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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 maltreatment.

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 Practice?

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.

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