How Does the Body Keep the Score? Understanding the Physical Manifestations of Trauma

By, Waller Thompson, EdD, LPC, SEP, NARM

Trauma is a complex and deeply impactful experience that can affect individuals in profound ways. Many think of trauma as stemming from a range of events, from natural disasters and accidents to abuse and violence. However, it’s important to recognize that even less intense experiences, especially those that happen repeatedly or while we were younger, can also be encoded as traumatic. While many people associate trauma primarily with emotional and psychological distress, it’s essential to recognize its lasting imprint on the physical body. This phenomenon is succinctly captured by trauma expert Bessel Van der Kolk’s now famous phrase, “the body keeps the score.”

In this introductory post, we will begin to explore why and how both the body and mind retain the memory of trauma and how this impacts healing and recovery. 

The Mind-Body Connection

In the Western world, we have come to view mental and physical health as separate domains which have been treated as such by our medical and psychiatric systems. However, as traditional cultures have never forgotten, new advancements in traumatology and psychobiology now demonstrate that mind and body are intrinsically linked. Accordingly, the most effective, cutting edge mental health treatments in trauma recovery use body-based interventions.

When a person experiences an event that is overwhelming, their brain and nervous system responds automatically in a way that leads to the greatest chance of survival. When danger or life threat is percevied, the body will automatically kick into one of the three primary survival responses of Fight, Flight or Freeze. Most people have a “preferred” nervous system reaction that becomes a learned pattern based on prior experiences. These responses involve the release of stress hormones like cortisol and adrenaline to support the body to react swiftly, either by confronting the threat, getting away from it or by becoming very still. Problems also arise when something prevents the nervous system from completing its natural, survival-based response, such as being held down, held against your will, or being immobilized. These automatic responses often don’t allow time for logical thought, decision making or even to notice our emotions. The experience can become trapped in the body, resulting in mental or physical symptoms or both. Instead, our body takes over and protects us. While these automatic responses are essential for survival, without adequate support and time to process and integrate the experience afterwards, our bodies might not realize the experience is in the past. 

There are filtering systems within the nervous system that help your brain to autonomically decide whether a situation is safe or not, and tell your body how to respond accordingly. Trauma experts, such as van der Kolk, Porges and Levine describe how changes to a person’s filtering systems in the nervous system result in difficulties in distinguishing between relevant and irrelevant stimuli that lead to overwhelm in a survivor’s capacity to cope. This causes a breakdown in the normal self-regulating systems and results in nervous system dysregulation.

Many of us are familiar with the classic PTSD mental and emotional symptoms of disturbing memories, emotions or flashbacks, or avoidance of situations that are familiar or similar to when the trauma happened. Beyond challenging emotions and upsetting thoughts, this stuck trauma will show up in some of the following ways, as well. 

Many of our mind-body disruptions begin at the level of the nervous system, particularly our autonomic nervous system (ANS). The ANS is the branch of the nervous system that controls involuntary bodily functions like heart rate, digestion, and breathing. When trauma disrupts the balance of the ANS, the resulting dysregulation can lead to bodily symptoms such as rapid heartbeat, digestive issues, breathing difficulties or disturbed sleep. The Central Nervous System (our brain and spinal cord) can also be impacted, especially when there is trauma during early childhood (before the ANS is mature) or when there have been head or spinal injuries or near death experiences. 

Muscle tension can also be a result of stuck fight-or-flight response, where muscles originally tensed up in the face of the traumatic event to prepare us for action. When the mind and body don’t understand that the traumatic event is over, these muscles may remain in a state of tension, which can lead to chronic pain conditions, such as headaches, fibromyalgia, and back pain. Conversely, we might experience muscle weakness, lethargy, spaciness or dissociation when our systems are stuck in a Freeze response. Trauma survivors often remain hypervigilant, constantly on edge and scanning for potential threats as the ANS stays on high alert. This ongoing state of vigilance can contribute to chronic stress, sleep disturbances, and a range of physical health issues.

The Impact of Trauma on Physical Health

Research shows that trauma survivors suffer more illnesses and chronic medical problems. For example, the Adverse Childhood Experience Study (ACES) found that survivors of childhood trauma are many times more likely to use drugs, attempt suicide, and suffer from an eating disorder. Trauma-induced stress can increase the risk of heart disease, hypertension, and other cardiovascular problems. Gastrointestinal problems are also common and can manifest as digestive disorders, including irritable bowel syndrome (IBS) and chronic gastritis. Overall, this prolonged stress from stored trauma can weaken the immune system, making individuals more susceptible to illness.

Recognizing that the body does indeed keep the score is a crucial first step in your healing process. It is difficult, if not unlikely, that just talking about your trauma will provide full relief. When you include somatically based psychotherapy modalities into your healing journey, your nervous system will learn to shift from its chronic state of overwhelm and begin to accurately recognize when safety and well being are present. Several approaches, such as Somatic Experiencing (SE), Neuroaffective Relational Model (NARM), Polyvagal informed therapy, EMDR and Brainspotting, mindfulness skills, trauma-informed yoga and other experiential modalities will provide the mind-body reprocessing that is essential for mental and physical well being. 


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Levine P. A. (2012). In an unspoken voice : how the body releases trauma and restores goodness. Random House Publisher Services. 

Sherin, J., & Nemeroff, C. (2011). Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues In Clinical Neuroscience, 13(3), 263-278. 

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van der Kolk, B. A. (2004). Psychobiology of posttraumatic stress disorder. In J. Panksepp (Ed.), Textbook of biological psychiatry (pp. 319–344). Wiley-Liss.

Van der Kolk, Bessel A. (2014) The body keeps the score : brain, mind, and body in the healing of trauma. New York, New York : Viking.

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