When Your Body Keeps the Score: Understanding Somatic Symptoms of Relational Trauma

EMOTIONAL REGULATION & NERVOUS SYSTEM • April 13, 2026

LAST UPDATED: APRIL 2026

The Body That Won’t Be Quiet

She’s standing at the bathroom mirror at 5:47 a.m., rolling her jaw open and shut, trying to coax some give out of muscles that have been clenched all night. Her bite guard sits on the counter, warped from the force. Her dentist says she’s grinding through enamel. Her internist says the chest tightness is “just stress.” Her gastroenterologist says the stomach pain is functional — meaning they can’t find a structural cause — and hands her a pamphlet on the low-FODMAP diet.

She’s a senior vice president. She runs a team of forty. She doesn’t miss deadlines, doesn’t cancel meetings, doesn’t cry in the office. But her body — her body is doing all the things her voice won’t. It’s clenching, tightening, seizing, aching. It’s keeping a record she hasn’t agreed to read.

If you recognize this woman — if you are this woman — you’re not imagining things, and you’re not “just stressed.” What I see consistently in my clinical work is that the body becomes the first and most honest narrator of relational trauma. Long before a woman can name what happened in her childhood, her body is already telling the story through hypervigilance, through chronic pain, through a nervous system that won’t stand down.

This post is about what happens when trauma doesn’t live only in your memory — it lives in your muscles, your gut, your clenched jaw, your shallow breath. And it’s about what it takes to start listening.

What Are Somatic Symptoms of Trauma?

The word “somatic” comes from the Greek soma, meaning body. Somatic symptoms of trauma are the physical manifestations of psychological wounds — the body’s way of expressing what the mind hasn’t fully processed or what the relational environment made it unsafe to express verbally. These aren’t imagined symptoms. They aren’t weakness. They’re the architecture of survival.

In my work with clients, I’ve found that somatic symptoms are often the first sign that complex trauma is at play — particularly for driven women who’ve spent years intellectualizing their experience and bypassing their body’s signals. The body doesn’t lie. It doesn’t perform. It simply reports.

Common somatic symptoms of relational trauma include:

• Chronic jaw clenching or TMJ pain (unsaid words, swallowed anger)
• Chest tightness or the feeling of a weight on the sternum (compressed grief)
• Gastrointestinal distress — IBS, nausea, stomach “dropping” (gut-brain axis dysregulation)
• Chronic neck and shoulder tension (bracing, hypervigilance)
• Migraines and tension headaches
• Unexplained fatigue and immune suppression
• Shallow, restricted breathing
• Numbness or tingling in extremities (dissociative shutdown)
• Chronic pelvic pain or sexual pain disorders
• Skin conditions — eczema, hives, psoriasis flares tied to emotional stress

These symptoms don’t mean you’re fragile. They mean your body has been working overtime to protect you — and it’s exhausted.

The Neurobiology: How Trauma Lives in the Body

To understand why trauma produces physical symptoms, you need to understand what happens inside the nervous system when a child grows up in an environment that isn’t safe — and how that wiring persists into adulthood.

Stephen Porges, PhD, neuroscientist and Distinguished University Scientist at Indiana University, who developed polyvagal theory, has shown that the vagus nerve — the longest cranial nerve in the body, running from the brainstem to the abdomen — is the central highway of trauma’s physical expression. When a person experiences chronic relational threat (a parent’s rage, a caregiver’s emotional withdrawal, the unpredictability of living with an addicted or narcissistic parent), the vagus nerve shifts the body into a defensive state. Muscles brace. Digestion slows or seizes. Breathing becomes shallow. The heart rate either spikes or drops. The body is preparing for an attack that, for women who grew up in relationally traumatic homes, never fully came — and never fully stopped threatening to come.

Bessel van der Kolk, MD, psychiatrist and trauma researcher at Boston University, author of The Body Keeps the Score, has spent decades documenting how trauma literally reshapes the brain and body. His neuroimaging research demonstrates that traumatized individuals show reduced activity in the medial prefrontal cortex (the brain region responsible for body awareness and self-regulation) and heightened activity in the amygdala (the brain’s threat detection center). This means that trauma survivors are simultaneously hyper-alert to danger and disconnected from their own body’s signals — a cruel neurological paradox that shows up as a woman who can detect the faintest shift in her boss’s mood but can’t tell you whether she’s hungry.

Pat Ogden, PhD, founder of the Sensorimotor Psychotherapy Institute and pioneer in somatic psychology, describes how trauma gets encoded not just in memory but in procedural patterns — the body’s habitual postures, movements, and muscular tensions. A child who learned to make herself small around an unpredictable parent carries that contraction into her adult body: the pulled-in shoulders, the shallow chest breathing, the locked jaw. These aren’t personality traits. They’re survival strategies that became structural.

