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ORIGINAL RESEARCH ARTICLE

Childhood adversities and impairment in somatoform pain disorder: The role of psychological and somatic symptoms

Sebastian Trautmann1,2* ,  Lena Barth1,2* ,  Adrian M. Siegel3 ,  Katrin Feiks4 ,  Michael Rufer5,6 ,  Kyrill Schwegler7 ,  Bianca Schwennen8 ,  Kirstin Bernhardt6 ,  Uwe Wutzler9 ,  Paul Kaiser1,2 ,  Lutz Wittmann10 ,  Sandra Miethe1,2 ,  Barbara Ruettner1 ,  Lutz Goetzmann11,12
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1 Department of Psychology, Faculty of Human Science, MSH Medical School Hamburg, Hamburg, Germany
2 Institute for Clinical Psychology and Psychotherapy, MSH Medical School Hamburg, Hamburg, Germany
3 Department of Neurology, Faculty of Medicine, University of Zurich, Zurich, Switzerland
4 Department of Psychosomatic Medicine and Psychotherapy, Segeberger Kliniken, Bad Segerberg, Schleswig-Holstein, Germany
5 Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland
6 Center for Psychiatry and Psychotherapy, Clinic Zugersee, Triaplus AG, Oberwil-Zug, Zug, Switzerland
7 Psychiatric Practice, Zurich, Switzerland
8 Clinic for Psychosomatic Medicine and Psychotherapy, MediClin Seepark Clinic, Bad Bodenteich, Lower Saxony, Germany
9 Clinic of Psychosomatic, University Hospital Kiel, Kiel, Schleswig-Holstein, Germany
10 Department of Psychology, International Psychoanalytic University, Berlin, Germany
11 Department of Psychoanalysis, Institute of Philosophy, Psychoanalysis, and Cultural Studies, Berlin, Germany
12 Clinic of Psychosomatic, Psychiatry, and Psychotherapy, University of Lübeck, Lübeck, Schleswig-Holstein, Germany
JCBP, 025290054 https://doi.org/10.36922/JCBP025290054
Received: 17 July 2025 | Revised: 1 October 2025 | Accepted: 3 November 2025 | Published online: 25 November 2025
© 2025 by the Author(s).. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Adverse childhood experiences (ACEs) are common and have been linked to long-term somatic and psychological consequences, including an elevated risk of chronic and somatoform pain. This exploratory study examined how ACEs are correlated with pain-related impairment in adults with somatoform pain disorder (according to Diagnostic and Statistical Manual of Mental Disorders IV criteria), with a focus on the roles of somatic and psychological symptoms. A total of 200 patients (80% females; mean age: 49.1 years) from three psychosomatic clinics in northern Germany were assessed for childhood abuse, pain-related neglect, anxiety, depression, somatic symptoms, and pain-related impairment. Associations were analyzed using linear regressions and network analysis. Emotional abuse was significantly associated with greater impairment (b=1.66; 95% confidence interval [1.48–1.84]; p=0.001; d = 0.36), and the number of abuse types also predicted impairment (F(2, 2) = 39.3; p=0.025; f2 = 0.06). Pain-related neglect showed a modest association with impairment (b = 0.11; 95% confidence interval [0.02–0.2]; p=0.033, f2 = 0.05), but in network models, it was linked to impairment through multiple pathways involving anxiety, depression, and somatic symptoms. Physical abuse was associated with impairment primarily through depressive and somatic symptoms. Across models, anxiety emerged as a central node connecting symptoms to impairment. These findings suggest that pain-related neglect may particularly influence psychological and somatic processes contributing to impairment in somatoform pain. While consistent with prior research showing ACEs as risk factors for chronic pain outcomes, this study highlights potential mechanisms through which neglect and abuse exert their effects, warranting future longitudinal and interventional mechanistic studies. These findings underscore the potential benefit of trauma-informed treatments targeting anxiety and depression to reduce the impact of ACEs on pain-related impairment.

Keywords
Somatoform pain
Chronic pain
Adverse childhood experiences
Neglect
Psychotherapy
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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Journal of Clinical and Basic Psychosomatics, Electronic ISSN: 2972-4414 Print ISSN: 3060-8562, Published by AccScience Publishing
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