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Cited by 572Psychosomatic Disorders and Their TreatmentsFibromyalgia and Chronic Fatigue Syndrome ResearchPosttraumatic Stress Disorder Research

Psychological Trauma and Functional Somatic Syndromes: A Systematic Review and Meta-Analysis

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Afari, Niloofar, Ahumada, Sandra M., Wright, Lisa Johnson, Mostoufi, Sheeva, Golnari, Golnaz, Reis, Veronica, Cuneo, Jessica Gundy·2014·Psychosomatic Medicine
DOI 10.1097/psy.0000000000000010PMC PMC3894419
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Abstract

OBJECTIVE: This meta-analysis systematically examined the association of reported psychological trauma and posttraumatic stress disorder (PTSD) with functional somatic syndromes including fibromyalgia, chronic widespread pain, chronic fatigue syndrome, temporomandibular disorder, and irritable bowel syndrome. Our goals were to determine the overall effect size of the association and to examine moderators of the relationship. METHODS: Literature searches identified 71 studies with a control or comparison group and examined the association of the syndromes with traumatic events including abuse of a psychological, emotional, sexual, or physical nature sustained during childhood or adulthood, combat exposure, or PTSD. A random-effects model was used to estimate the pooled odds ratio and 95% confidence interval. Planned subgroup analyses and meta-regression examined potential moderators. RESULTS: Individuals who reported exposure to trauma were 2.7 (95% confidence interval = 2.27-3.10) times more likely to have a functional somatic syndrome. This association was robust against both publication bias and the generally low quality of the literature. The magnitude of the association with PTSD was significantly larger than that with sexual or physical abuse. The association of reported trauma with chronic fatigue syndrome was larger than the association with either irritable bowel syndrome or fibromyalgia. Studies using nonvalidated questionnaires or self-report of trauma reported larger associations than did those using validated questionnaires. CONCLUSIONS: Findings are consistent with the hypothesis that traumatic events are associated with an increased prevalence of functional somatic syndromes. The analyses also highlight limitations of the existing literature and emphasize the importance of prospective studies, examining the potential similarities and differences of these conditions, and pursuing hypothesis-driven studies of the mechanisms underlying the link between trauma, PTSD, and functional somatic syndromes.

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  • Early adverse life experiences, negative affectivity, neuroticism, depression, and anxiety have been identified as psychological predisposing conditions for persistent physical symptoms.

    “Early adverse life experiences, negative affectivity, neuroticism, depression, and anxiety have been identified as psycho logical predisposing conditions for persistent physical symptoms”

    From Persistent physical symptoms: definition, genesis, and management (2024) · cites this paper as [65]

    The Introduction (page unavailable) links childhood trauma with functional somatic syndromes and says these conditions are commonly associated with anxiety and depression. It does not identify negative affectivity or neuroticism as predisposing conditions, and an association with anxiety or depression does not establish that they precede persistent symptoms. (LLM, conf=0.88)

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  • The fibromyalgia results show a positive and significant association with violence.

    “However, the fibromyalgia results show a positive and significant association, in line with the original hypothesis and previous studies [19, 29, 30].”

    From The association between violence against women and chronic pain: a systematic review and meta-analysis (2024) · cites this paper as [30]

    The Results (Subgroup Analyses for Type of Trauma and FSS; page unavailable) report an association between reported trauma and fibromyalgia, while the Overall Meta-Analysis reports a positive association for functional somatic syndromes collectively. The paper distinguishes trauma types, including abuse and PTSD, but the passages do not establish a separate statistically significant fibromyalgia–violence association. (LLM, conf=0.82)

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  • The findings are consistent with reports that women experiencing violence have adverse health outcomes and with other systematic reviews associating pain symptoms or syndromes with some type of adult or childhood abuse.

    “Our findings are consistent with reports that women experiencing violence have adverse health outcomes [18–21], and with other systematic reviews that associate some pain symptoms/syndromes with some type of adult or childhood abuse [30–34].”

    From The association between violence against women and chronic pain: a systematic review and meta-analysis (2024) · cites this paper as [30]

  • The operant conditioning model of chronic pain proposes that other people's responses to pain behavior contribute to chronic pain and disability.

    “the operant conditioning model of chronic pain posits that others’ responses to pain behavior play a role in chronic pain and disability 2, 105.”

    From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [2]

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Research works printed but not linked: 6

  1. [4]Amital D Fostick L Polliack ML Segev S Zohar J Rubinow A Amital H Posttraumatic stress disorder, tenderness, and fibromyalgia syndrome: are they different entities? J Psychosom Res 2006 61 663 9 17084145
  2. [25]Gerson A Fox D Fibromyalgia revisited: Axis II factors in MMPI and historial data in compensation claimants American Journal of Forensic Psychology 2003 21 21 5
  3. [38]Kang HK Natelson BH Mahan CM Lee KY Murphy FM Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: a population-based survey of 30,000 veterans Am J Epidemiol 2003 157 141 8 12522021
  4. [45]Muhvić-Urek M Uhac I Vuksić-Mihaljević Z Leović D Blecić N Kovac Z Oral health status in war veterans with post-traumatic stress disorder J Oral Rehabil 2007 34 1 8 17207072
  5. [50]Ross CA Long Term Effects of Child Sexual Abuse: Childhood Sexual Abuse and Psychosomatic Symptoms in Irritable Bowel Syndrome Journal of Child Sexual Abuse 2005 14 27 38 15914403
  6. [59]Sundbom E Henningsson M Holm U Söderbergh S Evengård B Possible influence of defenses and negative life events on patients with chronic fatigue syndrome: a pilot study Psychol Rep 2002 91 963 78 12530752

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Authors
Afari, N., Ahumada, S. M., Wright, L. J., Mostoufi, S., Golnari, G., Reis, V., & Cuneo, J. G.
Affiliations
  • University of California San Diego (US)
  • University of Minnesota (US)
  • VA Northern California Health Care System (US)
  • VA San Diego Healthcare System (US)
  • VA Palo Alto Health Care System (US)
Corresponding author
Afari, Niloofar
ORCID
Afari, Niloofar
Venue
Psychosomatic Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2014-01
Volume
76
Issue
1
Pages
2-11
ISSN
0033-3174 (ISSN-L)
DOI
10.1097/psy.0000000000000010
PMC
PMC3894419
OpenAlex
W2004733995
Cited by
572
References
116
Citations by year
2026: 41 · 2025: 53 · 2024: 62 · 2023: 47 · 2022: 53 · 2021: 58 · 2020: 49 · 2019: 43 · 2018: 43 · 2017: 40 · 2016: 36 · 2015: 35 · 2014: 9 · 2012: 2
FWCI
3.64
Type
journal article
Language
en
Open access
Locations
  • Psychosomatic Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institute of Mental Health (2T32MH15755-34, T32MH015755)
  • National Institute of Nursing Research (R03NR012841)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01DK082325)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
psychological trauma, post-traumatic stress disorder, functional somatic syndromes, fibromyalgia, chronic widespread pain, chronic fatigue syndrome, temporomandibular disorders, irritable bowel syndrome, childhood abuse, combat exposure, sexual abuse, physical abuse, emotional abuse
MeSH terms
Humans, Neuromuscular Diseases, Stress Disorders, Post-Traumatic, Temporomandibular Joint Disorders, Irritable Bowel Syndrome, Chronic Pain

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