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The body keeps the score. This is not a metaphor — it’s a neurobiological fact. Unprocessed trauma is stored in the body as dysregulated nervous system states, chronic muscular tension, altered interoceptive processing, and dysregulated immune and endocrine function. The chronic fatigue, the persistent pain, the autoimmune conditions, the digestive disorders, the sleep disruptions — these are not random misfortunes. They are the body’s faithful record of experiences that were too overwhelming to be fully processed. In this article, Annie Wright, LMFT, explains the neurobiology of trauma storage in the body, the specific somatic presentations of relational trauma in driven women, and what body-based healing actually looks like.
- The Body That Wouldn’t Stop Talking
- The Neurobiology of Trauma Storage in the Body
- The ACE Study: How Childhood Adversity Becomes Adult Illness
- The Specific Somatic Presentations of Relational Trauma
- The Polyvagal Perspective: Autonomic Dysregulation and Physical Health
- Interoception: The Body’s Internal Reporting System
- Both/And: Your Body Is Not Betraying You — It’s Protecting You
- The Systemic Lens: Medicine’s Failure to Hear the Body’s Story
- Body-Based Healing: What Actually Works
- Frequently Asked Questions
The Body That Wouldn’t Stop Talking
Isabel is a 38-year-old attorney. She came to me not because of a psychological crisis but because her body had stopped cooperating with her life. In the three years since her divorce — a marriage that had been, in her words, “quietly terrible” — she had developed fibromyalgia, irritable bowel syndrome, chronic migraines, and a fatigue so profound that she sometimes couldn’t get out of bed. She had seen seven different specialists. She had received seven different diagnoses and seven different treatment plans. None of them had helped.
“I know something is wrong,” she told me. “I can feel it. But no one can find it. Every test comes back normal. Every doctor tells me it’s stress. And I want to scream at them: I know it’s stress. But what does that mean? What do I do with that?”
What Isabel was experiencing was the body’s faithful record of years of unprocessed relational trauma — the chronic hyperactivation of the stress response system, the dysregulation of the autonomic nervous system, the alterations in immune and endocrine function that are the predictable physiological consequences of sustained psychological threat. Her body wasn’t broken. It was doing exactly what bodies do when they’ve been carrying unprocessed trauma for years: it was talking. Loudly. In the only language it had.
The doctors who told her it was stress were not wrong. They were just not telling her the whole story — not explaining the mechanism through which the psychological experience of sustained threat produces the specific physiological dysregulations she was experiencing, and not pointing her toward the treatments that address the mechanism rather than the symptoms.
The Neurobiology of Trauma Storage in the Body
Somatic trauma storage refers to the ways in which unprocessed traumatic experience is encoded in the body — in the nervous system, the musculoskeletal system, the immune system, and the endocrine system — as dysregulated physiological states that persist after the traumatic experience has ended. Bessel van der Kolk, MD, psychiatrist and trauma researcher, describes this process in The Body Keeps the Score: the brain’s threat response system (the amygdala and the hypothalamic-pituitary-adrenal axis) encodes the traumatic experience as an ongoing threat, maintaining the physiological activation of the stress response even in the absence of current threat. The result is the chronic dysregulation of the autonomic nervous system, the chronic elevation of stress hormones (cortisol, adrenaline), the chronic activation of the inflammatory response, and the chronic dysregulation of the body’s self-regulatory systems — all of which produce the physical symptoms that characterize somatic trauma storage.
In plain terms: Trauma is stored in the body because the brain’s threat response system doesn’t distinguish between past and present. When the traumatic experience is not fully processed, the brain continues to treat it as an ongoing threat — maintaining the physiological activation of the stress response even when the threat is over. The body is not broken. It’s doing exactly what it was designed to do: protecting you from a threat that, from the nervous system’s perspective, has never ended.
Bessel van der Kolk, MD, opens The Body Keeps the Score with a statement that has become one of the most cited in trauma literature: “The body keeps the score.” This is not a metaphor. It’s a description of a specific neurobiological process: the encoding of traumatic experience in the body’s physiological systems in ways that persist long after the traumatic experience has ended.
