Trauma Is Not Just a Memory: The Body's Response and the Dialogue Between Psychology and Osteopathy

Article written in collaboration with @osteopata_dilettamacchi and @ppsycotips 

Introduction

When we talk about trauma, the collective imagination tends to evoke something distant and extraordinary: a war, a natural disaster, or physical violence. Something that is recounted, processed through words, that belongs to the domain of the mind and memory. Yet the neuroscientific and clinical research of the last thirty years has profoundly and irreversibly transformed this vision.

Trauma is not merely a mental experience. It is a physiological response that involves the entire organism — the brain, the nervous system, the muscles, the viscera, and the breath. It is something the body lives, registers, and preserves, often far beyond what the mind is able to remember or name (van der Kolk, 2014). Understanding this somatic dimension of trauma is not a secondary detail: it is the starting point for any clinical approach that truly aims to be effective.

This article explores the neurophysiological nature of trauma, the role of the autonomic nervous system in survival responses, the psychological and physical manifestations that follow, and the possibilities offered by an integrated approach combining psychology and osteopathy. The goal is to restore a unitary vision of the human being — one in which mind and body are never truly separate.

Redefining Trauma: From Event to Response

The Evolution of the Clinical Concept

The history of the concept of trauma is a history of progressive expansion and growing complexity. The first systematic clinical descriptions date back to the late nineteenth century, with Charcot's studies on hysteria and the subsequent work of Janet and Freud, who already intuited the connection between unprocessed experiences and physical symptoms (van der Kolk, 2014). For many decades, however, trauma remained confined to events of exceptional gravity — the shell shock of the First World War, the war neuroses of the second conflict — and its understanding remained fragmented and often stigmatizing.

It was with the introduction of post-traumatic stress disorder (PTSD) in the DSM-III in 1980, and especially with subsequent developments in affective neuroscience and somatic psychology, that the field underwent a true conceptual revolution (American Psychiatric Association, 2022). The question shifted from "what happened?" to "how did the nervous system experience it?".

Trauma as a Subjective Response

Levine (2010) offered one of the most illuminating and clinically useful definitions: trauma is not in the event, but in the organism's response to that event. What matters is not the objective severity of what happened, but whether the nervous system had sufficient resources — internal and external — to move through that experience without being overwhelmed.

This radically shifts the point of observation. A car accident that becomes a source of PTSD for one person may leave no lasting trace in another. A relationship breakdown, repeated emotional devaluation, a prolonged period of intense work-related stress, the loss of an attachment figure — events that apparently do not reach the threshold of "catastrophe" — can leave deep and lasting traces in the nervous system (Porges, 2011).

This understanding has important clinical and ethical implications: it restores legitimacy to experiences that are often minimized, reduces shame and self-blame, and opens the door to therapeutic work that does not ask the person to "justify" their suffering.

Complex Trauma and Relational Trauma

A further broadening of the concept concerns what is known as complex trauma (complex PTSD), recognized in the ICD-11 classification of the World Health Organization (World Health Organization, 2019). Unlike classic PTSD, which typically follows a single traumatic event, complex trauma emerges from repeated, prolonged, and often relational exposure: chronic physical or emotional abuse, neglect, domestic violence, situations of captivity or dependency.

Herman (1992) was among the first to systematically describe this form of trauma, highlighting how its consequences extend far beyond the classic PTSD symptom triad (intrusions, avoidance, hyperarousal), including profound alterations in identity, emotional regulation, and the capacity for relationship. The traces of these experiences — when they occur during early developmental stages — become inscribed in attachment patterns, neurological structures, and the individual's postural and respiratory habits.

The Autonomic Nervous System and Survival Responses

Porges' Polyvagal Theory

To understand how trauma acts on the body, it is essential to understand the functioning of the autonomic nervous system (ANS). The polyvagal theory, developed by Stephen Porges from the 1990s onwards, has provided the most influential and clinically useful neurobiological framework of recent decades (Porges, 2011).

