"The body keeps the score. What cannot be spoken is written on the body—in chronic pain, tension, illness, and exhaustion. Trauma that remains unprocessed doesn't disappear; it is stored in tissue, posture, and physical symptom. To heal the mind, we must also listen to the body."
What Are Somatic Symptoms?
Somatic symptoms are physical symptoms that have psychological roots or are significantly influenced by emotional and psychological states. “Soma” means body in Greek—somatic symptoms are how psychological experience manifests in the physical body.
These are not “fake” or “imagined” symptoms. They are real physical experiences—real pain, real fatigue, real dysfunction. The fact that they connect to psychological states doesn’t make them less physical; it reflects that mind and body are one system.
Common Somatic Symptoms
Pain
- Chronic pain without clear medical cause
- Back pain, especially lower back
- Neck and shoulder tension
- Headaches and migraines
- Jaw pain (TMJ)
- Widespread body pain
Digestive Issues
- IBS (irritable bowel syndrome)
- Nausea, especially when stressed
- Stomach pain
- Appetite changes
- Constipation or diarrhea
- “Gut problems”
Fatigue
- Chronic exhaustion
- Sleep that doesn’t refresh
- Low energy
- Feeling drained
- Difficulty functioning despite rest
Cardiovascular
- Heart palpitations
- Chest tightness
- Shortness of breath
- High blood pressure
- Irregular heartbeat sensations
Immune System
- Frequent illness
- Autoimmune flares
- Slow healing
- Inflammation
- Chronic infections
Other
- Skin problems (eczema, hives, breakouts)
- Hair loss
- Dizziness
- Numbness or tingling
- Temperature regulation issues
Why Trauma Causes Physical Symptoms
The Stress Response
Trauma triggers the stress response, which creates real physiological changes:
- Cortisol and adrenaline flood the body
- Heart rate and blood pressure increase
- Digestion slows
- Immune function shifts
- Muscles tense for action
When stress is chronic, these changes become chronic.
The Body Keeps the Score
This phrase (from Bessel van der Kolk’s book) captures a key insight: trauma that isn’t fully processed remains stored in the body. The body “remembers” what the mind may not consciously recall or what emotions haven’t been fully expressed.
Incomplete Survival Responses
When fight-or-flight is activated but you can’t fight or flee:
- The mobilized energy stays in the body
- Muscles remain braced
- The cycle doesn’t complete
- Tension and pain can result
Nervous System Dysregulation
Chronic stress dysregulates the autonomic nervous system:
- Stuck in sympathetic: chronic tension, anxiety symptoms
- Stuck in dorsal vagal: fatigue, disconnection, depression
- Vagal function impaired: digestive issues, inflammation
Chronic Inflammation
Stress causes inflammation, which links to:
- Pain conditions
- Autoimmune disorders
- Cardiovascular issues
- Digestive problems
- Many chronic illnesses
Somatic Symptoms and Narcissistic Abuse
During the Abuse
Your body was surviving:
- Constant stress activation
- Vigilance and tension
- Suppressed fight-or-flight
- Energy diverted to survival
- Body on high alert
The Physical Toll
Living with a narcissist often causes:
- Chronic tension (walking on eggshells)
- Sleep disruption
- Appetite changes
- Exhaustion
- Stress-related illness
After Leaving
Paradoxically, symptoms may increase after leaving:
- The body finally has space to feel
- Suppressed responses emerge
- Stored trauma releases
- Processing begins
- Survival mode ends, and the cost becomes clear
This doesn’t mean you made a mistake leaving—it means your body is catching up.