The specific mechanisms of somatic trauma storage include: the chronic activation of the hypothalamic-pituitary-adrenal (HPA) axis, which produces the chronic elevation of cortisol and other stress hormones that disrupt immune function, sleep, digestion, and metabolic regulation; the chronic activation of the sympathetic nervous system, which produces the chronic muscular tension, cardiovascular activation, and digestive disruption that characterize the hyperarousal state; and the chronic activation of the inflammatory response, which produces the systemic inflammation that underlies many of the chronic conditions associated with trauma history.
Peter Levine, PhD, developer of Somatic Experiencing, adds the concept of incomplete defensive responses — the survival responses (fight, flight, freeze) that were mobilized in response to the original traumatic threat but were not completed, and that remain stored in the body as incomplete action patterns. The chronic muscular tension, the postural patterns, the movement restrictions that characterize somatic trauma storage are, in Levine’s framework, the incomplete defensive responses that were mobilized but never discharged — the energy of the survival response that was never released.
The ACE Study: How Childhood Adversity Becomes Adult Illness
The Adverse Childhood Experiences (ACE) Study is one of the largest investigations of childhood adversity and its long-term health consequences ever conducted. Initiated in 1995 by Vincent Felitti, MD, and Robert Anda, MD, at Kaiser Permanente in San Diego, the ACE Study surveyed over 17,000 adults about their childhood experiences of abuse, neglect, and household dysfunction, and correlated these experiences with their adult health outcomes. The findings were landmark: ACE scores (the number of adverse childhood experiences) were strongly and dose-dependently associated with virtually every major category of adult illness, including heart disease, cancer, chronic lung disease, liver disease, depression, anxiety, substance use disorders, and early death. The ACE Study established, with epidemiological rigor, the biological pathway from childhood adversity to adult illness — demonstrating that the psychological experience of childhood trauma produces specific, measurable physiological changes that increase the risk of virtually every major category of adult disease.
In plain terms: The ACE Study proved what trauma clinicians had long suspected: childhood adversity doesn’t just affect mental health. It affects physical health, in measurable, dose-dependent ways. The more adverse childhood experiences you had, the higher your risk of virtually every major category of adult illness. This is not destiny — it’s a risk factor. And understanding the mechanism is the beginning of addressing it.
Nadine Burke Harris, MD, pediatrician and former Surgeon General of California, describes the ACE Study’s findings and their implications in The Deepest Well: Healing the Long-Term Effects of Childhood Adversity. Burke Harris’s work is particularly important for understanding the specific biological mechanism through which ACEs produce adult illness: the toxic stress response.
The toxic stress response is the chronic, excessive activation of the stress response system in response to adverse childhood experiences — the chronic elevation of cortisol and adrenaline, the chronic activation of the inflammatory response, and the chronic dysregulation of the developing brain’s stress response circuits. Burke Harris describes the specific physiological consequences of the toxic stress response: the disruption of brain development (particularly in the prefrontal cortex, hippocampus, and amygdala), the dysregulation of the immune system, the disruption of metabolic regulation, and the acceleration of cellular aging (measured by telomere shortening).
The ACE Study’s findings have profound implications for how we understand and treat the physical symptoms that driven women present with. The chronic fatigue, the persistent pain, the autoimmune conditions, the digestive disorders — these are not random misfortunes or signs of weakness. They are the predictable physiological consequences of a developing nervous system that was exposed to chronic adversity and that encoded that adversity as an ongoing threat.
RESEARCH EVIDENCE
Peer-reviewed findings that inform this clinical framework:
- Childhood trauma positively associated with adult somatic symptoms (d = 0.30) (PMID: 37097117)
- 92.1% of 655 inpatients with severe PTSD from childhood abuse had high somatic symptoms (PMID: 34635928)
- Pooled prevalence of somatoform symptoms in children/adolescents: 31.0%; somatoform disorders: 3.3% (PMID: 36891195)
- 62% of 6830 patients with major depressive disorder reported childhood trauma history (PMID: 36137507)
- 81.8% emotional neglect, 80.3% emotional abuse, 71.1% sexual abuse in severe PTSD childhood trauma inpatients (PMID: 34635928)
The Specific Somatic Presentations of Relational Trauma
In my clinical work with driven women, the most common somatic presentations of relational trauma include:
Chronic fatigue and exhaustion. The chronic hyperactivation of the stress response system is metabolically expensive. The nervous system that is running in a chronic state of low-grade threat activation — scanning for danger, maintaining muscular tension, keeping the stress hormones elevated — is burning enormous amounts of energy. The result is the profound fatigue that many women with relational trauma history experience — a fatigue that sleep doesn’t resolve, because the nervous system is not actually resting even when the body is.
