Somatic symptom burden is associated with anger internalization measured as reduced reactive aggression

Difficulties in emotion regulation, including anger suppression, have been linked to more severe somatic symptoms in patients with chronic pain. Because this evidence comes mainly from clinical samples, it remains unclear whether such difficulties precede or follow symptom chronification. We examined whether somatic symptom burden is associated with reduced reactive aggression, as a behavioral marker of anger internalization. Forty-four healthy adults (25 females) completed the Taylor Aggression Paradigm, a competitive reaction-time task in which they selected noise intensity delivered to a fictitious opponent across three provocation conditions (low, moderate, and high). somatic symptom burden was evaluated using the Somatic Symptom Scale-8 (SSS-8) and Patient Health Questionnaire-15 (PHQ-15). Alexithymia was evaluated using the Toronto Alexithymia Scale (TAS-20). Participants with higher somatic symptom burden selected lower noise intensities overall, with significant differences at low and moderate provocation levels. Difficulty identifying feelings tended to be positively associated with somatic symptom burden, whereas alexithymia was not associated with reactive aggression. These findings suggest that inhibited retaliation, previously reported in chronic pain patients, may already be present in healthy individuals with higher somatic symptom burden, potentially aiding early identification of chronic pain risk. Difficulty distinguishing emotions from bodily sensations may also contribute to somatic symptom expression.