The Body Keeps the Score. But Not the Way You Think.

A Critical Look at One of Trauma Therapy’s Most Popular Claims

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If you have spent any time exploring trauma therapy, you have almost certainly encountered the phrase the body keeps the score. Popularised by Bessel van der Kolk’s influential 2014 book of the same name; this idea has become something of a mantra in trauma-informed circles. It captures something many trauma survivors recognise intuitively: that their distress lives not just in their thoughts, but in their muscles, their gut, their chest, their whole nervous system.

As a psychologist who works with trauma, including complex trauma presentations and the intersection of trauma with neurodivergence, I take the somatic dimension of trauma seriously. My clients describe it vividly: the tightness that arrives without warning, the startle responses that will not settle, the exhaustion that no amount of sleep resolves. These experiences are real, they matter, and they deserve clinical attention.

But real and accurately explained are two different things. And as the idea that trauma is literally stored in the body has moved from clinical observation to popular culture, it has picked up some significant problems along the way.

What the Science Actually Supports

Let us start with what is well established. Chronic stress and traumatic exposure produce measurable physiological changes. The hypothalamic-pituitary-adrenal (HPA) axis, which governs our stress response, becomes dysregulated.

Inflammatory markers shift. Autonomic nervous system patterns change (McEwen, 2007; Yehuda et al., 2015). Stephen Porges’ polyvagal theory (2011) offers one framework for understanding how threat responses become embedded in autonomic functioning.

Traumatised individuals frequently present with somatic complaints: chronic pain, altered body awareness, digestive issues, and patterns of physical tension that feel disconnected from any obvious physical cause (Payne, Levine & Crane-Godreau, 2015). The clinical observation that trauma survivors experience distressing bodily sensations, hyperarousal, muscular tension, and somatic flashbacks is robust and well documented in PTSD research (Nijenhuis, van der Hart & Steele, 2004).

None of this is seriously disputed. The body is profoundly affected by trauma. The question is what we mean when we say trauma is stored there.

Where the Popular Account Breaks Down

1. The Metaphor Gets Mistaken for a Mechanism

“Stored in the body” implies a discrete encoding process, as though traumatic experience is literally deposited in tissues, fascia, or organs the way a file is saved to a hard drive. This is a category error. What we actually observe is that trauma alters neural circuits that regulate bodily function, not that the body independently stores traumatic memories outside the central nervous system.

The somatic manifestations of trauma are mediated by the brain, particularly the amygdala, insula, anterior cingulate, and prefrontal regions (Lanius, Vermetten & Pain, 2010). As McNally (2003) argued in Remembering Trauma, conflating the phenomenology of bodily distress with a storage mechanism creates claims that resist scientific scrutiny.

2. Polyvagal Theory Is More Contested Than You Would Think

Porges’ polyvagal theory has been enormously influential in trauma therapy, and many clinicians (me included) find elements of it clinically useful. However, its core neuroanatomical claims have been challenged. Grossman and Taylor (2007) demonstrated that several foundational premises about the evolutionary development of vagal pathways are inconsistent with comparative neuroanatomy.

This matters because the theory is often presented in popular accounts as settled science rather than as a useful but debated framework. The therapeutic applications may have value without the underlying evolutionary neuroscience being entirely correct, but that distinction is rarely made.

3. "Body Memory" Lacks a Coherent Biological Basis

The concept of 'cellular memory' or 'tissue memory' sometimes invoked in somatic therapies has no established biological mechanism. Muscles do not encode autobiographical memories. What does occur is that implicit (nondeclarative) memory systems, including procedural memory and conditioned autonomic responses, can produce somatic experiences without conscious recall (Schacter, 1987; Brewin, 2001).

These are brain-based memory systems expressing through the body, not memories stored in the body. The distinction matters enormously for how we understand and treat traumatic stress.

4. The Claim Collapses Distinct Processes into One

The popular formulation bundles together several separable phenomena: conditioned autonomic responses (classical conditioning via amygdala circuits), altered interoceptive processing (insula dysfunction), chronic HPA dysregulation (neuroendocrine changes), somatic symptom presentations (which may involve central sensitisation), and the phenomenological experience of bodily distress.

Each has different mechanisms, different evidence bases, and different treatment implications (Kihlstrom, 2006). Treating them as a single unified phenomenon of "body storage" obscures more than it illuminates.

5. The Evidence for Body-Based Trauma Therapies Is Uneven

Somatic Experiencing (Levine, 1997), Sensorimotor Psychotherapy (Ogden, Minton & Pain, 2006), and similar approaches are built substantially on the premise that trauma is stored in the body. While emerging evidence shows promise for some somatic approaches (Price & Hooven, 2018), the evidence base remains considerably thinner than for cognitive and exposure-based trauma treatments (NICE, 2018; Phoenix Australia, 2020).

This does not mean these approaches are without value. But the theoretical framework has outpaced the empirical support, and that gap deserves honest acknowledgment.

