PTSD Includes Physical Symptoms. Here Are Some Of Them.

Our society tends to talk a lot about the ways that post-traumatic stress disorder impacts mental health. But the illness has profound effects across people’s well-being ― including their physical health.

According to “The Body Keeps the Score,” a book on trauma by psychiatrist and trauma specialist Bessel Van Der Kolk, physical symptoms with no clear cause are pervasive in traumatized children and adults. Among other physical manifestations, “they can include chronic back and neck pain, fibromyalgia, migraines, digestive problems, spastic colon/irritable bowel syndrome, chronic fatigue and some forms of asthma,” Van Der Kolk wrote.

In order to understand how PTSD manifests physically, it’s important to understand how PTSD is diagnosed. John Krystal, chief psychiatrist at Yale Medicine and a national expert on PTSD, said that the condition occurs “when exposure to extreme life events causes persisting and significant levels of distress and impairment in the ability to engage fully in meaningful relationships and work.”

Krystal explained that clinicians look for specific symptoms such as intrusive thoughts and feelings, avoidance in thinking about or addressing the trauma, depression, shame and other negative feelings related to the trauma, feelings of hopelessness and difficulty sleeping, concentrating and relaxing.

“When our brains detect danger, our brains activate systems that alert us consciously to the threat and the brain automatically mobilizes our entire body to cope with the threat and the possible injuries that could take place,” he said. “Unfortunately, PTSD builds on this framework in a maladaptive way.”

Here are some of the ways PTSD affects people physically:

“PTSD can be associated with a tendency for floods of adrenaline release,” Krystal said. Adrenaline is a hormone that’s part of the body’s fight or flight response and produces many physical signs of stress and fear, such as sweaty palms, a racing heart, increased startle reflexes, difficulty catching one’s breath, stomach discomfort and a feeling that something bad is going to happen.

Adrenaline release evolved as an essential component to human survival, Krystal said. If excess amounts of adrenaline are released at times when they’re not needed, this can cause distress and interfere with your ability to engage in normal and ordinary activities.

Very simply put, “these floods of adrenaline arise because brain circuits involved in the regulation of emotion learn to activate in response to trauma-related cues and then do not unlearn these associations after the threat passes,” Krystal said.

Some people with PTSD have trouble regulating cortisol, the body’s primary stress hormone. Krystal said that some patients with chronic PTSD experience deficits in cortisol release, which can make the organs of the body more vulnerable to inflammation. Meanwhile, some people with PTSD experience elevated blood levels of pro-inflammatory chemicals called cytokines.

“Together, these chemical changes may contribute to stress or PTSD-related worsening of a wide variety of medical problems,” Krystal added.

It’s also common for people with PTSD to isolate themselves, engage in far less physical activity and soothe themselves with food and alcohol, said Amit Etkin, professor of psychiatry and behavioral sciences at Stanford University and an investigator at the Palo Alto VA. As a result of these behaviors, they may become overweight or obese, have metabolic disturbances or develop diabetes and other chronic illnesses.

“It can age your body tremendously quickly,” Etkin said.

Exercise tends to play a huge role in how people feel, so if a person exercises less as a component of PTSD, this can lead to a negative cycle that’s hard to break away from.

“The less you exercise, the more it’ll exacerbate your illness and the more it will reinforce the tendency of patients with PTSD to isolate,” Etkin said, adding that he often advises patients to force themselves to engage in physical activity. Even if that means just walking around somewhere.

Cardiac issues are a risk, too.

People with PTSD may experience sleep apnea or have difficulty maintaining a healthy sleep schedule.

“Insomnia often comes just from the state of anxiety and distress that somebody with PTSD, also somebody with depression, might be experiencing,” Etkin said.

He added that most people suffer from sleep disturbances rather than actual insomnia, meaning they may feel distressed about their sleep and feel unrested, but may not show abnormalities if their brain activity and physical activity are measured during sleep.

Meanwhile, sleep apnea ― a condition where the upper airway is constricted during sleep, is common among some people suffering from PTSD who have weight issues, mainly because with obesity comes increased rates of sleep apnea, Etkin explained.

In general, sleep disturbances can be problematic because sleep is a building block for so many other cognitive and physical processes that we need in order to function well in our daily lives, said Jenny Owens, co-founder and outcomes director of Reboot Alliance, an organization that helps military veterans and first responders recover and heal from trauma.

Pain is common among people suffering from PTSD and can appear in many forms, from migraines to fibromyalgia and muscle tension. Etkin said that pain and PTSD commonly occur alongside one another, yet many people don’t report pain to their psychiatrist and many psychiatrists don’t ask about it.

For some people with PTSD, chronic pain then feeds into compensatory activities like drinking and drugs, which can then cause other negative health effects. “And so all of these things, as you can see, are just a vicious cycle,” he said.

Given such a wide range of symptoms, treating PTSD can be a challenge. “We really think a holistic approach is ideal,” Owens said, adding that PTSD treatment should address physical, mental, emotional and spiritual health.

Krystal said it’s more crucial for doctors to consider the severity of symptoms rather than the number of symptoms. “A person can be crippled by persisting severe insomnia, just as they can by severe anxiety or depression,” he said. “That is why in treatment, symptom severity can be very important.”

Etkin added that many people don’t have access to therapy, which can lead to just managing the PTSD with medication or not addressing it at all. If you’re experiencing any mental health issues (or any mental health-induced physical symptoms), chat with your doctor about a treatment plan, including affordable therapy options.