Page 10 - JCBP-3-1

Journal of Clinical and
Basic Psychosomatics Somatic symptom disorder etiology

the third, because recent research has identified childhood each of the three trauma outcomes remained unknown.
trauma, especially emotional abuse and sexual abuse, He argued that trauma led to either traumatic amnesia,
as explaining one-quarter of the variance in somatic resolution, or PTSD, depending on the victim’s
7
symptoms and levels of daily physical discomfort in a peritraumatic perception. Importantly, he identified the
large national sample of adults. Furthermore, Eilers et al. connection between PTSD and analgesia. To explore
2
2
showed a moderate size effect (d = 0.30) of childhood whether there is also a connection between dissociative
trauma on later somatic symptoms, after controlling amnesia and SSD, this paper begins with the traumatic
for gender, age, education level, and relationship amnesia neurochemical literature, addresses the PTSD
status. Trauma specifically, not more general “early neurochemical literature, and ends with the clinical
adversity,” is a key variable in the etiology of SSD, but the memory and somatization literature. Very quickly after
neurodevelopmental mechanisms linking the effects of sensory organs and the thalamus detect life-threatening
childhood trauma to long-term somatic complaints have situations, emotion, and memory systems are engaged,
8,9
not been well understood. Trauma-amnesia-pain (T-A-P) along with their relevant neurotransmitters. Cortisol,
theory is presented as a novel conceptualization of the acetylcholine (ACh), glutamate, adrenomedullin, and
neuroendocrinological cascade that maps how trauma enzyme acetylcholinesterase will factor large in the model.
explains the comorbidity of dissociative amnesia and SSD. Olff, Langeland, and Gersons’ stress-coping model for
Clinicians need to understand the critical link for many PTSD informs one-half of T-A-P theory. 10
patients between dissociative amnesia and SSD because The T-A-P pathway has five phases: Peritraumatic
treatment may not progress well without acknowledgment perception; trauma memory processing; sympathetic
of trauma experiences, or trauma-informed intervention. nervous system (SNS) response; acute somatic symptoms;
It is difficult to address trauma history given the possibility and chronic somatic symptoms. After the groundwork is
of a patient’s dissociative amnesia for trauma, but laid for the definition, prevalence, and clinical presentation
implications and intervention options are offered at the of traumatic amnesia, each phase of the T-A-P pathway
end of the paper. will be explained separately. Diagrams are provided that
In the DSM-5-TR under comorbidities of SSD, collectively distinguish and compare the triune trauma
dissociative amnesia is not listed, but post-traumatic stress outcomes: traumatic amnesia/SSD, which is the focus of this
disorder (PTSD) is listed. Somewhat confusingly, in the research; PTSD/analgesia, which is the opponent process
DSM-5-TR under comorbidities of dissociative amnesia, of T-A-P; and trauma integration/resolution, which is the
SSD is listed. 1,p. 344 It could be an oversight to not have non-clinical healthy resolution of trauma. It is important
listed the comorbidities in both places, or it could be an to note that although the cascade is robust in animal and
indication that dissociative amnesia is presumed to be human models for hours and days following trauma, the
primary and casual of SSD, a secondary effect. The T-A-P final phase of chronic psychobehavioral outcomes, such
model will address the primary nature of amnesia and the as dissociative amnesia, SSD, and PTSD can be altered by
secondary effect of somatic symptoms, such as pain. age, therapeutic intervention, social support, and cognitive
reappraisal in the months following the trauma. 8,10,11
To diagnose SSD, at least one somatic symptom must
be significantly disruptive or distressing to the sufferer, and 2. Traumatic amnesia
the time, thoughts, or anxiety the sufferer spends dealing Perhaps one reason traumatic amnesia has received
with the symptom(s) is abnormally high. Many sufferers little discussion in the literature in comparison to PTSD
have multiple somatic symptoms, such as neurological is because its behavioral consequences were generally
paralysis, numbness, tingling, and burning, but pain is unknown. If people cannot remember the trauma they
3,4
most common. Pain disorder, somatization disorder, experienced, why would they seek therapy? Large clinical
and functional somatic disorder (FSD) are considered populations were lacking. Furthermore, controversy
dimensions of SSD in the DSM-5-TR. Sometimes the swirled around how traumatic amnesia was defined and
5,6
somatic symptom is medically unexplained, but excessive whether amnesia was an appropriate term for a condition
focus on determining whether symptoms are “psychogenic in which trauma victims were unable to encode or
only” in earlier versions of the DSM led to the current consolidate key declarative memories of a trauma since
recognition that the mind-body connection cannot and the term amnesia often implies forgetting. Nevertheless,
12
should not be dissected when diagnosing SSD. 1
most experts have settled on the term traumatic amnesia if
Van der Kolk posited a triune trauma outcome based it is defined as an absence of declarative memory, for one
7
on his decades of case studies and experimental findings or more traumatic incidents, due to failure to encode or
but admitted the underlying mechanisms contributing to consolidate long-term memory at, or soon after, the time of

Volume 3 Issue 1 (2025) 4 doi: 10.36922/jcbp.4254