Page 9 - JCBP-3-1

Journal of Clinical and

Basic Psychosomatics

REVIEW ARTICLE
Comorbidity between somatic symptom

disorder and dissociative amnesia is best
explained by trauma-amnesia-pain theory

Jennifer B. Johnston*

Department of Behavioral Science, Western New Mexico University, Silver City, New Mexico,
United States of America

Abstract

Dissociative amnesia is comorbid with somatic symptom disorder (SSD), yet this link
is not well-understood. Clinical studies indicate that childhood trauma, especially
sexual abuse and emotional abuse, are primary causal factors in the etiology of SSD.
This paper provides evidence that dissociative amnesia is an explanatory variable
between childhood trauma and SSD. As many or more trauma victims develop
amnesia and somatic complaints as those who develop post-traumatic stress
disorder (PTSD), but SSD and dissociative amnesia receive much less attention. This
leaves clinicians and patients without effective intervention and sometimes causes
misdiagnosis. PTSD’s neuroendocrinological cascade, from peritraumatic perception
to psychobehavioral endpoints is well-mapped, and it informs an opponent-process
for dissociative amnesia and SSD, allowing a better conceptualization of a primary
*Corresponding author:
Jennifer B. Johnston cause of SSD – trauma. The novel trauma-amnesia-pain (T-A-P) neuroendocrinological
(johnstonj@wnmu.edu) map presented here is a mirror process of the tonic immobility-PTSD pathway
Citation: Johnston JB. Comorbidity initiated by the hypothalamus-pituitary-adrenal (HPA) axis. Dissociative amnesia-
between somatic symptom disorder SSD develops through the same HPA axis pathway, with PTSD essentially being a
and dissociative amnesia is best downregulated cortisol response and T-A-P an upregulated cortisol response.
explained by trauma-amnesia-pain
theory. J Clin Basic Psychosom. Copious evidence has now emerged from neurological, physiological, and clinical
2025;3(1):3-21. studies of animals and people regarding the role controllable stress/trauma plays
doi: 10.36922/jcbp.4254 in the etiology of both amnesia and analgesia. T-A-P also validates the decision to
Received: July 16, 2024 consolidate pain disorder, somatization disorder, and functional somatic disorder
under one nosological category in the Diagnostic and Statistical Manual of Mental
Revised: September 26, 2024
Disorders, Fifth Edition, Text Revision. The implications of this theory are important
Accepted: November 6, 2024 for both prevention and effective intervention with trauma-induced SSD.
Published Online: November 22,
2024
Keywords: Traumatic amnesia; Pain disorder; Functional somatic disorders; Somatic
Copyright: © 2024 Author(s). symptom disorder; Cortisol; Peritraumatic perception
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution
License, permitting distribution,
and reproduction in any medium, 1. Introduction
provided the original work is
properly cited. Three primary causes of somatic symptom disorder (SSD) are reported in the Diagnostic
Publisher’s Note: AccScience and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).
Publishing remains neutral with The first is biological and the last two are environmental: increased pain sensitivity,
regard to jurisdictional claims in
published maps and institutional caregiver/social-cultural conditioning and reinforcement of the sick role and somatic-
1
affiliations. only expressions of suffering, and early traumatic experiences. This paper focuses on

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