Psychological Trauma and Functional Somatic Syndromes: A Systematic Review and Meta-Analysis

Objective This meta-analysis systematically examined the association of reported psychological trauma and posttraumatic stress disorder (PTSD) with functional somatic syndromes including fibromyalgia, chronic widespread pain, chronic fatigue syndrome, temporomandibular disorder, and irritable bowel syndrome. Our goals were to determine the overall effect size of the association and to examine moderators of the relationship. Methods Literature searches identified 71 studies with a control or comparison group and examined the association of the syndromes with traumatic events including abuse of a psychological, emotional, sexual, or physical nature sustained during childhood or adulthood, combat exposure, or PTSD. A random-effects model was used to estimate the pooled odds ratio and 95% confidence interval. Planned subgroup analyses and meta-regression examined potential moderators. Results Individuals who reported exposure to trauma were 2.7 (95% confidence interval = 2.27–3.10) times more likely to have a functional somatic syndrome. This association was robust against both publication bias and the generally low quality of the literature. The magnitude of the association with PTSD was significantly larger than that with sexual or physical abuse. The association of reported trauma with chronic fatigue syndrome was larger than the association with either irritable bowel syndrome or fibromyalgia. Studies using nonvalidated questionnaires or self-report of trauma reported larger associations than did those using validated questionnaires. Conclusions Findings are consistent with the hypothesis that traumatic events are associated with an increased prevalence of functional somatic syndromes. The analyses also highlight limitations of the existing literature and emphasize the importance of prospective studies, examining the potential similarities and differences of these conditions, and pursuing hypothesis-driven studies of the mechanisms underlying the link between trauma, PTSD, and functional somatic syndromes.

[1]  R. Marcos,et al.  The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies. , 2013 .

[2]  M. Hotopf,et al.  Premorbid risk markers for chronic fatigue syndrome in the 1958 British birth cohort. , 2011, The British journal of psychiatry : the journal of mental science.

[3]  U. Nater,et al.  Cumulative life stress in chronic fatigue syndrome , 2011, Psychiatry Research.

[4]  M. Chung,et al.  The relationship between posttraumatic stress disorder, illness cognitions, defence styles, fatigue severity and psychological well-being in chronic fatigue syndrome , 2011, Psychiatry Research.

[5]  C. Sommer,et al.  Emotional, physical, and sexual abuse in fibromyalgia syndrome: A systematic review with meta‐analysis , 2011, Arthritis care & research.

[6]  J. Vandenberghe,et al.  Factors associated with co‐morbid irritable bowel syndrome and chronic fatigue‐like symptoms in functional dyspepsia , 2011, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[7]  E. Fuller-Thomson,et al.  Functional Somatic Syndromes and Childhood Physical Abuse in Women: Data From a Representative Community-Based Sample , 2011 .

[8]  N. Perrin,et al.  Risk factors predicting the development of widespread pain from chronic back or neck pain. , 2010, The journal of pain : official journal of the American Pain Society.

[9]  H. El‐Serag,et al.  Trauma history and risk of the irritable bowel syndrome in women veterans , 2010, Alimentary pharmacology & therapeutics.

[10]  Christopher F. Martin,et al.  Association Between Intimate Partner Violence and Irritable Bowel Syndrome: A Population-Based Study in Nicaragua , 2010, Violence against women.

[11]  N. Nicolson,et al.  Childhood Maltreatment and Diurnal Cortisol Patterns in Women With Chronic Pain , 2010, Psychosomatic medicine.

[12]  M. G. Haviland,et al.  Traumatic experiences, major life stressors, and self-reporting a physician-given fibromyalgia diagnosis , 2010, Psychiatry Research.

[13]  P. White Chronic fatigue syndrome: Is it one discrete syndrome or many? Implications for the "one vs. many" functional somatic syndromes debate. , 2010, Journal of psychosomatic research.

[14]  P. Salmon,et al.  Anger and childhood sexual abuse are independently associated with irritable bowel syndrome. , 2010, British journal of health psychology.

[15]  E. Tooley,et al.  Traumatic events, perceived stress and health in women with fibromyalgia and healthy controls , 2010 .

