Physical Manifestations of PTSD: Beyond Psychological Symptoms

Somatic Symptoms Linked to PTSD

No pathognomonic physical signs exist, but chronic hyperarousal and HPA-axis dysregulation produce measurable effects:

System	Manifestations	Mechanism
Cardiovascular	Tachycardia, hypertension, ↑ HRV (low), chest pain	Sympathetic overdrive, endothelial dysfunction
Neurological	Headaches, migraines, dizziness, paresthesias	Central sensitization, trigeminal activation
Musculoskeletal	Chronic pain, tension, TMJ, fibromyalgia overlap	Guarding, cortisol-catabolic, inflammation
GI	IBS, nausea, GERD, appetite dysregulation	Brain-gut axis, vagal tone alteration
Immune/Endocrine	↑ CRP, IL-6; cortisol blunting or elevation; metabolic syndrome	Allostatic load, glucocorticoid resistance
Dermatologic	Eczema, psoriasis flares, hives, hair loss	Neuroimmune, stress-induced inflammation
Sleep	Insomnia, nightmares, OSA comorbidity	Hyperarousal, REM fragmentation

Clinical Implications

• Screen for PTSD in chronic pain, functional somatic syndromes, refractory hypertension.
• Integrated care (mental health + primary care) improves outcomes.
• Somatic therapies (yoga, breathwork, somatic experiencing) complement trauma processing.

Physical symptoms are real—not "imagined"—and reflect embodied trauma.