Chronic pain and fibromyalgia. The chronic muscular tension that accompanies the hyperarousal state produces the widespread musculoskeletal pain that characterizes fibromyalgia and other chronic pain conditions. The central sensitization that develops in response to chronic pain — the lowering of the pain threshold that makes the nervous system increasingly sensitive to pain signals — is both a consequence of chronic stress and a mechanism that amplifies it.
Autoimmune conditions. The chronic activation of the inflammatory response that accompanies the stress response produces the immune dysregulation that underlies autoimmune conditions. Research has consistently found elevated rates of autoimmune conditions — including rheumatoid arthritis, lupus, multiple sclerosis, and thyroid disorders — in individuals with trauma history. The mechanism is the chronic activation of the inflammatory response, which eventually turns on the body’s own tissues.
Digestive disorders. The gut is the second brain — the enteric nervous system that lines the digestive tract contains more neurons than the spinal cord and is in constant bidirectional communication with the brain. The chronic activation of the stress response disrupts the enteric nervous system’s regulation of digestive function, producing the irritable bowel syndrome, inflammatory bowel disease, and other digestive disorders that are strongly associated with trauma history.
Sleep disruption. The hyperarousal state that characterizes trauma-related nervous system dysregulation is incompatible with the deep, restorative sleep that the body needs for repair and regulation. The woman with relational trauma history often lies awake at night with her mind racing, or wakes repeatedly in the night in a state of alarm, or sleeps but doesn’t feel rested — because her nervous system is not actually entering the deep sleep states that restore physiological function.
Chronic tension and postural patterns. The incomplete defensive responses that Peter Levine describes — the survival responses that were mobilized but never completed — are stored in the body as chronic muscular tension and postural patterns. The woman who grew up in a chronically threatening environment often carries the physical posture of that environment: the collapsed chest, the raised shoulders, the contracted core — the body’s preparation for impact that was never released.
The Polyvagal Perspective: Autonomic Dysregulation and Physical Health
Stephen Porges, PhD, neuroscientist and developer of Polyvagal Theory, provides the most comprehensive framework for understanding the relationship between autonomic nervous system dysregulation and physical health. Porges’ Polyvagal Theory identifies three distinct states of the autonomic nervous system — the ventral vagal (safe and social), the sympathetic (mobilized for fight or flight), and the dorsal vagal (immobilized, shutdown) — and describes the specific physiological consequences of chronic activation of the sympathetic and dorsal vagal states.
The ventral vagal state — the state of safety and social engagement — is the state in which the body’s self-regulatory systems function optimally: the immune system is regulated, the digestive system functions normally, the cardiovascular system is regulated, and the nervous system can enter the deep sleep states that restore physiological function. The sympathetic and dorsal vagal states — the states of mobilization and shutdown — are the states in which these self-regulatory systems are disrupted, in service of the survival response.
The woman with relational trauma history who is chronically in the sympathetic or dorsal vagal state — whose nervous system has been calibrated to chronic threat and cannot access the ventral vagal state — is chronically in a physiological state that disrupts her body’s self-regulatory systems. Her immune system is dysregulated. Her digestive system is disrupted. Her cardiovascular system is chronically activated. Her sleep is disrupted. And her nervous system cannot enter the deep sleep states that would allow her body to repair itself.
“The body keeps the score: if the memory of trauma is encoded in the viscera, in heartbreaking and gut-wrenching emotions, in autoimmune disorders and skeletal/muscular problems, and if mind/brain/visceral communication is the royal road to emotion regulation, this demands a radical shift in our therapeutic approaches.”
