Signs of Unresolved Trauma

Inability to tolerate feelings or conflicts:
  • Blunt or numbness, withdrawal, no obvious affect in appropriate situations
  • Movement to intense or overwhelming feelings suddenly and rapidly (e.g., rage)
  • Depression (problem sleeping, eating, poor energy, low motivation, poor self esteem, poor memory, anxiety)
  • Panic feelings (trouble breathing, feeling as if having a heart attack, fearful, anxious, etc.)

A pattern of out-of-control and self-injurious behavior:
  • Addictive behaviors (over/under-eating, gambling, drinking, smoking, etc.)
  • Patterns of repeated behavior to avoid feelings (promiscuity, internet use, sleeping, etc.)
  • Chaos in life (problems with relationships, employment, financial, etc.)
  • Self-harmful behavior (often “alluded to” but not obvious) such as scratching and cutting, burning self, hair-pulling, etc.

Intense self-blame and feelings of unworthiness or belief they are "ruined:"
  • Belief that they were responsible for original trauma
  • Irrational/illogical beliefs about responsibility for events in the present
  • Belief that they are bad, a failure, unlovable, a loser, damaged, insignificant, worthless
  • May induce others to treat them badly

Staying stuck in the victim, perpetrator, or rescuer roles:
  • Seek out relationships with abusive people
  • Induce abuse from others rather than waiting for it to happen
  • Perceive abuse which confirms the belief that they are unworthy and unlovable
  • Hurt others (different than appropriate self-protection)
  • Act aggressively toward others who are weak and vulnerable
  • Compulsively driven to help others, often to their own detriment
  • Acts of generosity not in accord with the relationship

Disorganized attachment patterns:
  • Inability to tolerate their ambivalence toward the perpetrator even after the trauma ceases
  • Inability to tolerate their ambivalence toward other trusted figures, such as failed rescuers or those who denied the trauma
  • Inability to tolerate their ambivalence toward significant persons currently in their lives

Difficulty maintaining healthy relationships:
  • Avoid relationships altogether
  • Avoid close relationships because of inherent risk
  • Avoid situations that might lead to closeness
  • Protect themselves, e.g., unfriendly to others before others are unfriendly to them
  • Have intense but brief relationships
  • Remain attached even when the relationship is unhealthy
  • Perceive the relationship in a distorted manner

Black and white thinking and other cognitive distortions:
  • Child-like, concrete, and magical thinking
  • What they think is normal and real does not coincide with "real life"
  • Derive "life rules" and “automatic thoughts” from childhood distortions
  • Cling to the distortions despite challenge or contrary evidence
  • Provoke a non-existent reality into being in order to verify a distortion
  • Collect evidence to support the distortion while ignoring evidence to the contrary
  • Patterns of distorted thinking (such as generalizations, all or nothing, discounting, jumping to conclusions, assuming, labeling, and emotional reasoning)

Intrusive thoughts, images, feelings, memories, and nightmares, pathological dissociation:
  • Loss of (long) spaces of time (can’t remember what they said or did)
  • Appear to "switch" personalities, or be different people, even in speech and behavior
  • Trances or sleepwalking
  • Childhood companions, "voices," "too much noise in my head"
  • Inability to recall important information, usually of a stressful or traumatic nature
  • Confusion about personal identity or assumption of a new identity

Extensive comorbidity/multiple diagnoses which may include addictions, mood disorders, and personality disorders

Suicidal ideation:
  • Talk about suicide
  • Wish they were dead
  • Have a plan to end their life