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REVIEW ARTICLE

Comorbidity between somatic symptom disorder and dissociative amnesia is best explained by trauma-amnesia-pain theory

Jennifer B. Johnston1*
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1 Department of Behavioral Science, Western New Mexico University, Silver City, New Mexico, United States of America
JCBP, 4254 https://doi.org/10.36922/jcbp.4254
Submitted: 16 July 2024 | Accepted: 6 November 2024 | Published: 22 November 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Dissociative amnesia is comorbid with somatic symptom disorder (SSD), yet this link is not well-understood. Clinical studies indicate that childhood trauma, especially sexual abuse and emotional abuse, are primary causal factors in the etiology of SSD. This paper provides evidence that dissociative amnesia is an explanatory variable between childhood trauma and SSD. As many or more trauma victims develop amnesia and somatic complaints as those who develop post-traumatic stress disorder (PTSD), but SSD and dissociative amnesia receive much less attention. This leaves clinicians and patients without effective intervention and sometimes causes misdiagnosis. PTSD’s neuroendocrinological cascade, from peritraumatic perception to psychobehavioral endpoints is well-mapped, and it informs an opponent-process for dissociative amnesia and SSD, allowing a better conceptualization of a primary cause of SSD – trauma. The novel trauma-amnesia-pain (T-A-P) neuroendocrinological map presented here is a mirror process of the tonic immobility-PTSD pathway initiated by the hypothalamus-pituitary-adrenal (HPA) axis. Dissociative amnesia-SSD develops through the same HPA axis pathway, with PTSD essentially being a downregulated cortisol response and T-A-P an upregulated cortisol response. Copious evidence has now emerged from neurological, physiological, and clinical studies of animals and people regarding the role controllable stress/trauma plays in the etiology of both amnesia and analgesia. T-A-P also validates the decision to consolidate pain disorder, somatization disorder, and functional somatic disorder under one nosological category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. The implications of this theory are important for both prevention and effective intervention with trauma-induced SSD.

Keywords
Traumatic amnesia
Pain disorder
Functional somatic disorders
Somatic symptom disorder
Cortisol
Peritraumatic perception
Funding
None.
Conflict of interest
The author declares no conflicts of interest.
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Journal of Clinical and Basic Psychosomatics, Electronic ISSN: 2972-4414 Print ISSN: 3060-8562, Published by AccScience Publishing
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