There is considerable evidence that immediate and long-term stress reactions are associated with increased somatic symptomatology. However, because of the scarcity of long-term longitudinal studies, the trend of mutual change of these factors has not been assessed. This study examined the chronological inter-relationships between post-traumatic stress reactions and somatization symptoms among combatants over a 20-year period.

Two groups of veterans were assessed 1, 2, 3 and 20 years after their participation in the 1982 Lebanon War: a clinical group of veterans who had been diagnosed with combat stress reaction (CSR) on the battlefield (n=363), and a matched control group of veterans (n=301).

The CSR veterans reported higher initial levels of intrusion and avoidance and a steeper decline in those symptoms over time in comparison to the control group. The former also reported higher initial levels of somatization symptoms than the latter. In addition, over the years, stress reactions were positively associated with somatization symptoms. For both study groups, in the first years after the war, stress reaction symptoms predicted somatization symptoms. However, with time, the trend was reversed and somatization symptoms predicted stress reactions.

The findings suggest that CSR is a marker for future stress reactions and somatization symptoms, and indicate a long-term role for these symptoms in veterans' psychological distress.