The Body Keeps the Score: Somatic Symptoms of Childhood Emotional Neglect

Therapy Topics • March 19, 2026

LAST UPDATED: APRIL 2026

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(PMID: 9384857) (PMID: 9384857)

Both/And: You Can Honor Your Family and Still Name What Happened

One of the hardest things about healing from a difficult childhood is the pressure — internal and external — to pick a side. Either your parents did their best or they failed you. Either your childhood was “that bad” or you’re being dramatic. In my practice, the women who make the most progress are the ones who stop trying to resolve this tension and learn to hold it instead.

Elena is a startup CEO who grew up in a home that looked enviable from the outside — good schools, family vacations, a mother who volunteered at every event. It took Elena years to name what was missing: emotional attunement. Her achievements were celebrated; her feelings were dismissed. “You have nothing to be upset about” was the family refrain. By the time she reached my office, she’d internalized that message so deeply that she felt guilty for being in therapy at all.

Both/And means Elena can love her parents and still be honest about the ways their limitations shaped her. She can acknowledge that they did their best with what they had and simultaneously acknowledge that their best wasn’t enough in some critical ways. These aren’t contradictions. They’re the full truth of most family stories, and particularly the stories of driven women who learned early that performance was the price of belonging.

The Systemic Lens: Why Childhood Wounds Are Cultural, Not Just Personal

When we talk about childhood wounds, we tend to locate them exclusively within families — this parent failed, that household was dysfunctional. But families don’t operate in isolation. They operate within cultural, economic, and social systems that shape what parenting looks like, what support is available, and what dysfunction is normalized or invisible.

Consider the driven woman who grew up with an emotionally unavailable father. Her father wasn’t emotionally unavailable in a vacuum — he was operating within a cultural framework that told men that providing financially was sufficient, that emotional engagement was women’s work, and that vulnerability was weakness. Her mother, likely overwhelmed and under-supported, may have coped by over-functioning or by placing emotional demands on her daughter that belonged between adults. These aren’t just family patterns. They’re cultural ones.

In my clinical work, naming the systemic dimension of childhood experience serves a critical function: it reduces shame. When a driven woman understands that her family’s dysfunction wasn’t a random aberration but a predictable product of generational trauma, cultural expectations, and structural pressures — including economic stress, immigration, racism, sexism, or the simple absence of mental health resources — she can begin to hold her parents with more complexity and herself with more compassion. The wound is real. It’s also bigger than any one family.

She’d Seen Every Doctor in San Diego

Lauren was forty-three, a family medicine physician in San Diego, and she had spent two years getting thoroughly checked out. Migraines every Sunday. IBS that flared before family gatherings. A jaw so tight her dentist had recommended a third night guard. Every specialist had told her the same thing: nothing structurally wrong. “I’m literally a doctor,” she told me in our first session, “and I don’t know what to do with a body that’s failing me for no reason.” I told her what I tell many of my clients: her body wasn’t failing her. It was trying, very loudly, to tell her something that her mind had learned to manage away a very long time ago. (Name and identifying details changed for confidentiality.)

Dr. Bessel van der Kolk opens The Body Keeps the Score with a simple, devastating observation: “The body keeps the score.” What he means is this: when we experience something too overwhelming to be processed consciously, the experience does not disappear. It is stored in the body — in the muscles, the fascia, the autonomic nervous system, the immune system — and it continues to shape our physiology until it is processed and released.

This is not a metaphor. It is a neurobiological reality.

When a child grows up with emotionally immature parents, they experience a specific form of chronic stress: the stress of emotional non-attunement. Not the acute stress of a single traumatic event — the chronic, low-grade stress of a nervous system that is perpetually slightly activated. Always scanning for the parent’s mood. Always managing the emotional climate. Always suppressing its own authentic responses in order to maintain the connection.

This chronic activation has physiological consequences. The HPA axis — the body’s primary stress-response system — becomes dysregulated. Cortisol levels, which should rise and fall in a predictable daily rhythm, become chronically elevated or chronically suppressed. The autonomic nervous system becomes stuck in a pattern of chronic sympathetic activation (fight or flight) or chronic dorsal vagal shutdown (freeze or collapse).

Over time, this dysregulation produces measurable changes in the body’s regulatory systems. This is the allostatic load of an emotionally neglected childhood. It is real. It is measurable. And it is not your fault.

What Happens to a Nervous System Under Chronic Stress

To understand why emotional neglect produces physical symptoms, you need to understand the autonomic nervous system and its three primary states.

Dr. Stephen Porges’s Polyvagal Theory describes three hierarchical states of the autonomic nervous system, each associated with a different physiological and psychological experience. (PMID: 7652107) (PMID: 7652107)

The Ventral Vagal State (Safety and Connection): When the nervous system is in this state, you feel safe, open, and connected. Your heart rate is regulated. Your digestion functions well. Your facial muscles are relaxed and expressive. You can think clearly, feel your feelings, and engage genuinely with other people. This is the state that emotionally attuned caregiving produces in a child — AND that emotional neglect chronically disrupts.

The Sympathetic State (Mobilization — Fight or Flight): When the nervous system perceives threat, it activates the sympathetic branch. Heart rate increases. Muscles tense. Digestion shuts down. The prefrontal cortex goes partially offline, and the amygdala takes over. This state is adaptive in genuine emergencies. It becomes pathological when it is chronically activated by relational stress that never fully resolves.

The Dorsal Vagal State (Immobilization — Freeze or Collapse): When the threat is overwhelming and the mobilization response is not available or effective, the nervous system collapses into the dorsal vagal state. Heart rate drops. Digestion shuts down. The person feels numb, dissociated, or profoundly fatigued. This is the freeze response — the physiological equivalent of playing dead.

Children who grow up with emotionally immature parents tend to oscillate between the sympathetic and dorsal vagal states, with limited access to the ventral vagal state of genuine safety and connection. Over time, this oscillation becomes the default setting of the nervous system — and it produces the physical symptoms that bring many of my clients to therapy.

Medical Disclaimer

Medical Disclaimer