Severe psychological trauma may affect the long-term psychiatric and physical health of survivors. This paper traces a theoretical link between the neurochemical changes in the brain that are induced by stress and the long-term medical morbidity in trauma victims. We present several animal models that illustrate the prolonged impact of environmental stressors on the catecholamine system of the brain. Although evidence of brain changes has never been documented in trauma survivors, there is ample evidence of increased reactivity of the autonomic nervous system to stressful stimuli subjects with posttraumatic stress disorder (PTSD). Increased reactivity to stress is associated with cardiovascular morbidity in the general population and may be an important factor in the long- term health of people who have experienced extraordinary stress. There is considerable, albeit controversial, evidence of increased cardiovascular and other medical morbidity in trauma victims. The objective of presenting this conceptual framework is to stimulate thought and research on the long-term sequelae of extraordinary stress.