What polyvagal theory makes clear is that these somatic symptoms aren’t a malfunction. They’re your nervous system doing exactly what it was designed to do — protect you. The problem is that the protection system was calibrated in childhood, and it hasn’t been updated to match your current reality. Your body is still responding to the emotional climate of a home you left decades ago.

How Somatic Symptoms Show Up in Driven Women

Here’s what makes somatic symptoms particularly insidious for driven, ambitious women: the same qualities that make them exceptional at their work — discipline, endurance, the ability to override discomfort — also make them exceptional at ignoring their body’s signals.

In my work with clients, I see a specific pattern. The woman who runs a department, leads a surgical team, or manages a portfolio worth hundreds of millions of dollars often has a remarkably high pain tolerance — not because she’s genetically gifted, but because she learned as a child that her body’s needs were inconvenient, that expressing pain was dangerous, that the only safe option was to keep going. This is the high-functioning trauma survivor at her most visible: impressive on the outside, quietly disintegrating on the inside.

Consider Nadia.

Nadia is forty, a CFO at a biotech company, and she hasn’t slept through the night in three years. She wakes at 2 a.m. with her heart pounding, sheets damp, jaw aching from clenching. By 5 a.m. she’s at her desk, reviewing financials, because at least the numbers make sense. Her gastroenterologist has diagnosed IBS. Her cardiologist has cleared her heart. Her GP has suggested Lexapro. No one has asked about her childhood — about the father whose temper turned the dinner table into a minefield, the mother who smiled through it and told Nadia everything was fine.

Nadia’s body is doing exactly what it learned to do at that dinner table: brace for impact, swallow the truth, keep performing. The IBS isn’t random. The insomnia isn’t a scheduling problem. The jaw pain isn’t a dental issue. They’re the physical transcript of a childhood spent in chronic hypervigilance, and they’ve followed her into every boardroom, every quarterly review, every relationship where she can’t quite let down her guard.

What I see consistently is that driven women don’t just experience somatic symptoms — they manage them with the same relentless efficiency they bring to everything else. They see the specialist. They adjust the diet. They buy the supplement, the mouth guard, the weighted blanket. They treat each symptom as a discrete problem to solve, never connecting the dots between the migraine, the gut issues, the insomnia, and the childhood emotional neglect that wired the whole system.

The Body as Messenger: What Your Symptoms Are Telling You

There’s a profound shift that happens in therapy when a woman stops treating her body as a problem to fix and starts treating it as a messenger to hear. This is one of the most important reframes in somatic trauma work: your symptoms aren’t your enemy. They’re your body’s attempt to communicate something that doesn’t have words yet.

In relational trauma, the body often becomes the repository for everything the child couldn’t say, couldn’t feel, couldn’t express. The grief that wasn’t allowed. The rage that wasn’t safe. The need that was met with ridicule or silence. These emotions don’t disappear. They get compressed into the body — into the tight throat, the churning stomach, the aching lower back, the numbness that settles like fog.

What I’ve observed in my clinical work is that each somatic pattern often carries a specific emotional signature. The clenched jaw frequently correlates with words that were never safe to speak — the woman who learned early that speaking up meant punishment or withdrawal of love. The chest tightness often maps to compressed grief — years of losses that were never acknowledged, never mourned. The gut distress frequently connects to a chronic sense of threat — the body’s oldest alarm system, the enteric nervous system (sometimes called the “second brain”), registering danger even when the conscious mind says, “You’re fine.”

This isn’t metaphorical. The gut contains over 100 million neurons and produces approximately 95% of the body’s serotonin. When the nervous system is chronically dysregulated, the gut-brain axis — the bidirectional communication pathway between the central nervous system and the enteric nervous system — becomes a primary site of somatic expression. Your “gut feeling” isn’t just a figure of speech. It’s neurobiology.

Learning to listen to these signals — rather than overriding, medicating, or intellectualizing them — is often the beginning of real trauma recovery. Not because the body has all the answers, but because it holds the questions that the mind has been too afraid to ask.

Both/And: Your Symptoms Are Real and They’re Also a Story

One of the most important frameworks I hold in my clinical work is the both/and — the refusal to collapse complex experiences into simple binaries. And nowhere is this more critical than with somatic symptoms of trauma.

Here’s the both/and: Your physical symptoms are real, legitimate, medical experiences that deserve proper evaluation and treatment — AND they may also be your body’s way of telling a story about what happened to you relationally. These two things don’t cancel each other out. They coexist.

