A door slams and your heart is racing before you have had a thought. Sleep is light, or will not come. Your stomach has been off for weeks. These are everyday pictures of reactions that official sources list as common after a traumatic event.
This article sets out what the VA's National Center for PTSD, the National Institute of Mental Health (NIMH) and published research say about trauma and the body. It leaves out popular claims that those sources do not support, and it says where the research stops.
Why does the body react after a traumatic event?
Because fear is physical as well as emotional. NIMH says it is natural to feel afraid during and after a traumatic situation. It describes fear as part of the body's fight-or-flight response, "which helps us avoid or respond to potential danger."
The VA's National Center for PTSD lists physical reactions among the common responses to trauma:
- "Stomach upset and trouble eating"
- "Trouble sleeping and feeling very tired"
- "Pounding heart, rapid breathing, feeling shaky"
- "Sweating"
The same VA page says: "Such stress reactions are normal and not weakness. Most people recover in time." After a traumatic event covers what is common in the first weeks.
You may have read explanations that name particular brain structures or stress hormones, or that say trauma is stored in the body. None of the official sources reviewed for this article explains trauma that way in plain language, so this article does not repeat those claims.
Why do you feel on edge or startle so easily?
Feeling keyed up is a recognized reaction to trauma, though the sources describe it more than they explain it. The VA's list of common reactions includes "Feeling jumpy and getting startled easily at sudden noises" and "Feeling on guard and alert all the time."
When reactions like these continue, clinicians group them under arousal and reactivity, one of the symptom groups of post-traumatic stress disorder (PTSD). NIMH's list for that group includes "Being easily startled" and "Feeling tense, on guard, or on edge." NIMH adds: "Arousal symptoms are often constant. They can lead to feelings of stress and anger and may interfere with parts of daily life, such as sleeping, eating, or concentrating."
Startling easily does not mean you have PTSD. The VA says only a mental health provider can diagnose it. PTSD symptoms: what clinicians look for explains the full picture, and the practice also has a guide to anxiety and trauma.
How does trauma affect sleep?
Trouble sleeping is on the VA's list of common reactions, and in PTSD it is close to universal. The VA says: "Almost everyone who has PTSD also has trouble sleeping. Both insomnia and nightmares are PTSD symptoms."
The VA gives two reasons that fit with feeling on edge: "People with PTSD may avoid going to sleep," and "It is difficult to have restful sleep when you feel the need to be always alert or are startled easily by noise." It also notes that sleep apnea is common among people with PTSD, particularly in veterans.
For insomnia, the VA names a specific treatment: "The best treatment for insomnia is Cognitive Behavioral Therapy for Insomnia, or CBT-I." On using alcohol or drugs to get to sleep, it warns: "Over time, drug and alcohol use can also have negative effects on sleep quality and on overall health and functioning." Trauma, alcohol and substance use has more.
Nightmares are covered in Flashbacks, nightmares and triggers.
Is there a link between trauma and chronic pain?
The two often occur together, and the VA is careful about what that means. It says chronic pain affects 1 in every 5 Americans, and: "It is also common for people who have PTSD to have chronic pain."
The VA describes the relationship with hedges worth keeping: "If you have chronic pain and PTSD, it can make each condition worse. This is not always the case." It adds that if the same traumatic event led to both, "the pain may be a reminder of the trauma, increasing PTSD symptoms."
None of this says that trauma is the cause of a particular pain. This article cannot tell you what is behind yours, and a doctor should look at pain in its own right. The VA's advice is practical: "it is important that your health care providers know that you are experiencing both so they can coordinate your care." It also reports: "Research now shows some evidence that trauma-focused talk therapy alone may improve pain-related functioning."
Does PTSD raise the risk of physical illness?
Research has found a link, and it has not shown cause. A VA review written for clinicians states: "Exposure to psychological trauma is known to negatively affect physical health, especially when such trauma leads to PTSD." It reports a meta-analysis of 20 observational studies in which people with PTSD had an increased risk of any cardiovascular disease, including heart attack and stroke, and a meta-analysis of 9 studies in which people with PTSD had a 50% greater risk of having diabetes than people without PTSD. The review notes that most of those studies relied on self-reported diabetes.
