Exposure to traumatic events such as military combat, physical
and sexual abuse, and natural disaster, can be related to poor
physical health. Posttraumatic Stress Disorder (PTSD) is also
related to health problems. This fact sheet provides information
on the relationships between trauma, PTSD, and physical health;
specific health problems associated with PTSD; health-risk
behaviors and PTSD; mechanisms that help explain how PTSD and
physical health could be related; and a clinical agenda to
address PTSD and health.
Before addressing these topics, it is necessary to provide
some basic information about how existing studies have measured
physical health. The most common way to measure physical health
is by having people report about their own health conditions,
symptoms, and overall physical health. Self-report measures of
physical health can be valid indicators of actual illness, but
they should be interpreted with caution because they may be
influenced by psychological health. The most reliable measure of
physical health involves a physician's diagnosis or
laboratory tests.
Is psychological trauma related to physical health?
A considerable amount of research has found that trauma has
negative effects on physical health. The relationship is clearest
when examining self-report of physical health problems and trauma
experienced as a result of time in the military, sexual assault,
childhood abuse, and motor vehicle accidents. Greater self-report
of military trauma, sexual assault, childhood abuse, and motor
vehicle accidents is related to greater self-report of health
problems. However, when health status is measured by
physician diagnosis, associations are not as consistent for
military trauma and sexual assault in adulthood. There is,
however, a probable association for survivors of natural
disaster. Two recent studies found that reports of childhood
abuse and neglect were related to an increase in physician
diagnosed disorders including cancer, ischemic heart disease, and
chronic lung disease. It is also likely that a relationship
exists between the experience of a trauma and an increase in
utilization of medical services for physical health problems. In
addition, health care costs have been found to be higher among
women who report a history of childhood abuse or neglect than
among women who report no history of maltreatment as a child.
What is the relationship between physical health and
PTSD?
A growing body of literature has found a link between PTSD and
physical health. Some studies have found that PTSD explains the
association between exposure to trauma and poor physical health.
In other words, trauma may lead to poor health outcomes because
of PTSD. When health problems are measured by self-report, there
is a clear association with PTSD for veterans and active duty
personnel, civilian men and women, firefighters, and adolescents.
Those who report that they have PTSD symptoms are more likely to
have a greater number of physical health problems than those who
do not have PTSD. Similar results are found when physical health
is measured by physician report or by laboratory tests. PTSD also
has been found to be associated with greater medical service
utilization for physical health problems. At present, however, an
association between PTSD and illness via physician diagnosis and
medical service utilization has only been examined in veteran
populations. Further research is indicated to examine PTSD,
physical illness, and medical service utilization in both veteran
and other traumatized populations.
Existing research has not been able to determine conclusively
that PTSD causes poor health. Thus, caution is warranted in
making a causal interpretation of what is presented here. It may
be the case that something associated with PTSD is actually the
cause of greater health problems. For example, it could be that a
factor associated with PTSD, such as smoking, is the actual cause
of the increased health problems. This is not likely, however,
given that we know that PTSD is associated with poor physical
health even when behavioral factors such as smoking are
controlled.
PTSD may promote poor health through a complex interaction
between biological and psychological mechanisms. The National
Center for PTSD and other laboratories around the world are
studying these mechanisms. Current thinking is that the
experience of trauma brings about neurochemical changes in the
brain. These changes may have biological, as well as
psychological and behavioral, effects on one's health. For
example, these neurochemical changes may create a vulnerability
to hypertension and atherosclerotic heart disease that could
explain in part the association with cardiovascular disorders.
Research also shows that these neurochemical changes may relate
to abnormalities in thyroid and other hormone functions, and to
increased susceptibility to infections and immunologic disorders
associated with PTSD.
The psychological and behavioral effects of PTSD on health may
be accounted for in part by comorbid depressive and anxiety
disorders. Many people with PTSD also experience depressive
disorders or other disorders. Depressed individuals report a
greater number of physical symptoms and use more medical
treatment than do individuals who are not depressed. Depression
also has been linked to cardiovascular disease in previously
healthy populations and to additional illness and mortality among
patients with serious medical illness. PTSD also may be related
to poor health through symptoms of comorbid anxiety or panic. The
evidence linking anxiety to cardiovascular morbidity and
mortality is quite strong, but the mechanisms are largely
unknown.
Hostility, or anger, is another possible mediator of the
relationship between PTSD and physical health. It is commonly
associated with PTSD and decades of research on the health risks
associated with the Type A behavior pattern have isolated
hostility as a crucial factor in cardiovascular disease. PTSD and
poor health also may be mediated in part by behavioral risk
factors for disease such as smoking, substance abuse, diet, and
lack of exercise.
Little is known about how coping and social support relate to
health in PTSD, but it is likely that both play important roles.
Further research is needed to better understand these potential
protective factors.
What specific health problems are related to PTSD?
There is not a lot of information about what specific health
problems are associated with PTSD. Many studies have not looked
at specific health problems but instead report only the number of
overall health problems associated with PTSD. Some studies have
examined specific health problems, but these problems have been
primarily self-reported. However, there is some evidence
to indicate PTSD is related to cardiovascular, gastrointestinal,
and musculoskeletal disorders. There is also one study with
similar findings that evaluated physician diagnosed disorders and
PTSD in relation to specific body systems.
A number of studies have found an association between PTSD and
poor cardiovascular health. These studies found that self-report
of circulatory disorders and symptoms of cardiovascular trouble
were each associated with PTSD in veteran populations, civilian
men and women, and male firefighters. Among studies that have
examined PTSD in relation to cardiovascular illness via physician
diagnosis or laboratory findings, PTSD has been consistently
associated with a greater likelihood of cardiovascular morbidity.
In a recent study, researchers used electrocardiogram (ECG)
findings to compare the cardiovascular function of Vietnam
veterans with PTSD to the cardiovascular function of veterans
without PTSD. After controlling for risk factors such as alcohol
consumption, weight, current substance abuse, and smoking, in
addition to controlling for current medication use, PTSD was
found to be associated with nonspecific ECG abnormalities,
atrioventricular conduction defects, and infarctions. Because the
PTSD group in this study included only those veterans with severe
PTSD, it is important to interpret this study with caution. It is
unknown whether men with less severe PTSD would show the same ECG
abnormalities. It is also important to be cautious about
generalizing the findings in this study since there have been no
studies specifically evaluating cardiovascular morbidity and PTSD
in women.
The gastrointestinal and musculoskeletal systems have also
been shown to be associated with PTSD, but the relationship of
PTSD to these two systems has not been as extensively researched
as the relationship between PTSD and the cardiovascular system.
The majority of the studies that have been conducted have
gathered information about veterans, but a study of civilian
young men and women found that there is a relationship between
gastrointestinal symptoms and PTSD. Similarly, researchers
found that PTSD was related to musculoskeletal symptoms among
male firefighters. Additional research is needed to learn more
about how these and other bodily system troubles may be related
to PTSD.
What is the agenda for clinical practice?
One agenda for clinical practice is for mental-health workers
to increase collaboration with primary and specialty medical care
professionals in order to better address this relationship
between PTSD and health problems. Medical personnel need to
become more aware of the potential harmful effects trauma and
PTSD can have on health. Specifically, it is important to screen
for PTSD in medical settings. Studies of patients seeking
physical-health care show that many have been exposed to trauma
and experience posttraumatic stress but have not received
appropriate mental-health care. In answer to this problem, it
might be useful to integrate PTSD treatment services with medical
care services.