Somatic Symptoms in High Achievers: When Your Body Keeps the Score at Work

She’s been to the gastroenterologist twice this year. She has a prescription for a daily migraine preventive. She wears a mouthguard every night because she grinds her teeth into a fine, expensive powder. Her rheumatologist suspects an autoimmune condition but the labs keep coming back “borderline.” She’s forty-one, vice president of something, the woman everyone calls when things get hard.

And when I ask her what she thinks is going on in her body, she says—almost always says—some version of this: “I think I’m just stressed. I’ve always been like this. I’m pretty high-strung.”

What she doesn’t say, because she doesn’t have the framework yet, is this: My body has been keeping a record of everything I couldn’t afford to feel, and now it’s presenting the bill.

That’s what this article is about. Not stress management tips. Not another listicle about sleep hygiene. But the deeper truth beneath the migraines and the insomnia and the gut that acts up before every big presentation—what it means when your body is speaking a language your mind has been trained to ignore.

The Body as Archive: How Unprocessed Trauma Lives in Tissue

Most high-achieving women I work with have a complicated relationship with their bodies. The body is something to be optimized, managed, pushed through. A good body performs on demand, shows up early, recovers fast, and doesn’t cause problems at inconvenient times. When the body starts to “act up”—with unexplained symptoms, chronic pain, immune disruptions—the first instinct is often the same one that applies to everything else: find the fix, manage the problem, get back to functioning.

But bodies don’t work the way spreadsheets do. And when the symptoms are rooted in unprocessed trauma, no amount of optimizing or managing gets to the source.

The foundational text here—the one I return to again and again in my practice—is Bessel van der Kolk’s The Body Keeps the Score. His central argument is that traumatic experiences don’t just live in memory. They live in the body itself: in the way the shoulders brace, in the shallow breathing that never quite deepens, in the gut that clenches at the sound of a particular tone of voice. The nervous system, shaped by early experience, continues to respond to the present through the lens of the past. The body, in other words, is an archive.

This is particularly true for high achievers whose overachievement is rooted in trauma. These are women who learned early that the safest thing they could do was keep moving, keep performing, keep the focus outward. Feeling was a luxury they couldn’t afford. Stopping was dangerous. The internal world—the grief, the fear, the rage, the exhaustion—got pressed down, packed away, compartmentalized with extraordinary efficiency. And the body absorbed it all.

Research by Jeronimus, Eilers, and Aan het Rot (2023), published in Psychosomatic Medicine, confirmed what trauma clinicians have long observed: childhood trauma is positively and significantly associated with adult somatic symptoms, both in cross-sectional measurement and in day-to-day ecological momentary assessment. The association holds even after controlling for age, sex, education, and relationship status. The body doesn’t forget, even when the mind has been trained to move on.

The High Achiever’s Body: What “Pushing Through” Actually Does

There is a specific kind of woman who comes through my door with a collection of physical complaints that no specialist has been able to fully explain. She’s usually been told her symptoms are “stress-related” or “probably anxiety.” She may have been gently directed toward better self-care. She’s usually doing all the self-care things—the yoga, the supplements, the sleep tracking app—and still, the body keeps pushing back.

What these women share, almost universally, is a profound fluency in pushing through. They’ve been doing it since they were small. Maybe the household required it: someone had to keep things together, and that someone was them. Maybe the message they received was that feelings were inconvenient, weakness was unacceptable, and the only viable strategy was performance. Maybe they learned that being the strong one was the price of admission in their family system.

Whatever the origin, the pattern is the same: the nervous system learns to override the body’s distress signals. Fatigue becomes fuel for more coffee. Anxiety becomes adrenaline for the next deadline. Sadness gets filed away for a “later” that never quite arrives. The emotional and physiological alarm system is suppressed, again and again, because suppression is what survival required.

This is where the nervous system becomes central to understanding what’s happening. The autonomic nervous system—the same system that governs fight, flight, and freeze—is running continuously beneath the surface of every high-achieving woman’s workday. When that system is chronically activated by unprocessed stress and trauma, it doesn’t just produce anxiety. It produces inflammation. It disrupts the gut-brain axis. It suppresses immune function. It elevates cortisol in ways that damage sleep architecture, accelerate cellular aging, and trigger the kind of diffuse, hard-to-locate physical suffering that makes specialists scratch their heads.

And because these women are so skilled at overriding their internal signals, the physical symptoms often reach a significant level of severity before they’re taken seriously—even by the woman experiencing them. “I can handle it,” is the most dangerous sentence in the high achiever’s vocabulary when it comes to her own body.

The Symptom Map: What the Body Is Trying to Say

Not every physical symptom in a high-achieving woman is rooted in trauma, of course. But in my clinical experience, certain presentations appear with striking frequency in women whose professional performance masks significant unprocessed pain. Recognizing these patterns is often the first step toward understanding what the body is actually communicating.

