Background & Aims
There is substantial clinical evidence from torture and war victims that violence, especially intentional forms of physical, sexual but also psychological violence can be at the origin of somatic disturbances such as chronic pain (1). Here we conducted in-depth interviews with twenty women who participated in adapted physical activity at a Hospital Woman Center (HWC) providing holistic medico-psycho-social and legal support for victims of violence (Re#Start), in order to address the relationship between their emotional and bodily experience, relationships with others and chronic pain symptoms. The aim was to trace somatisation of trauma in the making and explore the mediating role of bodily consciousness and emotion regulation. Indeed, interventions such as mindfulness (2) or trauma-sensitive yoga (3) might help emotion regulation through improved bodily – interoceptive (4) – consciousness (5).
Methods
We led in?depth qualitative interviews with twenty women who had been attending adapted karate classes regularly over 5 months at a HWC. Interview topics included women’s relationship to their body, emotions and social environment, before and after taking part in adapted karate classes. In parallel, mental health and bodily connectedness was assessed using the HADS, Beck anxiety scale, International Trauma Questionnaire (ITQ) and Scale of body connection. Interviews were analysed based on interpretative-phenomenological analysis (IPA,), a qualitative technique rooted in phenomenology, aiming to offer insights into how a patient, in a given context, makes sense of their experience. Material was assessed by two raters and categorised into several main emerging themes.
Results
Firstly, chronic pain complaints were abundant in the study sample. Five main themes emerged from our qualitative analysis; 1) Bodily disconnection; 2) Feeling overwhelmed by emotions in social context; 3) Lacking confidence and trust in others; 4) Manichaen perceptions of others, especially health professionals; 5) Disregard and insensibility for acute pain incidences. Whereas adapted karate reduced mainly anxiety and scores of body disconnection, it seemed to bear little input on interoceptive consciousness and emotion regulation. Chronic pain impacted everyday functioning and patients gave witness of this fact with striking detachment while often showing good awareness of their absence of access to bodily awareness and capacity to regulate emotions.
Conclusions
The experience of (intentional) violence seriously harms mental and somatic health. It further undermines confidence and trust in others, including health professionals, interfering with recovery. Severe disruption of access to bodily consciousness interferes with coping and emotion regulation. Together these deficits condition the development of chronic pain. More research is needed to develop efficacious intervention techniques to push back the danger of developing long-lasting somatic disturbances in victims of violence.
References
1. Chahraoui K. Violences intentionnelles, manifestations somatiques et traumas complexes chez les réfugiés et demandeurs d’asile. Douleur et Analgésie. Lavoisier SAS; 2020;33:75–82.
2. Bornemann B, Singer T. Taking time to feel our body: Steady increases in heartbeat perception accuracy and decreases in alexithymia over 9 months of contemplative mental training. Psychophysiology. Wiley Online Library; 2017;54:469–482.
3. van der Kolk BA, Stone L, West J, et al. Yoga as an adjunctive treatment for posttraumatic stress disorder: A randomized controlled trial. The Journal of clinical psychiatry. Physicians Postgraduate Press, Inc.; 2014;75:22573.
4. Craig AD. How do you feel? Interoception: the sense of the physiological condition of the body. Nat Rev Neurosci. 2002;3:655–666.
5. Trinkler I. Désaffiliation corporelle. Manuel de médecine de la douleur. Poisbeau, P. & Melchior, M. Dunod; 2024.
Presenting Author
Fiona Schuliar
Poster Authors
Topics
- Mechanisms: Psychosocial and Biopsychosocial