Bessel van der Kolk, MD, The Body Keeps the Score, Viking, 2014
Interoception: The Body’s Internal Reporting System
Interoception is the perception of the body’s internal state — the awareness of heartbeat, breathing, hunger, thirst, temperature, pain, and the full range of internal bodily sensations that provide the nervous system with information about the body’s current state. Interoception is the foundation of emotional awareness (emotions are, in part, the brain’s interpretation of interoceptive signals) and of the capacity for self-regulation (the ability to notice and respond to the body’s signals). Trauma disrupts interoception in two primary ways: hyperinteroception (the overwhelming flooding of interoceptive signals that characterizes the hyperarousal state) and hypointerception (the disconnection from interoceptive signals that characterizes the shutdown state). Both disruptions impair the capacity for emotional awareness and self-regulation.
In plain terms: Interoception is your body’s internal reporting system — the capacity to notice what’s happening inside you. Trauma disrupts this system in both directions: either you’re overwhelmed by internal sensations (the flooding of the hyperarousal state) or you’re disconnected from them (the numbness of the shutdown state). Either way, you lose access to the body’s intelligence — the signals that tell you what you need, what you feel, and what’s happening in your relationships. Restoring interoception is one of the most important goals of body-based trauma healing.
The disruption of interoception is one of the most clinically significant consequences of relational trauma — and one of the least recognized. The woman with relational trauma history who has learned to disconnect from her body’s signals — who has suppressed her interoceptive awareness in service of the survival strategies that kept her safe in the original traumatic environment — has lost access to the body’s intelligence. She doesn’t know what she feels. She doesn’t know what she needs. She doesn’t know when she’s hungry or tired or in pain — because the interoceptive signals that would tell her these things have been suppressed.
This disconnection from interoception is not just a psychological problem. It’s a physiological one. The body’s self-regulatory systems depend on the nervous system’s capacity to perceive and respond to interoceptive signals. When interoception is disrupted, the body’s self-regulatory systems are disrupted with it — producing the chronic dysregulation that manifests as the physical symptoms of somatic trauma storage.
Both/And: Your Body Is Not Betraying You — It’s Protecting You
The most important both/and in somatic trauma work is this: your body is not betraying you, and the symptoms are real. Both things are true. The chronic fatigue, the persistent pain, the autoimmune conditions, the digestive disorders — these are real physiological processes, not imaginary symptoms or signs of weakness. They are the body’s faithful record of experiences that were too overwhelming to be fully processed. And the body is not betraying you. It’s doing exactly what it was designed to do: protecting you from a threat that, from the nervous system’s perspective, has never ended.
This reframe — from “my body is broken” to “my body is protecting me” — is not just a therapeutic nicety. It’s a neurobiological truth that has important implications for treatment. The body that is treated as broken — as a malfunctioning system that needs to be fixed — will resist treatment, because the symptoms are not malfunctions. They are protective responses. The body that is treated as wise — as a system that is doing exactly what it was designed to do in response to the threat it has experienced — can begin to receive the message that the threat has ended, and can begin to release the protective responses that are no longer needed.
The Systemic Lens: Medicine’s Failure to Hear the Body’s Story
The medical system’s failure to hear the body’s story — to recognize the somatic presentations of trauma as trauma responses rather than as isolated physiological disorders — is one of the most significant barriers to healing for women with relational trauma history. The woman who presents to her physician with chronic fatigue, widespread pain, and digestive disorders is typically offered a series of specialist referrals, a series of diagnoses, and a series of treatments that address the symptoms without addressing the mechanism.
Gabor Maté, MD, in The Myth of Normal, argues that this failure is not accidental — it reflects the fundamental assumptions of the biomedical model, which treats the body as a biological machine and disease as the malfunction of specific biological components, without reference to the psychological and social context in which the body exists. The biomedical model cannot hear the body’s story because it doesn’t have the framework to understand the body as a system that is shaped by and responsive to psychological and social experience.
The trauma-informed medical model — which is slowly emerging in progressive clinical settings — takes a different approach: it asks not “what is wrong with you?” but “what happened to you?” It recognizes the somatic presentations of trauma as trauma responses, addresses the mechanism (the dysregulated nervous system) rather than just the symptoms, and integrates psychological and somatic treatment in a way that the biomedical model cannot.