According to this theory, the ANS does not respond to experiences in a simply binary way (activation/deactivation), but through an evolutionary hierarchy of three response systems, each associated with specific neurological structures and specific behavioral and emotional states:

• The ventral vagal system (ventral vagal complex): this is the phylogenetically most recent system, exclusive to mammals. It regulates social response — the capacity to connect with others, to communicate through facial expression and voice, to feel safe in the presence of trustworthy figures. When this system is active, the organism is in a state of regulated calm, capable of learning, curiosity, and intimacy.

• The sympathetic system (sympathetic nervous system): this is the system of mobilization. In the face of a perceived threat, it activates fight or flight responses: increased heart rate, pupil dilation, muscle tension, suppression of digestive functions. It is a powerful and adaptive system, but energetically costly.

• The dorsal vagal system (dorsal vagal complex): this is the evolutionarily oldest system, shared with reptiles. When a threat is perceived as insurmountable — when neither fight nor flight seems possible — it activates an immobilization response (freeze): slowing of metabolism, dissociation, numbness, or collapse.

Neuroception: The Invisible Radar

Porges (2011) introduced the concept of neuroception to describe the process by which the nervous system continuously evaluates the environment in search of signals of safety or danger, below the threshold of consciousness. It is not a conscious perception: it is an automatic and continuous monitoring that occurs before the cortical brain has had time to rationally process the situation.

This explains why traumatic responses often seem "irrational" to those who experience them: the nervous system has detected something that has triggered a defensive response, but the conscious mind cannot always understand why. A tone of voice, a smell, another person's body posture can activate an intense alarm response in someone with a traumatic history, even in the absence of real danger (van der Kolk, 2014).

Post-Traumatic Blocking

The central problem in trauma is not that these responses exist — they are fundamental survival resources, evolutionarily invaluable. The problem arises when the response cycle does not complete itself, and the nervous system remains locked in a state of activation or immobilization long after the threat has passed (Levine, 2010).

Through the study of animal behavior, Levine observed that animals in the wild spontaneously move through a process of completing the response cycle — often through trembling, shaking, deep breathing — that allows the nervous system to "discharge" the accumulated survival energy and return to a state of equilibrium. In human beings, this natural process is often interrupted by shame, dissociation, the need to "keep everything under control," or simply by the impossibility of moving during the traumatic event. The undischarged energy remains trapped in the body, generating the chronic symptoms we recognize as post-traumatic.

The Psychological Manifestations of Trauma

The PTSD Symptom Triad

Post-traumatic stress disorder, in its classic form, is characterized by three main categories of symptoms (American Psychiatric Association, 2022):

1. Intrusive symptoms: flashbacks, nightmares, images or sensations that intrude into consciousness involuntarily, intense physical and emotional reactions to stimuli associated with the traumatic event. It is as if the nervous system relives the experience in the present, losing the distinction between past and present.

2. Avoidance symptoms: active avoidance of thoughts, emotions, places, people, or situations associated with the trauma. Avoidance can progressively extend to increasingly large areas of experience, significantly limiting the person's life.

3. Alterations in mood and cognition: guilt, shame, negative beliefs about oneself or the world ("I am weak," "the world is dangerous," "no one can be trusted"), loss of interest, feeling of detachment from others.

4. Hyperarousal: difficulty concentrating, insomnia, hypervigilance, exaggerated startle responses, irritability.

Complex Trauma and Identity Alterations

In complex trauma, the picture is enriched by dimensions that go far beyond the symptoms of classic PTSD (Herman, 1992; World Health Organization, 2019). People with a history of early relational trauma tend to develop:

• Emotional dysregulation: difficulty tolerating, modulating, and understanding one's own emotions; intense oscillations between states of hyperactivation and hypoactivation

• Identity alterations: a fragmented, unstable, or empty sense of self; difficulty recognizing oneself over time

• Relational alterations: difficulty with trust, insecure or disorganized attachment patterns, tendency toward unstable or avoidant relationships

• Dissociation: sense of unreality, depersonalization, partial amnesia for specific periods or events

The Window of Tolerance

A central concept in clinical work with trauma is the window of tolerance, introduced by Siegel (1999) and extensively developed by Ogden and colleagues (2006). The window of tolerance represents the optimal zone of physiological activation within which the individual is able to process experiences without being overwhelmed.

