When the Body Holds Stress: Understanding Trauma, Chronic Pain, and Somatic Symptoms

Physical pain is not always caused solely by structural injury.

Many individuals experience chronic tension, fatigue, gastrointestinal distress, headaches, muscular guarding, and persistent pain long after the original stressor, injury, or traumatic event has passed. Research continues to demonstrate a strong relationship between psychological stress, nervous system dysregulation, and physiological symptom expression (American Psychiatric Association [APA], 2022).

As a trauma-informed bodywork practitioner and behavioral science student, I have observed how unresolved stress responses often continue affecting the body physically, emotionally, and behaviorally even after structural healing has occurred.

This does not mean symptoms are imagined. Rather, it reflects the complex relationship between the nervous system, emotional processing, physiological regulation, and chronic stress activation.

Understanding Somatic Symptoms

Somatic Symptom Disorder (SSD) is characterized by distressing physical symptoms accompanied by excessive psychological distress, anxiety, or behavioral responses related to those symptoms (APA, 2022). Symptoms may include:

• chronic pain

• fatigue

• digestive issues

• muscular tension

• dizziness

• headaches

• autonomic nervous system dysregulation

  
  

Importantly, modern diagnostic understanding no longer focuses solely on whether symptoms can be medically explained. Instead, clinicians examine the severity of distress, symptom-focused anxiety, and the ways chronic physiological activation affects daily functioning (Getzfeld, 2018).

This shift reflects a broader understanding of the biopsychosocial relationship between the body and mind.

The Nervous System and Chronic Stress

From a trauma-informed perspective, chronic stress and trauma significantly affect physiological regulation.

Van der Kolk (2014) explains in The Body Keeps the Score that trauma is not only stored cognitively through memory, but physiologically through altered stress responses, muscular tension, hypervigilance, and chronic nervous system activation.

When the nervous system remains in a prolonged survival state, the body may continue responding as though danger is still present. Over time, this can contribute to:

• chronic muscular guarding

• shallow breathing patterns

• increased pain sensitivity

• emotional dysregulation

• fatigue and burnout

• persistent physiological tension

  
  

In my own work within trauma-informed somatic bodywork, I frequently observe how chronic tension patterns, restricted breathing, and hypervigilance continue reinforcing pain cycles long after the body has healed structurally.

Trauma, Hypervigilance, and Physical Pain

Research continues supporting the relationship between trauma exposure and persistent somatic symptoms.

Perez et al. (2025) found significant associations between interpersonal trauma, psychological distress, and chronic somatic symptom presentation, particularly symptoms involving pain, fatigue, and physiological dysregulation.

This research aligns closely with what many trauma-informed practitioners observe clinically: unresolved stress responses may continue expressing themselves physically through the body.

The body adapts to survive.

However, survival responses that remain activated too long may eventually begin disrupting overall physiological regulation and quality of life.

Why a Holistic Approach Matters

Because chronic stress affects both psychological and physiological functioning, treatment approaches are often most effective when they address both.

Cognitive Behavioral Therapy (CBT) remains one of the most evidence-based interventions for Somatic Symptom Disorder because it helps individuals identify maladaptive thought patterns, reduce catastrophic thinking, and improve behavioral responses to symptoms (Orzechowska et al., 2021).

However, psychological interventions alone may not fully address chronic physiological activation stored within the nervous system and body.

This is why trauma-informed and somatic approaches continue gaining attention as complementary interventions alongside evidence-based psychological treatment.

Supportive approaches may include:

• breathwork

• mindfulness practices

• massage therapy

• yoga and movement therapy

• grounding techniques

• nervous system regulation strategies

• stress management interventions

  
  

These approaches are not intended to replace medical or psychological care, but rather to support more comprehensive healing by addressing chronic physiological dysregulation and stress activation patterns.

A Trauma-Informed Perspective on Healing

One of the most important shifts within trauma-informed care is recognizing that symptoms are real, even when they are complex.

Rather than dismissing individuals as “overreactive” or assuming symptoms are imagined, trauma-informed care acknowledges that chronic stress and trauma can significantly affect physiological functioning, symptom perception, emotional regulation, and nervous system responses.

This perspective creates space for more compassionate and integrated approaches to healing.

Final Thoughts

The relationship between stress, trauma, and physical symptoms is complex, but growing research continues supporting the importance of integrated, biopsychosocial approaches to care.

Healing often requires more than simply treating symptoms in isolation. It may also involve addressing the physiological effects of chronic stress, emotional overwhelm, nervous system dysregulation, and maladaptive survival responses stored within the body.

As both research and trauma-informed practices continue evolving, the connection between emotional health, nervous system regulation, and physical well-being deserves continued attention within both healthcare and wellness spaces.

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References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.

Getzfeld, A. R. (2018). Abnormal psychology (2nd ed.). Bridgepoint Education.

Orzechowska, A., Gałecki, P., & Talarowska, M. (2021). Cognitive behavioral therapy of patients with somatic symptoms—Diagnostic and therapeutic difficulties. Psychiatria Polska, 55(4), 809–821.

Perez, L. A., et al. (2025). Somatic symptoms among young adults: The role of interpersonal trauma and psychological distress. BMC Psychiatry, 25(1).

Van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.