Body-Based Healing: What Actually Works
Body-based healing for somatic trauma storage requires approaches that work directly with the body — that address the nervous system dysregulation, the incomplete defensive responses, and the interoceptive disruption that are the mechanisms of somatic trauma storage. Talk therapy alone is not sufficient for somatic trauma — because the trauma is stored in the body, not in the narrative, and the body requires body-based interventions to release it.
The most evidence-based body-based approaches include: Somatic Experiencing (SE), developed by Peter Levine, PhD, which works with the incomplete defensive responses stored in the body and facilitates their completion and discharge; Sensorimotor Psychotherapy, developed by Pat Ogden, PhD, which integrates somatic interventions with attachment theory and cognitive processing; EMDR (Eye Movement Desensitization and Reprocessing), developed by Francine Shapiro, PhD, which uses bilateral stimulation to facilitate the processing of traumatic memories and their somatic components; and yoga and mindful movement practices, which have been shown to restore interoceptive awareness and expand the window of tolerance.
Bessel van der Kolk’s research has consistently found that body-based approaches — yoga, EMDR, neurofeedback — are more effective for trauma than talk therapy alone, particularly for the somatic presentations of trauma. This is not a criticism of talk therapy. It’s a recognition that the body needs to be part of the healing process — that the nervous system needs to learn, through direct experience, that the threat has ended and that safety is possible.
If you’re ready to begin the work of healing the body’s record of your relational trauma — to address the mechanism rather than just the symptoms — individual therapy with Annie integrates somatic approaches with attachment-informed relational therapy. Annie is licensed in 9 states and offers both in-person and virtual sessions.
The Window of Tolerance: The Physiological Framework for Body-Based Healing
One of the most clinically useful concepts for understanding the body’s experience of trauma — and for guiding body-based healing — is the window of tolerance, developed by Daniel Siegel, MD, and elaborated by Pat Ogden, PhD, in Sensorimotor Psychotherapy. The window of tolerance describes the optimal zone of nervous system arousal within which the person can process experience without being overwhelmed by it or dissociating from it. Within the window of tolerance, the nervous system is activated enough to engage with experience but not so activated that it is overwhelmed. Outside the window of tolerance — in the hyperarousal zone above it or the hypoarousal zone below it — the nervous system cannot process experience effectively.
For the woman with relational trauma history, the window of tolerance is typically narrow. The nervous system that has been calibrated to chronic threat has a hair-trigger response to perceived danger — moving rapidly into hyperarousal (the flooding, the panic, the overwhelm) or hypoarousal (the numbness, the dissociation, the shutdown) in response to stimuli that would not activate these responses in a person with a wider window of tolerance. The physical symptoms of somatic trauma storage — the chronic fatigue, the persistent pain, the sleep disruption — are, in part, the physiological consequences of this narrow window of tolerance: the body that is chronically oscillating between hyperarousal and hypoarousal, never settling into the regulated state in which its self-regulatory systems function optimally.
Body-based healing expands the window of tolerance. Through the gradual, titrated exposure to somatic experience within the therapeutic relationship — the pendulation between activation and settling that Peter Levine describes in Somatic Experiencing, the tracking of body sensation that Ogden describes in Sensorimotor Psychotherapy, the bilateral stimulation of EMDR — the nervous system learns, through direct experience, that it can move into activation and return to regulation. Each successful return to regulation expands the window of tolerance slightly. Over time, the cumulative effect of these small expansions is a nervous system that can hold more experience without being overwhelmed — a body that can begin to rest, to repair, and to heal.
The practical implications of the window of tolerance framework for body-based healing are significant. Healing does not happen by pushing through the activation — by forcing the nervous system to process more than it can hold. It happens by working at the edge of the window of tolerance — by approaching the activation gently, staying within the capacity to regulate, and returning to the regulated state before moving forward. This is the principle of titration in Somatic Experiencing: the careful, graduated approach to traumatic material that keeps the nervous system within the window of tolerance and allows the processing to happen without retraumatization.