A 2013 meta-analysis in the American Heart Journal pooled six studies, with 402,274 participants, that followed people who had no coronary heart disease at the start. The pooled hazard ratio for PTSD and later coronary heart disease was 1.55 (95% confidence interval 1.34 to 1.79) before adjustment for depression, and 1.27 (1.08 to 1.49) across the five estimates that adjusted for depression. A hazard ratio above 1 means a higher rate in the group with PTSD.
Hold these numbers carefully. The studies were observational, and most of the participants were military veterans. They show an association. They do not show that PTSD causes heart disease, and they describe groups, so they cannot tell you what will happen to your own health. The authors wrote that PTSD "may be a modifiable risk factor" and called for research on whether treating it changes heart risk.
When should you see a doctor?
Right away for some symptoms, and soon for anything new. The American Heart Association says to call 911 if you have chest discomfort, which can last more than a few minutes or go away and then return, or shortness of breath, which can happen with or without chest discomfort. The National Heart, Lung, and Blood Institute says: "Any time you think you might be having a heart attack, don't ignore it. Call 9-1-1 for emergency medical care, even if you are not sure that you're having a heart attack." Do not decide for yourself that chest pain or trouble breathing is a stress reaction. That is a conclusion for a clinician to reach after a medical evaluation, and having had stress reactions before does not rule out a medical problem now.
For any other physical symptom that is new or is not going away, see a doctor. No symptom should be put down to trauma without being checked. The VA's general advice applies too: "Talk to your doctor about your trauma and your PTSD symptoms. That way they can take care of your health better."
If what you are carrying feels unbearable, or you are thinking about harming yourself, call or text 988, or call 911 in an emergency.
Where does therapy fit?
Therapy addresses the trauma reactions; it does not replace medical care. The VA says to talk to a doctor or mental health care provider if your symptoms last longer than a month, are very upsetting, or disrupt your daily life.
The evidence for treatments is uneven. The 2023 guideline from the Departments of Veterans Affairs and Defense (VA/DoD) and the American Psychological Association's 2025 guideline give their strongest recommendations to specific trauma-focused psychotherapies for PTSD, such as cognitive processing therapy and prolonged exposure. Psychodynamic therapy has been studied much less for PTSD. Both guidelines list it as having insufficient evidence to recommend for or against, which reflects too little research and is not a finding that it fails. Types of trauma therapy sets out the research.
Dr. Rabin offers trauma therapy in Brookline and by secure telehealth to clients anywhere in Massachusetts. Her approach is psychodynamic, attachment-based, trauma-informed and mindfulness-based, guided by safety, pacing and the therapeutic relationship. She is a psychologist and does not prescribe. You can request a free consultation of about 15 minutes through the contact page.
Keep reading
Sources
- National Institute of Mental Health, Post-Traumatic Stress Disorder, NIH Publication No. 23-MH-8124 (revised 2023)
- VA National Center for PTSD, Common Reactions After Trauma (last updated September 25, 2026)
- VA National Center for PTSD, PTSD Basics (page header: Last Updated October 2026)
- VA National Center for PTSD, Sleep Problems and PTSD (last updated September 25, 2026)
- VA National Center for PTSD, Chronic Pain and PTSD (last updated September 25, 2026)
- VA National Center for PTSD, Trauma, PTSD, and Physical Health (last updated August 25, 2025)
- Edmondson D, Kronish IM, Shaffer JA et al., Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review, full text. Am Heart J (2013)
- VA National Center for PTSD, Coping with Traumatic Stress Reactions (last updated March 26, 2025)
- U.S. Department of Veterans Affairs and Department of Defense, VA/DoD Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder (June 2023)
- American Psychological Association, Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults (2025)
- American Heart Association, Warning Signs of a Heart Attack (last reviewed December 12, 2024)
- National Heart, Lung, and Blood Institute, Heart Attack: Symptoms (last updated March 24, 2022)
Last reviewed October 2026. This guide is general information, not medical advice or a diagnosis. If you are in crisis or thinking about harming yourself, call or text 988, or call 911 in an emergency.