The Mind-Body Connection
Not Either/Or
Somatic symptoms aren’t “psychological instead of physical” or “in your head instead of real.” The mind-body split is a false dichotomy:
- Psychological states create physiological effects
- Physical states affect psychological experience
- They’re one interconnected system
- Trauma affects the whole person
Your Symptoms Are Real
If you’ve been told “it’s all in your head”:
- Your pain is real
- Your exhaustion is real
- Your physical symptoms are real
- The psychological connection doesn’t diminish their realness
- You deserve treatment for both aspects
Approaches to Healing
Address the Trauma
Somatic symptoms often improve when underlying trauma is processed:
- Trauma therapy (EMDR, somatic experiencing)
- Processing stored emotions
- Completing interrupted survival responses
- Nervous system regulation
Work with the Body Directly
Somatic Therapies
- Somatic Experiencing (SE)
- Sensorimotor Psychotherapy
- Trauma-sensitive yoga
- Body-based PTSD treatments
Bodywork
- Massage therapy
- Craniosacral therapy
- Acupuncture
- Movement practices
Self-Practices
- Yoga
- Breathwork
- Progressive muscle relaxation
- Gentle movement
- Body awareness practices
Medical Care
Somatic symptoms still deserve medical attention:
- Rule out other conditions
- Get symptom relief
- Work with trauma-informed providers if possible
- Integrate medical and psychological care
Nervous System Regulation
Work with your autonomic nervous system:
- Vagal stimulation techniques
- Grounding practices
- Co-regulation with safe others
- Building capacity for calm
Lifestyle Factors
- Sleep (crucial for physical healing)
- Nutrition (supports body and brain)
- Movement (helps discharge activation)
- Stress reduction
- Social support
Common Questions
”Why is my body falling apart now that I’m safe?”
Your body held it together for survival. Now that you’re safe, it can finally process. The symptoms emerging are part of healing, not evidence you’re worse. Your body is catching up.
”My doctors can’t find anything wrong”
Medical testing often can’t detect somatic symptoms well. “No findings” doesn’t mean “nothing wrong.” Trauma-related physical symptoms are real even without clear medical markers. Seek providers who understand the mind-body connection.
”Am I making this up?”
No. The fact that symptoms connect to psychological states doesn’t mean you’re creating them voluntarily. You can’t “decide” to have chronic pain. The symptoms are real, involuntary, and deserving of care.
”Will this ever get better?”
Yes. As trauma is processed and the nervous system regulates, somatic symptoms typically improve. Healing takes time, and the body heals more slowly than insight comes. But it does heal.
For Survivors
If your body is struggling:
- Your physical symptoms are real
- They make sense given what your body has been through
- The body holds what the mind cannot
- Your pain is not weakness or failure
- Healing the mind and body go together
The body that protected you through abuse—that kept you alive, that carried you through—now needs care. The symptoms it carries are not betrayal; they are the record of what you survived. Listen to your body. It has been speaking all along.
As you heal, your body can heal too. What was stored can be released. What was braced can soften. What was disconnected can be reconnected. The body keeps the score—but the score can change. The body that remembers trauma can also remember safety, pleasure, and ease again.
Frequently Asked Questions
Somatic symptoms are physical symptoms that are caused, triggered, or significantly worsened by psychological factors—particularly stress, trauma, and unprocessed emotions. Examples include chronic pain, digestive problems, fatigue, tension, headaches, and immune system issues that can't be fully explained medically.
Trauma affects the body, not just the mind. The stress response creates physiological changes. Unprocessed trauma remains 'stored' in the nervous system and tissues. Chronic stress causes inflammation and illness. The body holds what the mind cannot fully process.
Common somatic symptoms include: chronic fatigue, insomnia, digestive issues (IBS, nausea), chronic pain (especially back, neck, shoulders), headaches/migraines, immune dysfunction (frequent illness), autoimmune flares, skin problems, heart palpitations, and unexplained medical issues.
Somatic symptoms are absolutely real. They cause real physical pain and dysfunction. The fact that they have psychological components doesn't make them less physical. Mind and body are not separate—psychological distress creates genuine physiological effects. The pain is real.
Treatment combines addressing both body and mind: trauma therapy (somatic experiencing, EMDR), bodywork (massage, yoga), nervous system regulation practices, medical care for symptoms, reducing overall stress, and processing underlying trauma. The body needs healing alongside the mind.
The body may have suppressed symptoms during survival mode, only releasing them when safety allows. Or leaving triggered physiological stress responses. Or processing began, bringing stored trauma into awareness. It's common for physical symptoms to emerge or worsen after escape as the body catches up.
