National Center for
Post-Traumatic Stress Disorder,
Department of Veterans Affairs
PTSD and Physical Health
A National Center for PTSD Fact Sheet
By Kay Jankowsi, Ph.D.
Exposure to traumatic events, such as military combat, physical and
sexual abuse, and natural disaster, has been found to be related to poor
physical health. Posttraumatic Stress Disorder (PTSD) also is related to
health problems. The following fact sheet provides information on: the
relationship between trauma, PTSD, and physical health; specific health
problems associated with PTSD; health risk behaviors and PTSD; mechanisms
that help explain how PTSD and physical health could be related; and a
clinical agenda to address PTSD and health.
Before addressing these topics, it is first necessary to provide some
basic information about the different ways that physical health has been
measured in existing research studies. The most common way is for people
to report about their own health conditions or symptoms, or to provide
their perceptions of their overall physical health. Self-report measures
of health can be valid indicators of actual illness, but should be
interpreted with caution because they may be influenced by psychological
as well. The most reliable measure of physical health is one that does not
rely on self-report, but instead assesses illness through physician
diagnosed medical disorder or by laboratory tests.
Is Trauma Related to Physical Health?
A considerable amount of research has accumulated that has found
negative effects of trauma on physical health. Relationships between
self-report of physical health and military trauma, sexual assault,
childhood abuse, and motor vehicle accidents are most clear. When health
status is measured by physician diagnosis, associations are not as
consistent for both military trauma and sexual assault in adulthood, but a
probable association is suggested for survivors of natural disaster. Two
recent studies found that reports of abuse and neglect during childhood
were related to increased risk of physician diagnosed disorders, including
cancer, ischemic heart disease, and chronic lung disease. There is also a
likely relationship between utilization of medical services for physical
health problems and trauma. In addition, health care costs have been found
to be higher among women who report a history of abuse or neglect during
childhood as compared to women who report no history of child
What Is the Relationship between
Physical Health and PTSD?
There is a growing body of literature that finds a link between PTSD
and physical health. Some studies have found that PTSD explains the
association between exposure to trauma and poor physical health. In other
words, trauma may lead to poor health outcomes through PTSD. When health
problems are measured by self-report, there is a clear association with
PTSD for veterans and active duty personnel, civilian men and women,
firefighters, and adolescents alike. Those who endorse PTSD are more
likely to have a greater number of physical health problems than those who
do not have PTSD. Similar results are found when physical health is
measured by physician report or by laboratory tests. PTSD also has been
found to be associated with greater medical service utilization for
physical health problems. At present, however, an association between PTSD
and illness via physican diagnosis and medical service utilization has
only been examined in veteran populations. Further research is indicated
to examine PTSD, physical illness, and medical service utilization in both
veteran and other traumatized populations.
It is important to note that at the present time, existing research is
not able to determine conclusively that PTSD causes poor health. Thus,
caution is warranted in making a causal interpretation of what is
presented here. It may be the case that something associated with PTSD is
actually the cause of greater health problems. For example, it could be
that a factor associated with PTSD, such as smoking, is the actual cause
of the increased health problems. This is not likely, however, given that
we know that PTSD is associated with poor physical health even when
behavioral factors such as smoking are controlled.
What Specific Health Problems Are
Related to PTSD?
At this point we do not have a lot of information about what specific
health problems, or bodily systems, are associated with PTSD. Many studies
have not looked at specific health problems, but instead report only
number of health problems overall. Although studies that did examine
specific health problems have been based primarily on self-report, there
is some evidence to indicate PTSD is related to cardiovascular,
gastrointestinal, and musculoskeletal disorders. The one study that
examined physician diagnosed disorders and PTSD in relation to specific
bodily systems also found similar results.
A number of studies have found an association between PTSD and poor
cardiovascular health. These studies found that either self-report of
circulatory disorders or cardiovascular symptoms were associated with PTSD
in veteran populations, civilian men and women, and male firefighters.
Among studies that have examined cardiovascular illness in relation to
PTSD via physician diagnosis or laboratory findings, PTSD has been
consistently associated with greater likelihood of cardiovascular
morbidity. In a recent study, Vietnam veterans were examined in regard to
cardiovascular function by comparing veterans with and without PTSD on
electrocardiogram (ECG) findings. While controlling for risk factors such
as alcohol consumption, weight, current substance abuse, and smoking, in
addition to current medication use, PTSD was found to be associated with
having a nonspecific ECG abnormality, atrioventricular conduction defects,
and infarctions. Caution is warranted in interpreting this study insofar
as the PTSD group included only those veterans with severe PTSD. It is
therefore unknown at this point whether men with less severe PTSD would
show the same ECG abnormalities. In addition, there have been no studies
of cardiovascular morbidity and PTSD in women.
Other bodily systems that have been shown to be associated with PTSD
include the gastrointestinal and musculoskeletal systems. Studies using
self-report and physician diagnosis have found PTSD related to illness in
these systems, but neither has been as extensively researched in relation
to PTSD as the cardiovascular system. The majority of the available
studies have been with veterans, but a similar finding was found among
civilian young men and women for GI symptoms, and among male firefighters
for musculoskeletal symptoms. Additional research is needed to learn more
about these and other bodily systems that may be related to PTSD.
How is PTSD Related to Physical Health?
PTSD may promote poor health through a complex interaction between
biological and psychological mechanisms. Study of these mechanisms is in
progress at the National Center for PTSD and at other laboratories around
the world. Current thinking is that the experience of trauma brings about
neurochemical changes in the brain. These changes may have biological, as
well as psychological and behavioral effects, on health. Biologically,
there may be a vulnerability to hypertension and atherosclerotic heart
disease that would explain in part the association with cardiovascular
disorders. Research also shows that there may be abnormalities in thyroid
and other hormone functions, in addition to increased susceptability to
infections and immunologic disorders, associated with PTSD.
The psychological and behavioral effects of PTSD on health may be
accounted for in part by comorbid depressive and anxiety disorders. Many
people with PTSD also experience depressive disorders or other anxiety
disorders. Depressed individuals report more physical symptoms and use
more medical treatment than do nondepressed individuals. Depression also
has been linked to cardiovascular disease in previously health populations
and to additional illness and mortality among patients with serious
medical illness. PTSD also may be related to poor health through symptoms
of comorbid anxiety or panic. The evidence linking anxiety to
cardiovascular morbidity and mortality is quite strong, but the mechanisms
are largely unknown.
Hostility, or anger, is another possible mediator of the relationship
between PTSD and physical health. It is commonly associated with PTSD and
decades of research on the health risks associated with the Type A
behavior pattern have isolated hostility as a crucial factor in
cardiovascular disease. PTSD and poor health also may be mediated in part
by behavioral risk factors for disease such as smoking, substance abuse,
diet, and lack of exercise.
Little is known about how coping and social support relate to health in
PTSD, but it is likely that both play important roles. Further research is
needed to better understand these potential protective factors.
What Is the Agenda for Clinical
An agenda for clinical practice is to increase collaboration with
primary and specialty medical care professionals in order to better
address this relationship between PTSD and health problems. Greater
awareness is needed among medical personnel of the potential harmful
effects of trauma and PTSD on health. Increased attention should be paid
to the role of screening for PTSD in medical settings. Studies of patients
seeking physical health care show that many have been exposed to trauma
and experience post-traumatic stress, but have not received appropriate
mental health care. Efforts to integrate PTSD treatment services with
medical care services may be warranted.