Sexual Assault and the Long Shadow of the Body: Higher 5‑Year Risk of Functional Somatic Disorders and Chronic Widespread Pain

Highlights

– In a population-based Danish cohort (DanFunD) with 5‑year follow-up, self-reported lifetime sexual assault (SA) was associated with increased risk of incident functional somatic disorders (FSD), notably multiorgan FSD (RR 6.47; 95% CI, 1.93–21.75) and chronic widespread pain (CWP) (RR 1.89; 95% CI, 1.11–3.23).

– Associations persisted after adjustment for emotional distress, life adversity, personality traits (neuroticism), health anxiety, perceived stress, subjective social status, somatic comorbidities, and self-efficacy.

– Those exposed to SA developed a higher burden of incident somatic symptoms across musculoskeletal, gastrointestinal, cardiopulmonary, and fatigue domains; associations for IBS and chronic fatigue did not reach significance in this sample.

Background and disease burden

Sexual assault (SA) is a prevalent public‑health problem with far‑reaching physical and mental health consequences. Global estimates indicate that a substantial proportion of women and a nontrivial proportion of men experience sexual violence during their lifetime, and many survivors develop long-term sequelae that cross medical specialties. Functional somatic disorders (FSDs) and functional somatic syndromes (FSSs) — clinical presentations characterized by persistent somatic symptoms not fully explained by conventional organ pathology — include conditions such as chronic widespread pain (CWP), irritable bowel syndrome (IBS), and chronic fatigue (CF). These disorders are common, disabling, and costly, and their etiology is multifactorial, implicating biological, psychological, and social mechanisms.

Prior cross‑sectional and retrospective studies have linked interpersonal trauma, including childhood maltreatment and adult sexual violence, to higher prevalence of FSS and somatic symptom burden. However, prospective, population‑based data examining incident FSD after SA exposure with careful adjustment for confounders have been limited.

Study design and methods

The authors used 5‑year follow-up data (2017–2020) from the Danish Study of Functional Disorders (DanFunD), a population-based cohort of adults aged 18–72 from the western greater Copenhagen area. Eligibility required completion of baseline SA measures and follow-up assessments. Sexual assault exposure at baseline was assessed using two items from the self-reported Cumulative Lifetime Adversity Measure and dichotomized into exposed versus nonexposed.

Incident FSD cases were identified using standardized symptom questionnaires and structured diagnostic interviews, and outcome definitions included single-organ and multiorgan FSD, and three common functional somatic syndromes (CWP, IBS, CF). The primary analytic approach used generalized linear models to estimate risk ratios (RRs) for incident FSD outcomes with adjustment for a comprehensive set of covariates: sex, baseline emotional distress (anxiety/depression), other life adversity or trauma, subjective social status, somatic comorbidities, neuroticism, health anxiety, perceived stress, and self-efficacy. Sensitivity analyses were performed using diagnostic interview‑based case definitions to corroborate questionnaire-based findings.

Key findings

Study population and baseline characteristics: The analytic sample comprised 4,229 adults (53.9% women) with median age 56 years (IQR 47–64). Baseline prevalence of reported lifetime SA was not provided here but was used to compare incident cases over the 5‑year interval.

Main adjusted associations

– Incident overall FSD: RR 1.69 (95% CI, 1.17–2.44). Participants reporting baseline SA had a 69% higher adjusted risk of developing FSD over 5 years compared with those not reporting SA.

– Single‑organ FSD: RR 1.65 (95% CI, 1.14–2.38).

– Multiorgan FSD: RR 6.47 (95% CI, 1.93–21.75). Although case counts for multiorgan FSD were small (reflected in the wide confidence interval), the point estimate signals a markedly higher risk after SA.

– Functional somatic syndromes (pooled): RR 1.54 (95% CI, 1.14–2.07).

– Chronic widespread pain (CWP): RR 1.89 (95% CI, 1.11–3.23).

– Irritable bowel syndrome (IBS): RR 1.60 (95% CI, 0.81–3.16) — not statistically significant in this sample.

– Chronic fatigue (CF): RR 1.47 (95% CI, 0.89–2.42) — not statistically significant.

Symptom burden

Individuals reporting SA developed significantly more incident somatic symptoms across multiple domains: musculoskeletal, gastrointestinal, cardiopulmonary, and fatigue-related symptoms, compared with nonexposed peers.

Effect modification and sensitivity analyses

Baseline emotional distress (symptoms of anxiety or depression) did not modify the association between SA and incident FSD, suggesting that SA predicts FSD independent of concurrent affective symptoms. Sensitivity analyses using diagnostic interviews confirmed the primary findings, supporting robustness against misclassification from questionnaire-only case definitions.

Interpretation and biological plausibility

These prospective results strengthen causal inference that lifetime sexual assault can increase risk of subsequent FSD and FSS presentations. Several plausible mechanisms could account for this relationship and are consistent with the broader literature:

• Neurobiological effects of trauma: SA can alter stress-responsive systems (eg, HPA axis), autonomic regulation, and central pain processing, promoting hypervigilance and central sensitization that predispose to persistent somatic symptoms.
• Inflammation and immune dysregulation: Psychosocial trauma has been associated with proinflammatory signaling that may contribute to symptom amplification and multisystem complaints.
• Behavioral and social pathways: Trauma can lead to sleep disturbance, deconditioning, altered health behaviors, and reduced social support, all of which increase vulnerability to chronic somatic symptomatology.
• Illness attribution and health‑seeking: Survivors may interpret bodily sensations through a trauma‑primed lens, increasing symptom reporting and disability.

