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