Within this window, the organism is capable of integrating emotional and cognitive information, of remaining present and in contact with others, of learning. Above it — in the zone of hyperactivation — anxiety, panic, anger, and defensive reactions predominate. Below it — in the zone of hypoactivation — numbness, dissociation, and a sense of emptiness or absence from oneself prevail.

Trauma narrows this window, often significantly. Therapeutic work — both psychological and corporeal — aims to re-expand it, increasing the organism's capacity to stay with experience without being overwhelmed (Ogden et al., 2006).

The Somatic Manifestations of Trauma

The Body as Archive of Trauma

Van der Kolk (2014) systematically and rigorously documented how trauma leaves specific and measurable traces in the body. Through neuroimaging studies, he showed how, during traumatic flashbacks, the brain areas linked to emotions and bodily sensations (amygdala, insula, somatosensory cortex) become activated, while those linked to emotional regulation and language (prefrontal cortex, Broca's area) become deactivated. This explains why trauma is so difficult to process through words alone: during traumatic re-experiencing, the brain literally "loses" access to its higher functions.

But the body is not merely a screen onto which trauma is projected — it is also the place where trauma resides. Chronic muscle tension, altered breathing patterns, visceral dysfunctions, closed and protective posture are not accessory symptoms: they are the physical manifestation of a nervous system that continues to prepare for defense (Levine, 2010).

Specific Somatic Manifestations

The somatic manifestations of trauma are numerous and often not immediately traceable to their traumatic origin:

• Musculoskeletal system: cervical and dorsal rigidity, chronic muscle tension (particularly in the psoas, trapezius, and jaw muscles), paravertebral contractures. Posture tends to become defensive — shoulders raised and forward, chest contracted, neck tense.

• Diaphragm and breathing: the diaphragm is one of the muscles most sensitive to emotional stress. In people with a traumatic history, it is common to find a contracted and poorly mobile diaphragm, generating short, thoracic, shallow breathing. This breathing pattern in turn maintains the nervous system in a state of alert (Ogden et al., 2006).

• Digestive system: the enteric nervous system — often called "the second brain" — is directly influenced by the state of the ANS. Conditions such as irritable bowel syndrome, functional gastritis, and chronic nausea can be somatic manifestations of a chronically alarmed nervous system (Porges, 2011).

• Immune system and pain: research on ACEs (Adverse Childhood Experiences) has documented how early traumatic experiences are associated with a significantly increased risk of chronic illness, autoimmune disorders, and pain sensitization (Felitti et al., 1998). Chronic pain without apparent organic cause is one of the most common presentations of somatized trauma.

• Autonomic system: tachycardia, sweating, hot flashes, goosebumps — sympathetic responses that are triggered in reaction to stimuli associated with trauma.

The Contribution of Osteopathy in Trauma Treatment

The Body as a Gateway to Regulation

Osteopathy is founded on the fundamental principle that structure and function are reciprocally interrelated: every structural alteration has functional consequences, and every functional dysfunction is reflected in structure (Liem & Dobler, 2013). Applied to the field of trauma, this principle opens significant clinical possibilities: by intervening on the body — its tensions, restrictions, postural and respiratory patterns — it becomes possible to directly influence the state of the autonomic nervous system.

This does not mean that osteopathy "cures" trauma in the psychological sense. It means rather that manual work on the body can offer the nervous system a new somatic experience — an experience of release, openness, freer breathing — that progressively helps it exit the state of chronic alarm (Levine, 2010).

Craniosacral Osteopathy and the Nervous System

Among osteopathic approaches, craniosacral technique deserves particular mention in the context of trauma work. Developed by Sutherland and later by Upledger, this technique works with subtle tissue rhythms and with the membranes that surround the central nervous system, with the aim of promoting greater freedom of movement and better nervous system regulation (Liem & Dobler, 2013).