[16]  Helena K. Chandler,et al.  Chronic widespread pain, mental health, and physical role function in OEF/OIF veterans. , 2009, Pain medicine.

[17]  M. Murad,et al.  Sexual abuse and lifetime diagnosis of somatic disorders: a systematic review and meta-analysis. , 2009, JAMA.

[18]  K. Taber,et al.  Association of trauma exposure with psychiatric morbidity in military veterans who have served since September 11, 2001. , 2009, Journal of psychiatric research.

[19]  Juncal Plazaola-Castaño,et al.  Risk factors for fibromyalgia: the role of violence against women , 2009, Clinical Rheumatology.

[20]  H. El‐Serag,et al.  Irritable bowel syndrome and dyspepsia among women veterans: prevalence and association with psychological distress , 2009, Alimentary pharmacology & therapeutics.

[21]  D. Hinton,et al.  The `Multiplex Model' of Somatic Symptoms: Application to Tinnitus among Traumatized Cambodian Refugees , 2008, Transcultural psychiatry.

[22]  Christopher F. Martin,et al.  M1780 Positive Association Between Intimate Partner Violence and Irritable Bowel Syndrome in Latina Women: A Population-Based Study in Nicaragua , 2008 .

[23]  M. Hosoi,et al.  Childhood physical abuse in outpatients with psychosomatic symptoms , 2008, BioPsychoSocial medicine.

[24]  W. Whitehead,et al.  Early Life Risk Factors That Contribute to Irritable Bowel Syndrome in Adults: A Systematic Review , 2008, The American Journal of Gastroenterology.

[25]  MarshaM . Cohen,et al.  Unexplained and Underpowered: The Relationship Between Psychosomatic Disorders and Interpersonal Abuse—A Critical Review , 2008, Harvard review of psychiatry.

[26]  K. Roelofs,et al.  Trauma and medically unexplained symptoms towards an integration of cognitive and neuro-biological accounts. , 2007, Clinical psychology review.

[27]  M. Fleming,et al.  Prevalence of Interpersonal Abuse in Primary Care Patients Prescribed Opioids for Chronic Pain , 2007, Journal of General Internal Medicine.

[28]  D. Drossman,et al.  Relationship of Abuse History to Functional Gastrointestinal Disorders and Symptoms , 2007, Trauma, violence & abuse.

[29]  R. Saitz,et al.  PTSD in Urban Primary Care: High Prevalence and Low Physician Recognition , 2007, Journal of General Internal Medicine.

[30]  J. Zohar,et al.  Posttraumatic stress disorder, tenderness, and fibromyalgia syndrome: are they different entities? , 2006, Journal of psychosomatic research.

[31]  James F. Jones,et al.  Early adverse experience and risk for chronic fatigue syndrome: results from a population-based study. , 2006, Archives of general psychiatry.

[32]  H. Jamil,et al.  Iraqi Gulf War Veteran Refugees in the U.S. , 2006, Social work in health care.

[33]  A. Erkanli,et al.  Lifetime trauma exposure in veterans with military-related posttraumatic stress disorder: association with current symptomatology. , 2006, The Journal of clinical psychiatry.

[34]  K. Raphael,et al.  Psychiatric comorbidities in a community sample of women with fibromyalgia , 2006, Pain.

[35]  B. Doebbeling,et al.  Predictors of Incident Chronic Widespread Pain Among Veterans Following the First Gulf War , 2006, The Clinical journal of pain.

[36]  K. Leder,et al.  Medically evaluated psychological and physical health of Australian Gulf War veterans with chronic fatigue. , 2006, Journal of psychosomatic research.

[37]  S. Furner,et al.  A twin study of posttraumatic stress disorder symptoms and chronic widespread pain , 2006, Pain.

[38]  R. Moss‐Morris,et al.  To “Lump” or to “Split” the Functional Somatic Syndromes: Can Infectious and Emotional Risk Factors Differentiate Between the Onset of Chronic Fatigue Syndrome and Irritable Bowel Syndrome? , 2006, Psychosomatic medicine.

[39]  G. Macfarlane,et al.  The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors? , 2006, International journal of epidemiology.

