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Psychological Trauma and Functional Somatic Syndromes: A Systematic Review and Meta-Analysis

Afari, Niloofar PhD; Ahumada, Sandra M. BA; Wright, Lisa Johnson PhD; Mostoufi, Sheeva MS; Golnari, Golnaz MD; Reis, Veronica PhD; Cuneo, Jessica Gundy PhD

doi: 10.1097/PSY.0000000000000010
Systematic Review/Meta-Analysis

Objective This meta-analysis systematically examined the association of reported psychological trauma and posttraumatic stress disorder (PTSD) with functional somatic syndromes including fibromyalgia, chronic widespread pain, chronic fatigue syndrome, temporomandibular disorder, and irritable bowel syndrome. Our goals were to determine the overall effect size of the association and to examine moderators of the relationship.

Methods Literature searches identified 71 studies with a control or comparison group and examined the association of the syndromes with traumatic events including abuse of a psychological, emotional, sexual, or physical nature sustained during childhood or adulthood, combat exposure, or PTSD. A random-effects model was used to estimate the pooled odds ratio and 95% confidence interval. Planned subgroup analyses and meta-regression examined potential moderators.

Results Individuals who reported exposure to trauma were 2.7 (95% confidence interval = 2.27–3.10) times more likely to have a functional somatic syndrome. This association was robust against both publication bias and the generally low quality of the literature. The magnitude of the association with PTSD was significantly larger than that with sexual or physical abuse. The association of reported trauma with chronic fatigue syndrome was larger than the association with either irritable bowel syndrome or fibromyalgia. Studies using nonvalidated questionnaires or self-report of trauma reported larger associations than did those using validated questionnaires.

Conclusions Findings are consistent with the hypothesis that traumatic events are associated with an increased prevalence of functional somatic syndromes. The analyses also highlight limitations of the existing literature and emphasize the importance of prospective studies, examining the potential similarities and differences of these conditions, and pursuing hypothesis-driven studies of the mechanisms underlying the link between trauma, PTSD, and functional somatic syndromes.

From the VA Center of Excellence for Stress and Mental Health (N.A., S.M.), San Diego, California; VA San Diego Healthcare System (N.A., S.M., J.G.C.), San Diego, California; Department of Psychiatry (N.A., G.G.) University of California, San Diego, San Diego, California; Institute of Child Development (S.M.A.) University of Minnesota, Minneapolis, Minnesota; VA Northern California Health Care System (L.J.W.), Oakland, California; and VA Palo Alto Healthcare System (V.R.), Palo Alto, California.

Address correspondence and reprint requests to Niloofar Afari, PhD, Department of Psychiatry, 9500 Gilman Dr, La Jolla, CA 92093-0737. E-mail:

Received for publication February 8, 2013; revision received September 4, 2013.

Copyright © 2014 by American Psychosomatic Society
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