Survivors of traumatic events commonly suffer from long‐term pain and related somatic symptomatology. To test the predominant hypothesis that survivors’ pain comprises sequela of persistent posttraumatic stress symptoms (PTSS), we assessed the sequential order of symptom development among young survivors of a terrorist attack. All 490 survivors of the 2011 Utøya (Norway) attacks were invited to the longitudinal Utøya cohort study; 355 (72.4%) participated. The mean survivor age was 19.3 years (SD = 4.6) and 169 were female (47.6%). Somatic symptoms, including headache, other pain and fatigue, and PTSS, were measured 4–5 months (T1), 14–16 months (T2), and 32–33 months (T3) after the attack. Longitudinal associations between somatic symptoms and PTSS were assessed in cross‐lagged structural equation model (SEM) analyses, which were adjusted for known confounders. Higher pain levels and other somatic symptoms at T1 consistently predicted PTSS at T2 in SEM analyses, r = .473, p < .001. Beyond this early‐to‐intermediate posttraumatic phase, somatic symptoms did not significantly predict PTSS: T2–T3, r = .024, p = .831; T1–T3, r = −.074, p = .586. PTSS did not significantly predict later somatic symptomatology at T1–T2, r = .093, p = .455; T2–T3, r = .272, p = .234; or T1–T3, r = −.279, p = .077. The findings indicate that survivors’ early pain and related somatic symptoms strongly and consistently predict later psychopathology. After severe psychological trauma, early interventions may need to address individuals’ pain to hinder chronification.
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