Why This Matters

This is not just an academic debate. How we explain trauma to our clients shapes their understanding of their own experience and their expectations for recovery. If we tell someone their trauma is stored in their hip flexors, we are making a claim about mechanism that the evidence does not support, and we may inadvertently create anxiety about whether their body is full of unprocessed traumatic material waiting to emerge.

A more accurate and ultimately more empowering framing is this: trauma alters brain circuits that regulate bodily function, producing persistent changes in autonomic arousal, interoceptive processing, and conditioned physiological responses that are experienced somatically.

The body is the site of expression, not the site of storage. This keeps the clinical focus where it belongs: on neural circuit regulation, interoceptive retraining, and the processing of implicit threat memories through evidence-based approaches, while still honouring the very real somatic distress that clients report.

What This Means for Your Recovery

If you are someone living with the physical impacts of trauma, none of this invalidates your experience. Your body sensations are real. Your hyperarousal is real. The tension, the pain, the exhaustion: these are legitimate consequences of what your nervous system has been through.

What this critical perspective offers is a more precise understanding of why you experience these things, and therefore a clearer path to addressing them. Evidence-based approaches including trauma-focused CBT, EMDR, and carefully adapted ACT and DBT can address both the cognitive and somatic dimensions of trauma, with strong research support behind them.

The goal is not to dismiss the body’s role in trauma. It is to understand it accurately, so that treatment can be as effective as possible.

References

• Brewin, C. R. (2001). A cognitive neuroscience account of posttraumatic stress disorder and its treatment. Behaviour Research and Therapy, 39(4), 373–393.

• Grossman, P., & Taylor, E. W. (2007). Toward understanding respiratory sinus arrhythmia: Relations to cardiac vagal tone, evolution and biobehavioral functions. Biological Psychology, 74(2), 263–285.

• Kihlstrom, J. F. (2006). Trauma and memory revisited. In B. Uttl, N. Ohta, & A. L. Siegenthaler (Eds.), Memory and Emotion: Interdisciplinary Perspectives. Blackwell.

• Lanius, R. A., Vermetten, E., & Pain, C. (Eds.). (2010). The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic. Cambridge University Press.

• McEwen, B. S. (2007). Physiology and neurobiology of stress and adaptation: Central role of the brain. Physiological Reviews, 87(3), 873–904.

• McNally, R. J. (2003). Remembering Trauma. Harvard University Press.

• Nijenhuis, E. R. S., van der Hart, O., & Steele, K. (2004). Trauma-related structural dissociation of the personality. Activitas Nervosa Superior, 46, 3–4.

• Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the Body: A Sensorimotor Approach to Psychotherapy. W. W. Norton.

• Payne, P., Levine, P. A., & Crane-Godreau, M. A. (2015). Somatic experiencing: Using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology, 6, 93.

• Phoenix Australia. (2020). Australian Guidelines for the Prevention and Treatment of Acute Stress Disorder, Posttraumatic Stress Disorder and Complex PTSD.

• Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. W. W. Norton.

• Price, C. J., & Hooven, C. (2018). Interoceptive awareness skills for emotion regulation: Theory and approach of Mindful Awareness in Body-Oriented Therapy (MABT). Frontiers in Psychology, 9, 798.

• Schacter, D. L. (1987). Implicit memory: History and current status. Journal of Experimental Psychology: Learning, Memory, and Cognition, 13(3), 501–518.

• van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.

• Yehuda, R., Hoge, C. W., McFarlane, A. C., Vermetten, E., Lanius, R. A., Nievergelt, C. M., ... & Hyman, S. E. (2015). Post-traumatic stress disorder. Nature Reviews Disease Primers, 1, 15057.

About Behavioural Edge Psychology

Behavioural Edge Psychology is a specialised psychology practice in Victoria, Australia, offering the unique intersection of individual therapeutic support and organisational psychology expertise.

Dr. Sarah Fischer holds both a Masters and PhD in Psychology with AHPRA registration, providing:

·      Individual therapy for adults using evidence-based models

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About the Author: Dr Sarah Fischer, MAPS

Dr Sarah Fischer is a PhD- and Masters-qualified Principal Psychologist and AHPRA-endorsed Organisational Psychologist with over 15 years of experience in high-stakes clinical and corporate environments. Specialising in the intersection of neuro-affirming care and systemic workplace health, her work focuses on Anxiety, Depression, Trauma, Stress, Burnout, Adult Neurodivergence, and the management of Psychosocial Hazards under Victoria’s 2025/2026 OHS Regulations.

As a ‘Prac-academic,’ Dr Fischer bridges the gap between clinical research and real-world application. She is a published researcher on cognitive flexibility and clinical governance, ensuring all interventions at Behavioural Edge Psychology are evidence-based and trauma-informed.

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This article reflects expert observations from Dr. Sarah Fischer's practice at Behavioural Edge Psychology. Content is intended for educational purposes and does not replace professional psychological assessment treatment. For assessment or psychological support, please consult with an appropriately qualified psychologist.