Trauma Exposure and Health: A Review of Outcomes and Pathways

A growing body of literature has established robust relations between trauma and a variety of adverse physical health outcomes. In both retrospective and prospective research, adults with a history of self-reported or court-substantiated maltreatment report significantly more health concerns than those without maltreatment histories, in both clinical and community samples, whether health problems are self-reported or physician-diagnosed. Two pathways by which poor health outcomes are theorized to occur include the biological pathway, which largely implicates severe stress and subsequent dysregulations in central stress-response systems as the underlying cause of health problems, and the behavioral pathway, which suggests that health risk behaviors are largely responsible for the relations between trauma and health. This article reviews the research evaluating the relations between various types of trauma, particularly physical and sexual abuse in childhood, and three such health outcomes: pain, gastrointestinal disorders, and cardiovascular disease. Evidence to support the biological and behavioral pathways is also reviewed.