[40]  D. Ronis,et al.  PTSD and physical comorbidity among women receiving Medicaid: results from service-use data. , 2006, Journal of traumatic stress.

[41]  N. Talley,et al.  A History of Abuse in Community Subjects with Irritable Bowel Syndrome and Functional Dyspepsia: The Role of Other Psychosocial Variables , 2005, Digestion.

[42]  K. Raphael Childhood abuse and pain in adulthood: more than a modest relationship? , 2005, The Clinical journal of pain.

[43]  Helena K. Chandler,et al.  Sexual and Physical Abuse in Women With Fibromyalgia Syndrome: A Test of the Trauma Hypothesis , 2005, The Clinical journal of pain.

[44]  L. Espinoza,et al.  Prevalence of Abuse in Fibromyalgia and Other Rheumatic Disorders at a Specialized Clinic in Rheumatic Diseases in Guatemala City , 2005, Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases.

[45]  C. Ross Childhood Sexual Abuse and Psychosomatic Symptoms in Irritable Bowel Syndrome , 2005, Journal of child sexual abuse.

[46]  H Stefan Bracha,et al.  Freeze, Flight, Fight, Fright, Faint: Adaptationist Perspectives on the Acute Stress Response Spectrum , 2004, CNS Spectrums.

[47]  R. Sandler,et al.  Prevalence and Characteristics of Irritable Bowel Syndrome Among Women With Chronic Pelvic Pain , 2004, Obstetrics and gynecology.

[48]  S. Wessely,et al.  There is only one functional somatic syndrome , 2004, British Journal of Psychiatry.

[49]  K. Raphael,et al.  Familial aggregation of depression in fibromyalgia: a community-based test of alternate hypotheses , 2004, Pain.

[50]  T. M. Davis,et al.  Posttraumatic stress disorder in female veterans: association with self-reported health problems and functional impairment. , 2004, Archives of internal medicine.

[51]  W. Smith,et al.  Post-traumatic stress disorder among patients with chronic pain and chronic fatigue , 2004, Psychological Medicine.

[52]  Yasutaka Osada,et al.  Self-reported symptoms and medical conditions among 11,868 Gulf War-era veterans: the Seabee Health Study. Gray, G. C., Reed, R. J., Kaiser, K. S., Smith, T. C., and Gastanaga, V. M. Am. J. Epidemiol., 155(11):1033-1044, 2002.(Abstracts of foreign literature) , 2003 .

[53]  D. Buchwald,et al.  Chronic diffuse musculoskeletal pain, fibromyalgia and co-morbid unexplained clinical conditions. , 2003, Best practice & research. Clinical rheumatology.

[54]  K. Imbierowicz,et al.  Childhood adversities in patients with fibromyalgia and somatoform pain disorder , 2003, European journal of pain.

[55]  P. Pezzotti,et al.  Prevalence of sexual and physical abuse and its relationship with symptom manifestations in patients with chronic organic and functional gastrointestinal disorders. , 2003, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[56]  Robin S. Edelstein,et al.  A Prospective Study of Memory for Child Sexual Abuse , 2003, Psychological science.

[57]  C. Burton Beyond somatisation: a review of the understanding and treatment of medically unexplained physical symptoms (MUPS). , 2003, The British journal of general practice : the journal of the Royal College of General Practitioners.

[58]  P. Salmon,et al.  Abuse, Dissociation, and Somatization in Irritable Bowel Syndrome: Towards an Explanatory Model , 2003, Journal of Behavioral Medicine.

[59]  Han K. Kang,et al.  Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: a population-based survey of 30,000 veterans. , 2003, American journal of epidemiology.

[60]  Steven Taylor,et al.  PTSD and the Experience of Pain: Research and Clinical Implications of Shared Vulnerability and Mutual Maintenance Models , 2002, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[61]  E. Sundbom,et al.  Possible Influence of Defenses and Negative Life Events on Patients with Chronic Fatigue Syndrome: A Pilot Study , 2002, Psychological reports.

[62]  L. Jason,et al.  Chronic fatigue, abuse-related traumatization, and psychiatric disorders in a community-based sample. , 2002, Social science & medicine.

[63]  S. Thompson,et al.  Quantifying heterogeneity in a meta‐analysis , 2002, Statistics in medicine.