Importantly, the persistence of associations after adjusting for neuroticism, health anxiety, perceived stress, and emotional distress argues that the SA–FSD link is not simply explained by baseline psychological traits or concurrent mood symptoms but likely reflects an interplay of trauma‑specific biological and psychosocial mechanisms.

Clinical and public-health implications

For clinicians, these findings highlight the need to integrate trauma-informed care into evaluation and management of patients presenting with new or unexplained multisystem somatic symptoms. Key practical points include:

• Screening for history of sexual assault and other interpersonal trauma in patients with persistent somatic symptoms or recent onset of FSD, using sensitive, validated approaches and ensuring privacy and safety.
• Adopting trauma‑informed diagnostic and therapeutic strategies: validate symptoms, avoid dismissive language, and offer integrated care that addresses physical, psychological, and social needs.
• Referral pathways: consider early multidisciplinary management (primary care, pain medicine, gastroenterology as indicated, mental health, physical therapy), and evidence‑based interventions (e.g., cognitive behavioral therapy, graded activity, symptom‑focused physiotherapy) tailored to functional somatic presentations.
• Public‑health action: prevention of sexual violence remains essential, and survivors should have access to longitudinal healthcare supports that recognize multisystem risk.

Limitations

Key limitations acknowledged in the study and relevant to interpretation include:

• Potential underreporting or misclassification of SA: self-report measures can underestimate prevalence, and dichotomization may obscure dose or timing effects (eg, childhood vs adult assault).
• Small case numbers for some subtypes (notably multiorgan FSD) produced wide confidence intervals; replication in larger cohorts is warranted to refine effect estimates.
• Residual confounding: although the authors adjusted for many psychosocial and personality factors, unmeasured confounders cannot be fully excluded.
• Generalisability: cohort derived from a defined Danish population—findings may not generalize to other cultural or healthcare settings with differing baseline SA prevalence or healthcare access.

Research gaps and priorities

The study opens several avenues for further research:

• Prospective studies with repeated measures of trauma timing and severity to disentangle effects of childhood vs adult assault and dose‑response relationships.
• Mechanistic investigations combining neuroimaging, immune biomarkers, and autonomic testing to identify mediators of the SA–FSD pathway.
• Interventional trials testing trauma‑informed treatments for FSD in survivors of SA, assessing whether tailored approaches reduce symptom burden and prevent multisystem progression.
• Population health research to evaluate screening strategies, care pathways, and service models that improve outcomes for survivors at risk for FSD.

Conclusion

This well-conducted prospective cohort analysis from DanFunD provides compelling evidence that self‑reported lifetime sexual assault is associated with a substantially increased risk of developing functional somatic disorders over five years, particularly multiorgan FSD and chronic widespread pain. The associations were robust to adjustment for a broad range of psychosocial and personality factors and were supported by diagnostic interview sensitivity analyses. Clinicians and health systems should adopt trauma‑informed practices for evaluation and management of patients with unexplained multisystem somatic symptoms, and researchers should prioritize mechanistic and interventional studies to mitigate the long-term biopsychosocial consequences of sexual violence.

Funding and clinicaltrials.gov

Funding: See original publication for detailed funding sources and declarations of interest (Jacobsen et al., JAMA Psychiatry 2025). ClinicalTrials.gov identifier: not specified in the report excerpt provided.

References

1. Jacobsen SA, Petersen MW, Wellnitz KB, Ørnbøl E, Dantoft TM, Jørgensen T, McLean SA, Frostholm L, Carstensen TBW. Functional Somatic Disorders in Individuals With a History of Sexual Assault. JAMA Psychiatry. 2025 Nov 12:e253251. doi: 10.1001/jamapsychiatry.2025.3251. PMID: 41222960; PMCID: PMC12613088.

2. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine. 1998;14(4):245-258.

3. Henningsen P, Zipfel S, Herzog W. Management of functional somatic syndromes. Lancet. 2007;369(9565):946-955.

4. World Health Organization. Global and Regional Estimates of Violence against Women: Prevalence and Health Effects of Intimate Partner Violence and Non‑partner Sexual Violence. 2013.

5. Afari N, Ahumada SM, Wright LJ, Mostoufi S, Golnari G, Goodbody J, Osterman J, Barnhart T, Page GP. Psychological trauma and functional somatic syndromes: a systematic review and meta‑analysis. Psychosomatic Medicine. 2014;76(1):2-10.

Thumbnail prompt (AI image generation)

A clinical consultation scene in muted tones: a diverse adult patient seated on an examination chair looking thoughtful, a clinician in the foreground writing notes, ghosted anatomical outlines (musculoskeletal, abdomen, chest, and a faint brain silhouette) floating beside them, subtle visual cues for trauma (a small, respectful ribbon emblem), warm clinical lighting to convey empathy and complexity.