The association of interpersonal trauma with somatic symptom severity in a primary care population with chronic pain: exploring the role of gender and the mental health sequelae of trauma

J Psychosom Res. 2014 Sep;77(3):196-204. doi: 10.1016/j.jpsychores.2014.07.011. Epub 2014 Jul 21.


Objective: Female trauma survivors develop somatic symptoms more frequently than males. We propose a model for somatic symptom development among trauma survivors, focusing on gender.

Methods: Among 597 urban primary care patients with chronic pain, we examined the association between somatic symptom severity and three interpersonal trauma types: 1) sexual trauma (ST), 2) intimate partner violence (IPV), and 3) childhood trauma history (≥3 adverse childhood experiences (3+ACE)). We developed a structural equation model in which PTSD, depression, and substance abuse were evaluated as potential mediators of the path between trauma exposure and somatic symptom severity, and explored the role of gender in this model.

Results: 350 (59%) respondents were female; the mean age was 47. Women reported significantly more somatic symptoms than men, although somatic symptoms were increased among all interpersonal trauma survivors. In models in which the potential intervening variables are considered in aggregate, we did not find a signficant interaction between gender and trauma on somatic symptom severity, with the exception of 3+ACEs. A structural equation model showed depression and substance abuse, for men, and depression, for women, were associated with somatic symptom severity. PTSD was not associated with somatic symptom severity. Paths from trauma exposures to mental health sequelae were stronger for men.

Conclusions: Women have more severe somatic symptoms. With the exception of 3+ACEs, the association between trauma and somatic symptoms is amplified in both genders. Structural equation models showed the pathways differed by gender in function and strength of association.

Keywords: Adult; Depression; Pain; Post-traumatic; Psychosomatic medicine; Stress disorders; Substance-related disorders.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Chronic Pain / psychology*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Interpersonal Relations*
  • Male
  • Massachusetts / epidemiology
  • Middle Aged
  • Primary Health Care / statistics & numerical data*
  • Psychophysiologic Disorders / epidemiology
  • Psychophysiologic Disorders / etiology*
  • Severity of Illness Index
  • Sex Distribution
  • Sex Factors
  • Stress Disorders, Post-Traumatic / epidemiology
  • Stress Disorders, Post-Traumatic / etiology*
  • Survivors / psychology
  • Survivors / statistics & numerical data
  • Violence / psychology*