A central claim of trauma research, and the one that gives Bessel van der Kolk's book its title, is that unprocessed psychological distress frequently manifests as physical symptoms — not as a metaphor, but as an actual physiological process. Chronic pain, autoimmune flare-ups, and respiratory symptoms can be directly tied to unresolved emotional distress rather than (or in addition to) purely physiological triggers, which means treating the physical symptom alone, without addressing the underlying trauma, often leaves the root cause completely unaddressed.
This has real implications for how physical symptoms without a clear organic cause get treated: dismissing them as "not real" once no physiological cause is found misses the point entirely — the body is registering something real, it's just not something a purely physical examination is built to find.
Van der Kolk describes a patient, Sandy, whose asthma attacks were shown through careful clinical observation to be closely tied to specific episodes of unprocessed emotional distress rather than purely physiological triggers like allergens or exertion. As her therapy progressed and she developed language for the emotional experiences that had previously gone unprocessed, the connection between distress and asthma attacks became increasingly clear — the body, quite literally, was registering and expressing something the conscious mind hadn't yet found a way to process directly.