Somatic symptom burden, PTSD, and dissociation: Cross-sectional findings from 995 international female mental health service users

Objective: Somatic symptom burden is frequently linked to trauma-related psychopathology; Yet, the specific contributions of PTSD, disturbances in self-organization (DSO), and dissociation remain underexplored. Our study examined the prevalence of somatic symptom burden among female mental health service users and evaluated the associations between trauma-related symptoms and somatic symptom burden. Methods: Female participants (N = 995) from international clinical settings completed validated self-report measures assessing somatic symptoms (SSS-8), childhood trauma (BBTS), PTSD and DSO symptoms (ITQ), and dissociation (MDI). Results: Over half (54.9 %) reported elevated somatic symptom burden (SSS-8 ≥ 13). These individuals were significantly more likely to screen positive for probable ICD-11 PTSD/CPTSD (62.6 % vs 28.3 %), X² (1) = 116.685,p < 0.001,Φ = 0.34, and report dissociative symptoms (61.5 % vs 16.0 %), X² (1) = 210.883,p < 0.001,Φ = 0.46, compared to those with lower somatic symptom burden. Hierarchical regression revealed that PTSD, DSO, and dissociation accounted for an additional 32 % of variance in somatic symptom burden beyond demographics and childhood trauma exposure. Logistic regression confirmed that PTSD (OR = 1.54), DSO (OR = 1.67), and dissociation (OR = 2.08) were each significantly associated with elevated somatic symptom burden (all ps < 0.001). The final model demonstrated good classification performance (accuracy = 75.1 %, AUC = 0.824) and significantly outperformed individual symptom models. Conclusion: Trauma-related symptoms are closely linked to somatic symptoms among female clinical populations. Findings emphasize the need for trauma-informed screening and treatment to effectively identify Somatic Symptom Disorders and manage somatic symptoms in mental health settings.