, behaviors, and reactions and also use relaxation, imagery, and distraction (Grant 1997).
Researchers who have learned about trauma have helped us see that mind and body are one. Emotional learning occurs with a part of the brain called the amygdala; another part, called the hippocampus, is responsible for thoughts associated with those emotions (LeDoux 1997). These two parts of the brain are also involved in processing information after a trauma. The hippocampus is able to “remember” the facts of the situation and the context of the trauma. Van der Kolk (1996) has found that beliefs and cognition give meaning to the affect (emotion) that a trauma brings. Thoughts activate the amygdala and trigger emotions.
So what does this all mean to you? The emotions or emotional memories of a trauma get incompletely processed and then are constantly getting reactivated through triggers. Chronic pain is part of this conditioned emotional learning and “is a kind of recurring ‘trauma,’ since the traumatic event consists of recurring pain attacks or constant physical discomfort” (Grant 1997, 36). Trauma and its associated pain get associated with emotions and the cognitive appraisal (that is, the judgment or perception) of pain. Over time, the true pain that occurred with the trauma becomes a psychological response as well.
If pain doesn’t get better over time, and if it gets more and more associated with emotions such as anxiety or fear, you may eventually have less awareness of your body and bodily sensations. You may even begin to dissociate chronic pain. Over time, dissociation maintains your traumatic stress reaction Eventually, you may be told to “learn to live with your pain” or “try to manage it” because no one can find a cure or way to stop it through pills or medical treatments.
So what does that mean for you, the trauma survivor with pain? If you have endured serious trauma, your emotional responses are the major source of information for your thoughts and the meanings you attach to things. Your thoughts appraise (look at, value, question) your emotional responses. If you are to change your emotional responses, it is important to look at your emotions and to work on challenging and changing the meanings associated with those emotions. If you are to understand the sources of your pain, you need to go back and process your traumatic experiences (as in chapter 4) and reconnect with as much information about your traumas as is possible.
Relaxation strategies (chapter 2) may help you reduce the intensity of your pain because they reduce emotional tension (Gatchel and Turk 1996). Exposure to and desensitization of parts of your traumatic experiences or your triggers can also help lessen suffering and tension (Grant 1997). As Grant has written, “chronic pain can be a somatization of unresolved trauma, and treatment of the trauma can lead to significant reduction in physical symptoms” (1997, 63).
Eye Movement Desensitization and Reprocessing (EMDR)
One way to work on pain is through eye movement desensitization and reprocessing (EMDR), a technique developed by Shapiro (1995). She observed that certain eye movements are able to reduce the intensity of disturbing thoughts that have not otherwise been dislodged or released. When information in the brain is associated with trauma or chronic pain and gets frozen in time along with its associated emotions and memories, EMDR seems to change the way the information is processed. After EMDR, pain sensations and the way a person experiences and perceives pain get changed. It is a technique that must be done in the context of a therapeutic relationship. The five tasks of pain management using EMDR are:
If you are interested in working on your pain using EMDR, contact the Eye Movement Desensitization and Reprocessing Institute (see Resources).
Exercise: My Pain
Do you have any pain that cannot be diagnosed medically?
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Have you ever looked at the sources for that pain outside your actual physical body? What was the result?
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What I have learned about myself from completing the exercises in this chapter is:
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