Chronic migraines and tension headaches. The head that carries all the cognitive load, the jaw that braces against every high-stakes conversation, the neck and shoulders that have been held rigid for years—these are the physical architecture of chronic vigilance. For women with high-functioning anxiety, the nervous system rarely fully discharges. The tension accumulates, often manifesting exactly where it’s been held the longest.

Gastrointestinal distress. The gut has its own nervous system—the enteric nervous system—and it’s in constant dialogue with the brain. When the body is in chronic stress or trauma response, that dialogue becomes disrupted. IBS, GERD, nausea before high-pressure situations, bloating with no clear dietary cause—these are very often the gut-brain axis reflecting unprocessed emotional material. Women who have learned to “stomach” things they never had permission to react to often carry that in the most literal way.

Insomnia and disrupted sleep. The body that never feels safe doesn’t easily surrender to sleep. When the nervous system is stuck in hypervigilance, the brain scans for threat even in the dark. Difficulty falling asleep, waking at 2 or 3 a.m. with a racing mind, non-restorative sleep despite adequate hours—these are the hallmarks of a system that doesn’t know how to register safety, even when the environment is objectively safe.

Jaw clenching and bruxism. The jaw is one of the primary places the body braces when it cannot express what it’s holding. Women who have swallowed enormous amounts of unexpressed anger, grief, or fear—who have smiled through things they desperately wanted to scream about—often hold it in the jaw. The mouthguard doesn’t solve this. It protects the teeth while the underlying tension looks for another outlet.

Autoimmune flares and immune dysregulation. The relationship between chronic stress, trauma, and autoimmune conditions is one of the most robustly documented in psychosomatic medicine. Chronic cortisol dysregulation suppresses and dysregulates immune function in ways that can trigger or exacerbate conditions like lupus, Hashimoto’s, rheumatoid arthritis, and psoriasis. The “borderline” labs, the diagnoses that almost-but-don’t-quite fit, the flares that seem correlated with high-stress periods—these patterns deserve a trauma-informed lens alongside the medical one.

Unexplained chronic pain. Back pain, pelvic pain, fibromyalgia-like presentations, pain that migrates and shifts and resists structural explanation—these are increasingly understood through the lens of central sensitization, in which the nervous system itself becomes hyperresponsive to pain signals. Research by Kearney and Lanius (2022), published in Frontiers in Neuroscience, offers a model of the “brain-body disconnect” in trauma-related conditions, in which dysregulation of somatic sensory processes underlies many of the physical symptoms that trauma survivors report. The pain is real. The origin is in the nervous system’s relationship to threat.

Why High Achievers Are Particularly Vulnerable

There is something specific about the high-achieving woman’s relationship to her body that makes somatic symptoms both more likely and harder to address. It has to do with the same skills that make her so effective in the world.

She is an expert at overriding discomfort. She has a highly developed capacity to dissociate from physical and emotional signals when there’s something important to accomplish. She has almost certainly received enormous positive reinforcement for exactly this pattern—the praise, the promotions, the respect—and she has internalized a story in which her worth is closely linked to her capacity to perform regardless of how she feels. This is the hyper-independence that looks like strength from the outside and feels like isolation and exhaustion from the inside.

The pattern is also deeply connected to perfectionism rooted in childhood trauma. When perfection was the price of safety, and performance was the condition of love, the body learned to be irrelevant. Needs were inconvenient. Symptoms were obstacles. Slowing down was not an option that the internal system could contemplate without significant anxiety. The result is a woman who has spent years—sometimes decades—winning by the rules of a game that was costing her, biologically, a very high price.

Thames and colleagues (2017), published in the Journal of Traumatic Stress, found that cumulative lifetime trauma exposure was significantly associated with somatic symptom severity, with PTSD symptoms and depression partially mediating that relationship. The more adverse experiences a person has absorbed, and the less those experiences have been processed, the more the body bears the weight.

For many high-achieving women, the body’s symptoms arrive at precisely the moment when the external performance is at its peak. The promotion happens, the business launches successfully, and then—almost immediately—the migraines become unbearable, or the autoimmune condition flares, or the insomnia becomes impossible to manage. This is not coincidence. This is the body, finally given a slightly less urgent external task, redirecting its attention to the internal emergency that has been waiting.

I’ve written about this specific dynamic in the context of the post-achievement crash—that disorienting collapse that can follow major accomplishments for trauma-affected high achievers. The body’s physical symptoms are often a central feature of that crash, and understanding them through a trauma lens rather than a “burnout management” lens makes a significant difference in how to approach healing.

