Trauma, Women's Health and the Whole Person: The Value of a Biopsychosocial Approach

Trauma is never purely psychological.

Our experiences are held in the context of our bodies, our health, our relationships and the circumstances in which events have taken place. This is particularly important when trauma has occurred within healthcare, pregnancy, childbirth, reproductive health or medical treatment.

My work as a specialist trauma therapist is informed by both my clinical background and my training in psychological therapies. I am a Registered Mental Health Nurse (RMN), as well as a therapist trained primarily in CBT and EMDR, alongside additional training in approaches such as Acceptance and Commitment Therapy (ACT) and Compassion Focused Therapy (CFT).

My nursing background means that I naturally consider the person as a whole. When working with trauma, I am interested not only in what has happened psychologically, but also in the physical and sometimes medical context in which it happened, and how that context may continue to affect someone today.

This is especially relevant when working with women whose experiences involve their bodies, reproductive health or healthcare.

A traumatic birth, pregnancy loss, fertility treatment, gynaecological procedure or significant medical diagnosis can leave an emotional imprint, but the experience may also affect how someone relates to their body, their sense of safety, their trust in healthcare professionals and their expectations of future medical care.

These experiences deserve to be understood in their full context.

Trauma doesn't happen separately from the body

It can be tempting to think of therapy as dealing with the psychological part of an experience while medical professionals deal with the physical part.

In reality, these things are often deeply connected.

A frightening pregnancy or birth can affect how someone feels about their body.

A gynaecological procedure can affect someone's sense of safety.

A reproductive-health diagnosis can have an emotional impact far beyond the diagnosis itself.

Repeated medical investigations can create anxiety around bodily sensations.

Fertility treatment can involve physical procedures, uncertainty, loss, hope and disappointment, sometimes repeatedly.

And an experience that was medically necessary can still have been psychologically traumatic.

For someone in this situation, understanding the medical context of their experience can be an important part of understanding their trauma.

A biopsychosocial approach to mental health

As an RMN, my professional training is grounded in a biopsychosocial approach.

This means that when I assess someone, I don't look solely at their psychological symptoms.

I consider the interaction between:

• Biological factors – physical health, medication, sleep, hormones, nutrition and other bodily factors.

• Psychological factors – trauma, emotions, thoughts, memories, beliefs and coping responses.

• Social factors – relationships, family, work, finances, support networks and wider circumstances.

This can also mean looking at the everyday things that can influence how someone is feeling and functioning, such as diet, sleep, physical activity, alcohol or substance use, daily routines and sources of stress.

These aren't viewed in isolation or as a list of things someone simply needs to "fix". They are part of understanding the wider context of someone's wellbeing and can sometimes provide useful areas to explore alongside psychological therapy.

This is particularly relevant when working with women's health because physical and psychological health can be so closely intertwined.

Someone may come to therapy saying:

"I'm exhausted, anxious and struggling to concentrate."

It may be entirely appropriate to explore these experiences psychologically.

But my clinical training also encourages me to remain curious about the wider picture.

Could there be a physical health factor that needs considering? Could medication be relevant? Has anything changed physically? How are sleep, nutrition and daily routines?

Is there a reason this person should speak with their GP or another healthcare professional?

That doesn't mean diagnosing physical illness within therapy. It means recognising that not every symptom should automatically be understood as psychological.

Why this can matter when you already have a medical condition

Having an existing medical or reproductive health condition can make therapy more complicated.

You may already be navigating appointments, investigations, medication, procedures or uncertainty.

You may also have been told that certain symptoms are "just anxiety" or "stress", which can leave you feeling unheard or unsure about what is happening in your body.

A therapist cannot and should not replace your GP or medical specialist. But a therapist with a clinical healthcare background may be more accustomed to recognising that physical health deserves to remain part of the conversation.

If something you describe raises a potential physical health concern, I may encourage you to discuss it with your GP or another relevant healthcare professional rather than simply incorporating it into a psychological formulation.

That can be an important safeguard in therapy.

Women's health can be particularly complex

Women's health doesn't always fit neatly into the categories of "physical" and "psychological."

Consider someone who has experienced:

• a traumatic birth

• an emergency caesarean or other obstetric intervention

• pregnancy loss

• fertility treatment

• recurrent pregnancy loss

• difficult or invasive examinations

• gynaecological surgery

• chronic pelvic or reproductive-health problems

• repeated investigations or procedures

• a diagnosis affecting fertility or reproductive health

• frightening symptoms that have required repeated medical investigation.

There may be a psychological response to what happened.

But there may also be ongoing physical symptoms, medical appointments, medication, hormonal changes, uncertainty about the body, concerns about fertility, or continuing treatment.

The therapy therefore needs to make sense within the person's actual medical reality.

Medical trauma can make the body feel unsafe

One of the things I find particularly important in medical trauma is the relationship a person develops with their own body.

Following a frightening medical experience, someone may become highly alert to physical sensations.

A racing heart may immediately feel dangerous.

Pain may trigger memories.

A medical examination may cause an overwhelming physiological response.

A hospital corridor, clinical smell or particular piece of equipment may bring back memories of what happened.

The person may intellectually know that they are safe, while their nervous system responds as though the original event is happening again.

This is where trauma-focused therapy can be incredibly important.

But understanding the medical context behind the response can also matter.

There is a difference between telling someone, "This is just anxiety," and understanding why their body has learned that a particular sensation, environment or procedure represents danger.

When physical symptoms need checking

A particularly important part of a biopsychosocial approach is knowing that not everything should automatically be attributed to mental health.

For example, symptoms such as fatigue, changes in mood, difficulties concentrating, sleep disturbance or changes in physical functioning can occur alongside psychological difficulties, but they can also have physical or medication-related explanations.

As an RMN, I am not acting as a GP or diagnosing physical conditions within therapy.

However, my clinical background means I am trained to consider the possibility that something may have a biological component and to recognise when it may be appropriate to encourage someone to seek medical assessment.

The aim is not to medicalise every symptom.

It is to avoid psychologising every symptom.

That distinction matters.

Bringing the whole picture into the therapy room

My professional background brings together mental health nursing and specialist psychological therapies.

As an RMN, I have been trained to consider the biological, psychological and social aspects of a person's experience. My CBT and EMDR training provides specialist therapeutic approaches for working with psychological distress and trauma.

For me, these aren't separate areas of practice. They inform one another.

When trauma has occurred within healthcare, pregnancy, childbirth or reproductive health, the psychological impact cannot always be separated from the physical experience, the medical circumstances or what happened afterwards.

There may be memories to process, but there may also be changes in the way someone experiences their body. There may be fear around future healthcare, ongoing physical symptoms, grief, uncertainty or a loss of trust.

All of these experiences can have a place in the therapy room.

My role is not to replace the medical professionals involved in your care, nor to assume that every physical experience has a psychological explanation. It is to understand the person as a whole and to recognise how physical health, psychological wellbeing and life circumstances can interact.

For me, this is the value of a biopsychosocial approach to trauma.

Understanding what happened, understanding its impact, and understanding the person who is living with that impact.