Gina Scaramella, executive director of the Boston Area Rape Crisis Center, said she once knew a young woman who was in so much emotional pain that she put a false cast on her arm so that people would ask her what was wrong.
Survivors who do seek treatment can search in vain if their ailments are difficult to diagnose, and they often are. Such patients often suffer from nonspecific chronic pain conditions such as endometriosis, fibromyalgia, gastrointestinal problems, frequent headaches and joint pain.
Howard, a dancer/choreographer from Vancouver, was diagnosed with IBS, a notoriously indeterminate gastrointestinal problem, during her senior year of college after years of stomach pains, nausea and acid reflux.
She continues to experience pain sometimes because of her abuse history, which included forced oral sex.
"That was the most traumatic of the abuse that I experienced," Howard said. "That's why I responded with such a strong sense of nausea."
Ringel pointed out that the study did not show that a history of abuse leads to IBS, or any other chronic pain problem. Nor did they suggest that people with IBS necessarily have a history of abuse.
Rather, Ringel and Drossman were able to provide quantifiable data on how trauma can have long-term effects on the brain, amplifying pain sensations.
During a traumatic experience, the prefrontal cortex, the rational part of the brain, shuts down. Anything the body experiences after that time -- including fear, confusion, feeling out of control and physical pain -- is relayed directly to the emotion processing centers in the brain, creating areas of hypersensitivity. Later, pain can parallel those feelings.
"When triggered… they can't reason themselves out of it," Drossman said. "You get this very primitive emotional reaction that you can't control. And that's exactly what patients tell you: 'I can't control it.'"
And survivors of child abuse are less able to control their pain than other people. Children cannot protect themselves mentally, the way an adult might during a traumatic experience, by trying to calm and distract themselves. In addition, since the abuser is often a relative or friend, a child is more likely to have conflicted feelings toward their abuser and take the guilt and responsibility for the abuse upon themselves. Thus, the effects of abuse or other trauma are stronger and more lasting.
Though their sample size was small, Ringel and Drossman believe their study is representative and could help tip off doctors and therapists that a person who reports unusually intense amounts of pain for chronic problems may have a history of abuse. If so, including therapy in the treatment options could be an effective way to ease both the mental and physical pain the person experiences.
"We looked at the brain response before and after treatment," Ringel said. "These alterations in brain function are reversible with treatment. … This is where research needs to go."
Howard never told anyone close to her about her abuse until she told her husband one year after they were married. She also began therapy for her abuse history.
"I think [the pain] did get a bit better, it stopped being this constant thing," said Howard, who will now share in cupcakes and goldfish crackers with her two daughters. "I really enjoy eating now, taking it to a place of being really healthy. I feel good about that."