[64]  R. J. Reed,et al.  Self-reported symptoms and medical conditions among 11,868 Gulf War-era veterans: the Seabee Health Study. , 2002, American journal of epidemiology.

[65]  J. Escobar,et al.  Medically unexplained physical symptoms in medical practice: a psychiatric perspective. , 2002, Environmental health perspectives.

[66]  N. Read,et al.  A Re-examination of the Relationship between Abuse Experience and Functional Bowel Disorders , 2002, Scandinavian journal of gastroenterology.

[67]  R. Taylor,et al.  Sexual Abuse, Physical Abuse, Chronic Fatigue, and Chronic Fatigue Syndrome: A Community-Based Study , 2001, The Journal of nervous and mental disease.

[68]  A. Silman,et al.  Associations between adverse events in childhood and chronic widespread pain in adulthood: are they explained by differential recall? , 2001, The Journal of rheumatology.

[69]  A. Harvey,et al.  Chronic pain and posttraumatic stress disorder: mutual maintenance? , 2001, Clinical psychology review.

[70]  W. Katon,et al.  Medical Symptoms without Identified Pathology: Relationship to Psychiatric Disorders, Childhood and Adult Trauma, and Personality Traits , 2001, Annals of Internal Medicine.

[71]  L. Tanum [Functional somatic syndromes]. , 2000, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke.

[72]  L. Knorring,et al.  The impact of life events in female patients with fibromyalgia and in female healthy controls , 2000, European Psychiatry.

[73]  K. Kendall-Tackett Physiological correlates of childhood abuse: chronic hyperarousal in PTSD, depression, and irritable bowel syndrome. , 2000, Child abuse & neglect.

[74]  H. Finestone,et al.  Chronic pain and health care utilization in women with a history of childhood sexual abuse. , 2000, Child abuse & neglect.

[75]  Alisha Ali,et al.  Emotional Abuse, Self-Blame, and Self-Silencing in Women With Irritable Bowel Syndrome , 2000, Psychosomatic medicine.

[76]  R. Bryant,et al.  Treating acute stress disorder: an evaluation of cognitive behavior therapy and supportive counseling techniques. , 1999, The American journal of psychiatry.

[77]  S. Wessely,et al.  Functional somatic syndromes: one or many? , 1999, The Lancet.

[78]  B. Fielding,et al.  Domestic violence and sexual abuse in women physicians: associated medical, psychiatric, and professional difficulties. , 1999, Journal of women's health & gender-based medicine.

[79]  J. Thayer,et al.  Relations among psychological trauma, dissociative phenomena, and trauma-related distress: a review and integration. , 1999, Clinical psychology review.

[80]  Donald R. Miller,et al.  Medical profile of women Veterans Administration outpatients who report a history of sexual assault occurring while in the military. , 1999, Journal of women's health & gender-based medicine.

[81]  G. Baker,et al.  The association of sexual and physical abuse with somatization: characteristics of patients presenting with irritable bowel syndrome and non-epileptic attack disorder , 1999, Psychological Medicine.

[82]  N. Talley,et al.  Is the association between irritable bowel syndrome and abuse explained by neuroticism? A population based study , 1998, Gut.

[83]  D. Jamieson,et al.  The association of sexual abuse with pelvic pain complaints in a primary care population. , 1997, American journal of obstetrics and gynecology.

[84]  W. Katon,et al.  Psychosocial Factors in Fibromyalgia Compared With Rheumatoid Arthritis: II. Sexual, Physical, and Emotional Abuse and Neglect , 1997, Psychosomatic medicine.

[85]  Iowa-Persian-Gulf-Study-Group Self-reported illness and health status among Gulf War veterans: A population-based study , 1997 .

[86]  D. Buskila,et al.  Posttraumatic stress disorder, tenderness and fibromyalgia. , 1997, Journal of psychosomatic research.

[87]  M. Delvaux,et al.  Sexual abuse is more frequently reported by IBS patients than by patients with organic digestive diseases or controls. Results of a multicentre inquiry , 1997, European journal of gastroenterology & hepatology.