The Mind-Body Loop: Why Awareness Alone Doesn’t Fix It

One of the most common things I hear from clients who have read about the mind-body connection is some version of: “Okay, so I know it’s in my body. Now what?” They’ve done the reading. They understand intellectually that their migraines are probably stress-related, that their gut issues are probably connected to their anxiety, that their insomnia has roots in their nervous system’s inability to register safety. And the symptoms continue.

This is because insight, while valuable, doesn’t reach the level where the body holds trauma. The nervous system doesn’t update through understanding. It updates through experience—through felt, embodied, relational experiences that gradually teach it something different from what it has always known.

This is the essential limitation of purely cognitive approaches to trauma-rooted somatic symptoms. You can think your way into understanding the pattern perfectly and still find yourself clenching your jaw in every meeting, waking at 3 a.m. with a racing heart, watching your immune system flare every time work gets particularly intense.

What actually helps is working with the nervous system directly—through approaches that engage the body itself, not just the thinking mind. This is one of the reasons I’m a committed advocate for somatic therapies: approaches that recognize the body as the primary site of trauma storage and make body-based processing central to treatment.

I also want to name something that’s particularly relevant for high achievers: the tendency to approach healing the same way they approach everything else. To research it exhaustively, find the most efficient protocol, execute it with maximum discipline, and be confused and frustrated when the body doesn’t respond on the expected timeline. Healing the body’s trauma response is not a project to be optimized. It is a relationship to be developed—with your nervous system, with your body’s wisdom, with the parts of yourself that never got to be tended to.

If you recognize yourself in the imposter syndrome that says you’re fine, you don’t really have trauma, other people had it worse—I want to gently name that as part of the pattern. The high-achieving woman’s relationship to her own suffering is often characterized by minimization and comparison. The body’s symptoms are harder to argue with than the feelings, which is one reason they often become the entry point into healing.

Somatic Awareness as a Starting Point

Before we can work with what the body is holding, we need to be able to hear what it’s saying. For many high-achieving women, this is genuinely unfamiliar territory. They have been so trained to override body signals that they’ve lost the granularity of the body’s language. They know “tense” and “exhausted” and “in pain,” but the more subtle vocabulary—the difference between a bracing in the chest and a sinking in the stomach, the way fear feels different from excitement before a big presentation—has atrophied from disuse.

Building somatic awareness means, first, learning to slow down enough to notice. This is harder than it sounds for women whose nervous systems have been conditioned to keep moving. The very act of pausing and turning attention inward can feel uncomfortable, even threatening—which is important information in itself.

Some practices that I offer to clients as starting points:

• Body check-ins: Three times a day, pause for sixty seconds and simply note what is present in the body without trying to change it. Where is tension? Where is ease? What is the quality of the breath? This isn’t fixing—it’s listening.
• Orienting: Slowly moving the eyes and head around the environment, registering what is actually present and safe in the current moment. This is a basic nervous system regulation technique drawn from Somatic Experiencing, and it helps interrupt the nervous system’s scanning-for-threat default.
• Naming sensations: Rather than labeling body sensations as good or bad, pleasant or unpleasant, practice describing them with neutral language—tight, warm, buzzing, heavy, expanding. This creates a small amount of distance between sensation and reactivity, which is the beginning of working with rather than against the body.
• Tracking the relationship between stress and symptoms: Start keeping a simple log of when physical symptoms appear or intensify. What was happening emotionally or interpersonally in the hours or days before? What were you suppressing, managing, or pushing through? Patterns almost always emerge.

These are starting points, not treatments. But for a woman who has spent years treating her body as a machine to be managed, even five minutes of genuine curiosity about her own interior landscape can begin to shift something.

The relationship between rest resistance and somatic symptoms is also worth naming directly here. If rest feels like rebellion, or if stillness feels like falling, the body is never getting the recovery time it needs to process and discharge what it has been holding. The somatic symptoms will continue to escalate until rest becomes possible—which is why treating the rest resistance is often the prerequisite for everything else.

Treatment Approaches That Actually Reach the Body

When somatic symptoms in high achievers are rooted in unprocessed trauma, the most effective treatments are those that work at the level of the nervous system and the body, not just the thinking mind.

The approaches I find most useful in my practice, and that the research supports:

EMDR (Eye Movement Desensitization and Reprocessing). EMDR’s bilateral stimulation protocol directly engages the nervous system’s trauma processing capacity in a way that purely talk-based approaches cannot. For women whose somatic symptoms are linked to specific early experiences or recurring trauma patterns, EMDR can create rapid and significant shifts in both psychological and physical symptom burden.

