Psychological trauma causes both acute and long-term impacts on victims. The acute impact is the mind and body's response immediately after the event and may include confusion, dissociation, panic, agitation, or amnesia. Some people will develop acute stress disorder (ASD), with symptoms recurring for up to four weeks. An estimated 80 percent of those with ASD will go on to develop post-traumatic stress disorder (PTSD), a debilitating anxiety disorder marked by feelings of hyper-arousal, reliving the event, and avoidance. Studies show that trauma causes changes to the brain, but the extent to which trauma affects the body in the long term is still being explored. Several recent studies published by the Department of Health and Human Services regarding the long-term effects of trauma on physical health make interesting links between the two. Something to keep in mind is that the research is usually gathered through self-reporting; that is, individuals report how they perceive their own health. Another thing to consider is that it is still too early to determine if trauma causes poor physical health. Rather, we can see that there is an association and explore its implications for future research and treatment for trauma patients. Physical Response to Trauma Children commonly experience somatic symptoms as a result of trauma. Symptoms may include fainting, stomachache, headaches, muscle aches, and constipation. Adults often seek treatment for non-specific symptoms in children without being aware of any psychological trauma that has occurred. Likewise, adults who experience trauma are prone to developing somatic symptoms. These symptoms result in more frequent doctor visits and missed work than in individuals without PTSD. When the brain perceives a threat, the adrenal glands flood the body with adrenaline and cortisol. This is the body's "fight-or-flight" response. Experts believe that the brain becomes trained over time to maintain its fight-or-flight response and that persistent states of hyper-arousal or dissociation may lead to permanent neurological changes. Cortisol regulates the immune system, blood sugar, and depression, and is thought to be connected to some of the long-term changes that the body undergoes in times of overwhelming stress. Research shows that combat veterans with PTSD have a smaller hippocampus-the region of the brain that controls learning and short-term memory-than those without. Health Risks Adults who experienced childhood trauma are more likely to engage in unhealthy behaviors. These behaviors, though harmful, are often used as tools for coping in the short-term. Common health risks include alcohol or drug abuse, smoking, promiscuity, and obesity. Self-medicating with these behaviors can contribute to undesirable outcomes such as STDs, unwanted pregnancy, and heart and lung disease. Other Risk Factors The impact of trauma on the individual is based on a number of factors. Psychological trauma can result from one traumatic event (acute) or from repeated stress (chronic). Acute trauma may occur from an assault, accident, or natural disaster. Chronic trauma occurs in individuals who are abused over an extended period of time or are exposed to war. Those who experience chronic trauma are more likely to suffer a greater total negative impact due to the reinforcing nature of subsequent traumatic events. Other factors that influence an individual's response to trauma include gender, the severity of the event, the existence of a support system, and early intervention. Researchers also believe that personality or physiological differences may impact the severity of the trauma response. Physical Effects Trauma is associated with many chronic conditions and diseases. These include: \tHeart disease \tLiver disease \tAutoimmune disease \tInterstitial cystitis \tDementia \tHigh blood pressure \tIrritable bowel syndrome \tFibromyalgia\/chronic fatigue syndrome \tOther chronic pain conditions There is clearly an association between chronic conditions and PTSD. One study found that combat veterans with PTSD were two to three times as likely to develop heart disease as those without and were in poorer overall health despite controlling for combat injuries. Higher risk for diseases might be attributed to the presence of secondary health risk factors such as smoking or obesity. However, studies have begun to link some conditions to trauma in the absence of other risk factors. For example, heart disease is more prevalent in survivors of childhood trauma despite controlling for other health risks. Researchers are moving towards determining whether trauma is also linked with premature death. Looking to the Future There is still much to learn about the physical changes that occur in the body as a result of stress. For example, researchers know that the hippocampus is smaller in those who have had PTSD, but do not yet know if this can be reversed through medical or cognitive therapy. Likewise, the mechanism that makes those with PTSD more likely to develop heart disease is not yet known. Researchers are just scratching the tip of the iceberg, and studies being conducted now will hopefully contribute to better trauma responses in the future.