[88]  J. B. Kuhns,et al.  Childhood victimization and subsequent risk for promiscuity, prostitution, and teenage pregnancy: a prospective study. , 1996, American journal of public health.

[89]  W. Katon,et al.  Psychiatric diagnoses, sexual and physical victimization, and disability in patients with irritable bowel syndrome or inflammatory bowel disease , 1995, Psychological Medicine.

[90]  A. Zinsmeister,et al.  Self-reported abuse and gastrointestinal disease in outpatients: association with irritable bowel-type symptoms. , 1995, The American journal of gastroenterology.

[91]  J. Esdaile,et al.  Sexual and physical abuse in women with fibromyalgia syndrome. , 1995, Arthritis and rheumatism.

[92]  M. Csuka,et al.  The prevalence of sexual abuse in women with fibromyalgia. , 1995, Arthritis and rheumatism.

[93]  L. Williams,et al.  Recall of childhood trauma: a prospective study of women's memories of child sexual abuse. , 1994, Journal of consulting and clinical psychology.

[94]  W. Katon,et al.  Severity of somatization and its relationship to psychiatric disorders and personality. , 1994, Psychosomatics.

[95]  J. Richter,et al.  Altered pain perception and psychosocial features among women with gastrointestinal disorders and history of abuse: a preliminary model. , 1994, The American journal of medicine.

[96]  S. Leeder,et al.  A population based study , 1993, The Medical journal of Australia.

[97]  W. Katon,et al.  Histories of sexual victimization in patients with irritable bowel syndrome or inflammatory bowel disease. , 1993, The American journal of psychiatry.

[98]  G. Longstreth,et al.  Irritable bowel-type symptoms in HMO examinees , 1993, Digestive Diseases and Sciences.

[99]  R Rosenthal,et al.  Meta‐analysis: a review. , 1991, Psychosomatic medicine.

[100]  D. Drossman,et al.  Sexual and physical abuse in women with functional or organic gastrointestinal disorders. , 1990, Annals of internal medicine.

[101]  H. Sutton AN EPIDEMIOLOGICAL STUDY , 1937 .

[102]  P. Tugwell,et al.  The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses , 2014 .

[103]  Bryce Hruska,et al.  The physical health consequences of PTSD and PTSD symptoms: a meta-analytic review. , 2013, Journal of anxiety disorders.

[104]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. , 2010, International journal of surgery.

[105]  James F. Jones,et al.  Childhood trauma and risk for chronic fatigue syndrome: association with neuroendocrine dysfunction. , 2009, Archives of general psychiatry.

[106]  C. Knaevelsrud,et al.  Chronic pain and PTSD: the Perpetual Avoidance Model and its treatment implications. , 2008, Torture : quarterly journal on rehabilitation of torture victims and prevention of torture.

[107]  D. Buchwald,et al.  Are post-traumatic stress disorder symptoms and temporomandibular pain associated? Findings from a community-based twin registry. , 2008, Journal of orofacial pain.

[108]  I. Uhač,et al.  Oral health status in war veterans with post-traumatic stress disorder. , 2007, Journal of oral rehabilitation.

[109]  K R Abrams,et al.  Methods for exploring heterogeneity in meta-analysis. , 2001, Evaluation & the health professions.

[110]  P. Onghena,et al.  Victimization in chronic fatigue syndrome and fibromyalgia in tertiary care: a controlled study on prevalence and characteristics. , 2001, Psychosomatics.

[111]  R. Goldberg,et al.  Relationship between traumatic events in childhood and chronic pain. , 1999, Disability and rehabilitation.

[112]  B. Doebbeling,et al.  Self-reported illness and health status among Gulf War veterans. A population-based study. The Iowa Persian Gulf Study Group. , 1997, JAMA.

[113]  W. Maixner,et al.  Sexual and physical abuse history in subjects with temporomandibular disorders: relationship to clinical variables, pain sensitivity, and psychologic factors. , 1997, Journal of orofacial pain.

[114]  K. Schmaling,et al.  Interpersonal Stressors in Chronic Fatigue Syndrome , 1995 .

[115]  K. Raphael,et al.  Problems of recall and misclassification with checklist methods of measuring stressful life events. , 1991, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.