For the driven woman who is accustomed to pushing through — to overriding her body’s signals in service of her goals — this principle can be one of the most challenging aspects of body-based healing. The healing work requires a different relationship with the body than the one she has developed: not override and push through, but attune and respond. Not force the body to comply with the mind’s agenda, but listen to the body’s signals and work within its capacity. This is not weakness. It’s the intelligence of the healing process — the recognition that the body heals at its own pace, and that the pace of healing cannot be accelerated by willpower.
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Q: Can trauma really cause physical illness?
A: Yes. The ACE Study and subsequent research have established, with epidemiological rigor, the biological pathway from childhood adversity to adult illness. The mechanism is the toxic stress response — the chronic, excessive activation of the stress response system that disrupts immune function, metabolic regulation, cardiovascular function, and neurological development. Trauma doesn’t just affect mental health. It affects physical health, in measurable, dose-dependent ways.
Q: If my physical symptoms are trauma-related, does that mean they’re not real?
A: Absolutely not. Trauma-related physical symptoms are real physiological processes — real dysregulations of the nervous system, immune system, and endocrine system that produce real physical symptoms. The fact that they have a psychological origin does not make them less real. It makes them more understandable — and more treatable, because addressing the mechanism (the dysregulated nervous system) can resolve the symptoms in ways that treating the symptoms alone cannot.
Q: What’s the difference between somatic therapy and regular therapy?
A: Regular talk therapy works primarily through the cognitive and narrative processing of experience — the verbal articulation of thoughts, feelings, and memories. Somatic therapy works directly with the body — with the physical sensations, movement patterns, and nervous system states that are the body’s record of experience. Somatic therapy does not replace talk therapy. It complements it by addressing the aspects of trauma that are stored in the body rather than in the narrative, and that require body-based interventions to release.
Q: How does the ACE Study apply to me if I didn’t experience obvious abuse?
A: The ACE Study’s original questionnaire focused on categories of overt abuse, neglect, and household dysfunction — and many women with significant relational trauma histories score lower than they’d expect because the more subtle forms of harm weren’t included. Emotional neglect, chronic emotional unavailability, the stress of living with a depressed or anxious parent, or growing up in an environment of ongoing tension that never resolved — these experiences shape the nervous system in ways that are functionally similar to the ACEs the study measured, even if they don’t appear on the checklist. Your ACE score is a starting point, not a ceiling. If your body is showing the physiological pattern of stored adversity — the chronic fatigue, the pain, the immune disruption — the mechanism is operating regardless of what the checklist says.
Q: Can yoga really help with trauma?
A: Yes, with important caveats. Research by Bessel van der Kolk and colleagues has found that trauma-sensitive yoga — yoga that is specifically adapted for trauma survivors, with an emphasis on interoceptive awareness, choice, and the absence of physical adjustment — is effective for reducing PTSD symptoms, particularly the somatic presentations. Regular yoga, without trauma-sensitive adaptations, can sometimes be activating for trauma survivors. The key is the trauma-sensitive approach — the emphasis on noticing internal experience, making choices, and moving at one’s own pace.
Related Reading
- van der Kolk, Bessel. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking, 2014.
- Burke Harris, Nadine. The Deepest Well: Healing the Long-Term Effects of Childhood Adversity. Houghton Mifflin Harcourt, 2018.
- Levine, Peter A. Waking the Tiger: Healing Trauma. North Atlantic Books, 1997.
- Maté, Gabor. The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture. Avery, 2022.
- Porges, Stephen W. The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe. W. W. Norton & Company, 2017.
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Annie Wright, LMFT
LMFT · Relational Trauma Specialist · W.W. Norton Author
Helping ambitious women finally feel as good as their résumé looks.
Annie Wright is a licensed psychotherapist (LMFT #95719) and trauma-informed executive coach with over 15,000 clinical hours. She works with driven, ambitious women — including Silicon Valley leaders, physicians, and entrepreneurs — in repairing the psychological foundations beneath their impressive lives. Annie is the founder and former CEO of Evergreen Counseling, a multimillion-dollar trauma-informed therapy center she built, scaled, and successfully exited. A regular contributor to Psychology Today, her expert commentary has appeared in Forbes, Business Insider, Inc., NBC, and The Information. She is currently writing her first book with W.W. Norton.
