Acute and long-term mental and physical sequelae in the aftermath of traumatic exposure - some remarks on "the body keeps the score".

ABSTRACT

Traumata, by definition, refer to exterior events that expose a person to experiences of overwhelming threat and catastrophe and elicit feelings of death anxiety, panic, horror, helplessness, loss of personal control, and intractability. Most affected persons respond with at least some distressing symptoms of trauma-related memory intrusions, autonomic hyperarousal, dissociation, and depression in the acute aftermath. Fortunately, the majority of traumatized individuals succeed in coping with this major stress quite well during the following weeks and months unless the process of recovery is hampered by additional adverse psychosocial circumstances, psychological disposition or biological vulnerability. In a subgroup of persons a transition to acute and posttraumatic stress disorder or other major psychiatric disorders, e.g. depressive, anxiety, substance-related disorders may be observed. Posttraumatic stress disorders very often run a chronic course of illness enduring for many years or even life-long. The typical course of illness in PTSD is characterized not only by major psychiatric comorbidities contributing to a dramatically reduced health-related quality of life, to many deficits of psychosocial adaptation and a heightened suicide risk. It is also associated with a lot of major somatic health problems both in acute and long-term stages. The main focus here is on this special dimension of physical comorbidities in posttraumatic disorders. Empirical evidence underscores that trauma exposure, and in particular PTSD is significantly associated with major physical health problems in addition to well-known PTSD-related psychological, behavioural, and psychosocial impairments. Both self-report-based and objective assessments emphasized significantly increased rates of somatoform/functional syndromes and physical comorbidities, premature all-cause and specific mortality rates, heightened medical utilization behaviours, major socioeconomic costs, and reduced health-related quality of life in the aftermath of trauma exposure and posttraumatic stress disorders, thus defining a major challenge to any medical care system. Complex psycho-behavioural-somatic and somato-psycho-behavioural models are needed to better understand both acute and long-term effects of a perpetuating stress system on physical health.