Although research in this field still requires larger controlled studies, clinical evidence suggests that craniosacral work can promote deep states of relaxation and regulation, reducing sympathetic hyperactivation and facilitating access to the ventral vagal state (Porges, 2011).

The Diaphragm as a Junction Between Body and Nervous System

The diaphragm occupies an extraordinary anatomical and functional position: it separates the thorax from the abdomen, and is connected to the vertebral column, pericardium, great vessels, and autonomic nervous system. Its mobility directly influences the quality of breathing, lymphatic and venous circulation, and — through the vagus nerve — the state of the autonomic nervous system (Ogden et al., 2006).

Working on the diaphragm in an osteopathic approach does not simply mean "releasing" a contracted muscle. It means potentially facilitating a cascade of regulatory effects involving the entire organism: deeper breathing activates the parasympathetic system, reduces cortisol, lowers heart rate, and signals to the nervous system that it is possible to relax.

An Integrated Approach: Psychology and Osteopathy Together

Beyond the Mind-Body Dualism

The Cartesian separation between mind and body has profoundly marked Western medicine and psychology for centuries, generating parallel approaches that are often uncommunicative and sometimes in competition with one another. Contemporary research on trauma urges — with growing insistence — the transcendence of this division, recognizing that every psychological experience has a bodily correlate, and that every intervention on the body has effects on the psychological state (van der Kolk, 2014).

This is not a new age intuition: it is neuroscience. Damasio's research (1994) showed how emotions are fundamentally bodily, and how cognition itself depends on somatic feedback. Porges' polyvagal theory (2011) demonstrated how emotional regulation is inseparable from physiological regulation. Van der Kolk's work (2014) showed how approaches that include the body — trauma-sensitive yoga, EMDR, somatic experiencing, manual work — produce measurable neurobiological changes.

The Integrated Working Model

An integrated approach between psychology and osteopathy can act on multiple simultaneous and complementary levels:

• At the psychological level: therapeutic work helps the person make sense of their experience, recognize automatic response patterns, develop internal resources, and expand the window of emotional tolerance through cognitive, relational, and somatic interventions. Approaches such as sensorimotor therapy (Ogden et al., 2006) and somatic experiencing (Levine, 2010) explicitly integrate the bodily dimension into psychotherapeutic work.

• At the osteopathic level: manual work intervenes directly on the body, dissolving deep tensions, freeing the diaphragm, promoting a less defensive posture and freer breathing. This work offers the nervous system somatic experiences of safety and regulation that complement and potentiate the psychological work.

• At the relational level: both the psychotherapeutic and osteopathic relationships offer a relational experience of safety — an attentive, attuned, non-judgmental presence — that is in itself therapeutic for a nervous system that has learned not to trust (Herman, 1992).

The Principle of the Window of Tolerance in Integrated Work

A fundamental element in both approaches is respect for the window of tolerance. Whether in psychotherapy or osteopathy, the principle is the same: the goal is not to "relive" the trauma or to "force" the body to relax, but to work at the edge of the window of tolerance — close enough to the difficult experience to allow processing, far enough from the boundary to avoid triggering an overwhelm response (Ogden et al., 2006).

This requires clinical sensitivity, flexibility, and constant attention to the signals of the person's nervous system — as much in the psychotherapy room as on the osteopathic treatment table.

Conclusions

Trauma is an experience that transforms the nervous system, and through it, the entire body. It is not merely a memory that haunts the mind: it is a physiological response that continues to live in the muscles, the breath, the posture, the skin. Understanding this somatic dimension is not an optional addition to the understanding of trauma: it is at the heart of any clinical approach that genuinely aspires to be effective.

The dialogue between psychology and osteopathy represents one of the most promising frontiers in this field: not because it offers simple solutions to complex problems, but because it recognizes the complexity of the human being and the necessity of working on multiple levels simultaneously. Mind and body were never truly separate. And in the healing from trauma, as in life, they always work together.

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