Treating the Psychological Burden of Illness Without Treating the Illness as Psychological

People with autoimmune disease are sometimes told that stress is making them sick. Others encounter the opposite problem: medical care focuses entirely on the body, while the psychological effects of illness, pain, frightening symptoms, and difficult medical experiences receive little attention.

Neither approach is adequate.

Research increasingly demonstrates a relationship between trauma-related mental health conditions and autoimmune disease. That does not mean trauma is the sole cause of autoimmune illness, that symptoms are “all in someone’s head,” or that therapy can cure an immune disorder.

It means mental and physical health should not be treated as separate lanes.

What is the connection between PTSD and autoimmune disease?

One of the largest studies on this question followed more than 100,000 people in Sweden who had been diagnosed with a stress-related disorder, including PTSD, acute stress reaction, or adjustment disorder.

Over an average of 10 years, people with a stress-related diagnosis developed autoimmune diseases at a higher rate than people without one. The association remained even when researchers compared them with their own siblings, which helped account for some of the genetic and early environmental factors shared within families.

Overall, people with stress-related disorders had a 36% higher relative risk of subsequently developing an autoimmune disease. For people with PTSD specifically, the relative risk was 46% higher. PTSD was also associated with more than twice the risk of developing three or more autoimmune diseases.[1]

Those percentages can sound more dramatic than they are. In absolute terms, the rate of autoimmune disease was approximately 9.1 cases per 1,000 person-years among people with a stress-related disorder, compared with 6.0 cases among matched people without one.[1]

That is a meaningful population-level difference, but it does not mean most people with PTSD will develop an autoimmune disease.

The researchers studied 41 autoimmune conditions, including autoimmune thyroid disease, Addison disease, inflammatory bowel disease, lupus, rheumatoid arthritis, and multiple sclerosis. The strength of the association varied by condition. A later systematic review and meta-analysis also found that PTSD was associated with increased risk of several autoimmune diseases, including inflammatory bowel disease, lupus, rheumatoid arthritis, multiple sclerosis, and thyroiditis.[2]

Childhood adversity may also be part of the picture

A 2025 study examined adverse childhood experiences and autoimmune disease in more than 108,000 adult women from two large cohorts. Researchers found a dose-response pattern: as the number of adverse childhood experiences increased, so did the prevalence of autoimmune disease. Sexual abuse and physical and emotional neglect showed some of the most consistent associations.[3]

Symptoms of depression, anxiety, and PTSD appeared to account for approximately one-fourth of the relationship between childhood adversity and later autoimmune disease. Trauma is not the only factor involved. Genetics, immune regulation, stress physiology, health behaviors, environmental exposures, and access to care may all contribute. But mental distress appears to be one meaningful part of the larger picture, not an unrelated problem that should be addressed only after the medical work is finished.

The relationship can move in both directions

Much of this research asks whether trauma and prolonged stress may contribute to later physical illness. But the reverse direction matters just as much. Developing an autoimmune disease can itself be traumatic.

A person may experience frightening symptoms, medical emergencies, invasive procedures, delayed diagnosis, repeated dismissal, loss of physical functioning, or uncertainty about what their body will do next. They may have to make consequential treatment decisions while exhausted, in pain, or unsure whether clinicians believe them. For someone with an earlier trauma history, these experiences can also reactivate familiar states of helplessness, loss of control, or danger.

The result can become a reinforcing cycle. Trauma symptoms make it harder to tolerate uncertainty, trust the body, communicate with medical providers, or stay engaged with care. At the same time, ongoing symptoms and difficult healthcare experiences create new fear, grief, and vigilance.

This is why it is often difficult (and not especially useful) to decide whether the physical problem or the mental health problem came first. Each can affect the other.

What can therapy help with?

Therapy does not replace medical care or treat the underlying autoimmune disease. It addresses the emotional, behavioral, and physiological strain that can make illness even harder to live with and treat.