This is where so many driven women get stuck. The medical system often forces a false binary: either your symptoms have an organic cause (in which case they’re “real”) or they don’t (in which case the implicit — and sometimes explicit — message is that they’re “in your head”). This binary is not only clinically wrong, it’s a reenactment of the original relational wound for many women who grew up having their reality denied.

Consider Kira.

Kira is thirty-five, an emergency medicine physician, and she’s spent the last eighteen months trying to figure out why her hands go numb during shifts. Not during codes, not during the high-acuity moments — during the quiet ones. When she’s charting alone. When the department is still. The neurologist found nothing. The rheumatologist found nothing. She’s started to wonder if she’s developing conversion disorder, and the irony isn’t lost on her: she’s a doctor who diagnoses somatic presentations in her patients and can’t make sense of her own.

In our work together, what emerged was this: the numbness in Kira’s hands tracks almost perfectly to moments of interpersonal stillness — the absence of external demand. Growing up with a mother who had dissociative episodes, Kira learned that stillness wasn’t peace — it was the precursor to collapse. Her mother would go quiet, go blank, go somewhere Kira couldn’t reach her. So Kira’s body learned: when things get quiet, something bad is about to happen. Brace. Numb. Disconnect from the hands that couldn’t reach her mother, that couldn’t fix what was wrong.

The both/and for Kira: her numbness is a real neurological event (a vasomotor response driven by autonomic nervous system activation) AND it’s a relational story — her body replaying the helplessness of a child who couldn’t make her mother come back. Both things are true. Both need attention. The numbness doesn’t need to be “solved” — it needs to be understood.

This is the kind of nuanced work that body-based trauma therapy can hold. It doesn’t pathologize the symptom. It doesn’t dismiss it. It gets curious about it. What is this symptom protecting? What is it remembering? What does it need now that it didn’t get then?

For driven women in particular, the both/and is often a radical reframe. You can be a competent, brilliant, effective person AND have a body that’s carrying decades of unprocessed relational pain. These aren’t contradictions. They’re the full picture of a woman whose external achievements and internal experience have been running on parallel tracks — and the body is the place where those tracks finally converge.

The Systemic Lens: How Medicine Dismisses Women’s Somatic Complaints

We can’t talk about somatic symptoms of trauma without talking about the systemic context in which those symptoms are evaluated — and too often, dismissed.

The medical system has a well-documented history of minimizing, psychologizing, and undertreating women’s physical complaints. Research published in the New England Journal of Medicine has shown that women presenting to emergency departments with chest pain wait significantly longer to be evaluated than men with identical presentations. Women with chronic pain conditions receive fewer diagnostic workups and more psychiatric referrals. Women’s pain is more likely to be attributed to “anxiety” or “emotional factors” — a modern iteration of the centuries-old tendency to attribute women’s physical suffering to hysteria (a word that literally derives from the Greek hystera, meaning uterus).

For driven women with somatic symptoms of relational trauma, this systemic dismissal creates a devastating feedback loop. She presents with real, distressing physical symptoms. The medical system either can’t find a cause (leading to the implicit message that her symptoms aren’t real) or attributes them to stress (which she hears as “this is your fault for not managing better”). She internalizes the dismissal — because it perfectly mirrors the relational environment she grew up in, where her experience was minimized, her needs were inconvenient, and the message was always: you’re too much, or you’re making this up.

Then she does what she’s always done: she stops asking for help. She manages the symptoms alone. She adds another specialist to the rotation, buys another supplement, adjusts another variable in her already-optimized life. And the underlying wound — the relational trauma that’s expressing itself through her body — remains untouched.

The systemic lens also requires us to name the intersection of gender, race, and somatic dismissal. Women of color, particularly Black women, face even greater barriers to having their physical symptoms taken seriously. Research has documented that Black patients’ pain is systematically undertreated, and that Black women in particular face the compounded burden of gendered and racialized medical dismissal. When we talk about somatic symptoms of trauma, we have to acknowledge that the very system tasked with evaluating those symptoms is often replicating the dynamics of invalidation that caused them in the first place.

This isn’t about blaming individual clinicians. It’s about recognizing that the systems we inhabit carry their own biases, and those biases have real consequences for women whose bodies are trying to tell a story that the medical framework isn’t designed to hear.

Somatic Healing: What It Looks Like to Come Home to Your Body

If trauma lives in the body — and the research is unequivocal that it does — then healing must also involve the body. This doesn’t mean that talk therapy isn’t valuable. It is. But as Pat Ogden, PhD, founder of the Sensorimotor Psychotherapy Institute, has argued for decades, cognitive processing alone is often insufficient for resolving trauma that has become encoded in the body’s postures, movement patterns, and autonomic responses.