Somatic Experiencing. Developed by Peter Levine, Somatic Experiencing works directly with the body’s incomplete defensive responses—the freeze, the brace, the held breath—helping the nervous system complete cycles of activation and discharge that trauma interrupted. A 2017 randomized controlled trial by Brom and colleagues published in the Journal of Traumatic Stress found significant intervention effects for PTSD symptom severity and depression, with effect sizes in the large range. Winblad, Changaris, and Stein (2018), published in Frontiers in Neuroscience, found that professionals trained in Somatic Experiencing showed significant reductions in both anxiety symptoms and somatic symptoms, alongside improved quality of life—suggesting that the treatment works even with vicarious and occupational trauma.

Internal Family Systems (IFS). For the high-achieving woman who has a very well-developed “manager” part running her life and keeping her body’s signals at bay, IFS offers a way to get to know and gradually unburden the parts that are driving the push-through pattern. This is some of the most meaningful work I do with clients.

Attachment-focused and somatic therapy combinations. Because so many of these somatic patterns were established in early relational contexts, healing happens most durably in a relational therapeutic context—one where the nervous system learns safety through the therapeutic relationship itself, not just through techniques.

Understanding complex PTSD is particularly relevant here, because many of the high-achieving women I work with meet criteria for C-PTSD even if they would never describe themselves as trauma survivors. The chronic, relational, early-onset nature of their adversity is precisely what makes it so physically costly—and so amenable to the right kind of treatment.

If workaholism or self-sabotage patterns are part of the picture alongside somatic symptoms, it’s worth exploring whether the physical symptoms may actually be the body’s attempt to create the rest and deceleration that the will cannot produce. The illness that forces the cancellation. The migraine that makes the presentation impossible. The body, ultimately, always finds a way to make the message heard—and the more we ignore it, the louder it gets.

What Healing Can Look Like

I want to be honest with you: healing the body’s trauma response is not a linear process and it doesn’t happen quickly. I know that is not what the driven, efficient part of you wants to hear. But I also want to tell you what I have watched happen, again and again, when women finally bring their bodies into the healing work rather than treating them as obstacles.

The migraines become less frequent. Then less severe. The gut starts to signal distress earlier—before the crisis—in ways that are navigable rather than overwhelming. Sleep deepens, slowly. The jaw, with real work, begins to unclench. The autoimmune flares begin to correlate more clearly with emotional load and become more predictable, more manageable, more responsive to the right interventions.

More than the specific symptoms, something shifts in the relationship with the body itself. Instead of an adversarial “my body keeps breaking down” narrative, something more like a conversation becomes possible. The body’s signals start to be useful—early warning, real-time feedback, a compass that actually points somewhere meaningful.

This is related to what I explore in the context of ambition as armor—the shift from a body that is being driven through life to one that is being listened to in life is not a small thing. It changes the quality of ambition, the quality of presence, the quality of the work itself. Healing doesn’t make you less effective. In my experience, it makes you far more so—because you’re no longer running on the cortisol of unprocessed survival.

If you recognize yourself in this article—if you’ve been collecting diagnoses without resolution, if the specialists keep saying there’s nothing definitive, if your body keeps acting up at precisely the moments when everything else is going well—I want you to consider that this might not be a medical mystery. It might be a trauma story that hasn’t been fully heard yet.

You deserve care that meets you at that level. Working with a trauma-informed therapist who understands the body’s role in trauma storage is often the most direct path to the physical relief you’ve been seeking in every specialist’s office.

References

• Brom, D., Stokar, Y., Cawi, C., Nuriel-Porat, V., Ziv, Y., Lerner, K., & Ross, G. (2017). Somatic experiencing for posttraumatic stress disorder: A randomized controlled outcome study. Journal of Traumatic Stress, 30(3), 304–312. https://doi.org/10.1002/jts.22189
• Jeronimus, B. F., Eilers, H., & Aan het Rot, M. (2023). Childhood trauma and adult somatic symptoms. Psychosomatic Medicine, 85(5), 408–415. https://doi.org/10.1097/PSY.0000000000001208
• Kearney, B. E., & Lanius, R. A. (2022). The brain-body disconnect: A somatic sensory basis for trauma-related disorders. Frontiers in Neuroscience, 16, 1015749. https://doi.org/10.3389/fnins.2022.1015749
• Thames, A. D., Chin, D., Wyatt, G., Zhang, M., Joseph, N. T., Loeb, T., & Aswad, Y. (2017). Predictors of somatic symptom severity: The role of cumulative history of trauma and adversity in a diverse community sample. Journal of Traumatic Stress, 30(5), 471–480. https://doi.org/10.1037/tra0000334
• van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
• Winblad, N. E., Changaris, M., & Stein, P. K. (2018). Effect of somatic experiencing resiliency-based trauma treatment training on quality of life and psychological health as potential markers of resilience in treating professionals. Frontiers in Neuroscience, 12, 70. https://doi.org/10.3389/fnins.2018.00070

You deserve a life that feels as good as it looks. Let’s work on that together.

Medical Disclaimer