That may include:

• PTSD symptoms connected to childhood trauma, medical emergencies, or healthcare experiences

• fear of symptoms, procedures, recurrence, disability, or death

• constantly monitoring the body for signs that something is wrong

• avoiding appointments or delaying necessary medical care

• feeling dismissed, disbelieved, or unsafe with healthcare providers

• depression, anxiety, grief, and changes in identity

• difficulty distinguishing necessary caution from trauma-driven fear

• the effects of chronic illness on work, relationships, sexuality, and independence

• cycles of pushing through physical limits and then crashing

• pain-related fear and the ways pain begins to narrow daily life

  
  

In a randomized trial involving people with chronic pain and co-occurring anxiety and depression, an emotion-focused exposure treatment improved emotional symptoms and aspects of pain-related functioning.[4] The treatment did not remove the medical cause of pain. It helped participants respond differently to pain, fear, avoidance, and difficult emotions.

That distinction matters. Reducing the psychological burden of illness is not the same as claiming the illness is psychological. It means treating an important part of the person’s experience that medical care alone may not reach.

Why concurrent care matters

People are often expected to complete one kind of treatment before beginning another: stabilize the medical problem and then address the trauma, or treat the anxiety before continuing to pursue physical answers. Real life is rarely that orderly.

Someone may still be waiting for a diagnosis. Their treatment plan may be changing. They may have partial answers, conflicting medical opinions, or symptoms that fluctuate without warning. Trauma therapy does not have to wait until every physical question has been resolved.

Working on trauma alongside medical care can help someone:

• participate more fully in appointments and treatment decisions

• recognize when a current medical situation is activating an earlier trauma response

• communicate needs and boundaries more clearly

• reduce avoidance without ignoring legitimate physical limits

• make decisions from a more grounded place

• rebuild some trust in the body without pretending the body has always been safe

• create a life that is not organized entirely around symptoms, fear, and medical care

  
  

This is not about talking someone out of what their body is telling them. It is about helping them respond to both the medical reality and the psychological impact with more flexibility, information, and choice.

Treating the whole situation

A person can need excellent medical care and trauma-focused therapy at the same time. Therapy should not be used to explain away symptoms, pressure someone to feel differently about inadequate medical care, or suggest that recovery depends on maintaining the right attitude. Medical treatment should not require someone to ignore the fear, grief, or prior trauma that affects how they experience their body and engage with care.

The goal is not to choose between the physical and psychological. It is to recognize that both are happening in the same person. And that leaving either one untreated can make the entire situation harder.

I provide trauma-focused telehealth therapy for adults living with chronic illness, autoimmune disease, frightening medical experiences, and the lasting effects of childhood or adult trauma. I also work with physicians, nurse practitioners, therapists, and other healthcare professionals who need a referral option for patients whose medical and trauma histories have become intertwined.

If this describes what you are experiencing (or someone you are treating) a consultation is a straightforward next step.

References

1. Song H, Fang F, Tomasson G, et al. Association of Stress-Related Disorders With Subsequent Autoimmune Disease. JAMA. 2018;319(23):2388–2400. doi:10.1001/jama.2018.7028.

2. Mandagere K, Stoy S, Hammerle N, Zapata I, Brooks B. Systematic Review and Meta-Analysis of Post-Traumatic Stress Disorder as a Risk Factor for Multiple Autoimmune Diseases. Frontiers in Psychiatry. 2025;16:1523994. doi:10.3389/fpsyt.2025.1523994.

3. Köhler-Forsberg O, Ge F, Aspelund T, et al. Adverse Childhood Experiences, Mental Distress, and Autoimmune Disease in Adult Women. Psychological Medicine. 2025;55:e36. doi:10.1017/S0033291724003544.

4. Boersma K, Södermark M, Hesser H, et al. Efficacy of a Transdiagnostic Emotion-Focused Exposure Treatment for Chronic Pain Patients With Comorbid Anxiety and Depression. Pain. 2019;160(8):1708–1718. doi:10.1097/j.pain.0000000000001575.