Here’s what somatic healing approaches look like in practice:

Somatic Experiencing (SE). Developed by Peter Levine, PhD, somatic experiencing works with the body’s incomplete survival responses. In relational trauma, the body often initiated a fight, flight, or freeze response that was never completed — because completing it wasn’t safe. SE helps the body discharge that trapped survival energy through gentle, titrated attention to physical sensations. It’s not about reliving the trauma. It’s about allowing the body to finish what it started.

Sensorimotor Psychotherapy. Developed by Pat Ogden, PhD, this approach integrates body awareness with cognitive and emotional processing. It works with the procedural patterns — the habitual physical postures and tensions — that trauma has created. A woman who learned to collapse her chest and restrict her breath to be invisible around a volatile parent can, through sensorimotor work, begin to explore what it feels like to take up space, to breathe fully, to stand with her weight evenly distributed. These aren’t metaphors. They’re concrete, embodied experiences that rewire the nervous system from the bottom up.

Trauma-sensitive yoga. Research led by Bessel van der Kolk, MD, at the Trauma Center at JRI has demonstrated that trauma-sensitive yoga — a modified practice that emphasizes choice, interoception, and present-moment body awareness — can be as effective as conventional talk therapy for reducing PTSD symptoms. The mechanism isn’t flexibility or fitness. It’s the restoration of the interoceptive connection — helping traumatized individuals feel their body from the inside again, safely and on their own terms.

EMDR (Eye Movement Desensitization and Reprocessing). While EMDR is often categorized as a cognitive approach, it works through bilateral stimulation that appears to engage the body’s processing systems. Many of my clients report that during EMDR sessions, they experience spontaneous somatic releases — a loosening in the throat, a warming in the chest, a release of tension in the jaw — that correlate with shifts in how traumatic material is stored and experienced.

Breathwork and vagal toning. Because the vagus nerve is the primary conduit of trauma’s somatic expression, approaches that directly stimulate vagal tone — extended exhale breathing, humming, cold water exposure, specific grounding techniques — can help shift the nervous system out of chronic defensive states. These aren’t quick fixes. They’re daily practices that, over time, teach the body that the threat is over.

The therapeutic relationship itself. Perhaps the most important somatic healing tool is one that doesn’t look somatic at all: a safe, attuned, consistent relational connection with a therapist who can co-regulate the client’s nervous system. Stephen Porges, PhD, has emphasized that the human nervous system is designed to be regulated through connection — through what he calls the social engagement system. For women whose earliest attachment relationships were sources of threat rather than safety, the experience of being with another person who is calm, present, and attuned is itself a corrective somatic experience. The body learns, session by session, that connection doesn’t have to mean danger.

What I tell my clients is this: coming home to your body isn’t a single dramatic moment. It’s not a breakthrough. It’s a practice — slow, imperfect, sometimes frustrating, often tender. It’s noticing that your jaw is clenched and gently releasing it instead of powering through. It’s recognizing the chest tightness before the board meeting and taking three breaths instead of a Tums. It’s allowing yourself to feel the grief that’s been sitting in your throat for thirty years — not all at once, but in doses your nervous system can integrate.

It’s learning that your body isn’t the enemy. It never was. It’s the most loyal ally you’ve ever had — the one that kept you alive when the people who were supposed to protect you couldn’t or wouldn’t. And now, finally, it’s asking you to listen.

If you’re a driven, ambitious woman reading this and recognizing your own body in these descriptions — the clenching, the bracing, the symptoms no specialist can fully explain — I want you to know something: you’re not broken. You’re not “too stressed.” You’re not making it up. Your body is doing exactly what it was designed to do in the environment it adapted to. And with the right support — somatic, relational, trauma-informed — it can learn a new way. Not by overriding the signals, but by finally, gently, bravely, hearing them.

You don’t have to carry this alone. And you don’t have to figure it out by yourself. Reaching out for support is one of the bravest things a driven woman can do — because it means admitting that the body you’ve been pushing through deserves to be listened to, not just managed.

Related Reading

van der Kolk, Bessel. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Viking, 2014.

Porges, Stephen W. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York: W.W. Norton, 2011.

Ogden, Pat, Kekuni Minton, and Clare Pain. Trauma and the Body: A Sensorimotor Approach to Psychotherapy. New York: W.W. Norton, 2006.

Levine, Peter A. Waking the Tiger: Healing Trauma. Berkeley: North Atlantic Books, 1997.

Herman, Judith L. Trauma and Recovery: The Aftermath of Violence — From Domestic Abuse to Political Terror. New York: Basic Books, 1992; revised 2015.

Medical Disclaimer

Medical Disclaimer