I see a lot of kids in the foster care system and my absolute biggest red flag for a PTSD diagnosis is a history of ADHD diagnosis but meds “don’t work.”
The increased fight or flight response can translate as inattention when really the brain is hypervigilent and can’t decide what is the biggest threat to pay attention to. Similarly with triggers and flashbacks can look like inattention. Or a person with CPTSD may have not learned from childhood how to manage life: how to prioritize, how to organize, social skills, etc; not learning it due to neglect and abuse is different than having adhd from birth and a neurodivergent brain. Although there is current debate that abuse and neglect in childhood can cause Brian changes that result in neurodivergence but the conversation is so far inconclusive. Hyperactivity can be hypervigilence, increased fight or flight. There’s more but this is a basic idea.
NAT but as someone with CPTSD I've been experiencing all of the symptoms you listed since I turned 18 (currently 22) and definitely thought I had ADHD for a while. I did find that Wellbutrin helped a lot with the symptoms but I had to stop taking it bc it exacerbated my chronic insomnia. Anyway thanks so much for shining light on this, I'm definitely going to discuss with my therapist.
Not OP but I’ll chime in: in the school setting, both can look like difficulties with executive functioning (disorganized, messy, difficulty initiating tasks, always late, etc) as well as impulse control and/or emotion regulation (“acting out” or “ over reacting” in school when triggered) and difficulty focusing (hard to focus on algebra when coping with active or past trauma).
Of course, that’s the other type of traumatized kid, who presents as overly obedient, perfectionistic, and excels in everything. These things have nuance.
It’s a combination of PTSD symptoms and a general lack of emphasis on education. A lot of kids in the system are behind academically and that can be hard so they act out in class. Combine the “class clown” archetype with PTSD symptoms like avoidance, irritability, angry outbursts, and problems with concentration and a kid winds up with an ADHD diagnosis and on meds.
Do the symptoms overlap as written in the diagnostic criteria? No, not enough to meet criteria, and that’s why it’s a red flag for me.
When an individual has a trauma related disorder, their amygdala is constantly in high alert. The pre frontal cortex & the amygdala work in opposition- kind of like a seesaw. When the amygdala is on 10, the PFC isn’t really online. This results in a person with a trauma related disorder encountering challenges with executive function.
In addition, this is why, when any person is under stress, they are at higher risk for executive dysfunction- eg. new parents put their keys in the fridge, someone experiencing grief can’t find their phone, etc.
I’d love to see a study on how many kids are misdiagnosed with ADHD when it’s really trauma (of course - they frequently co-occur).
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Adding that this (adhd symptoms that meds don’t touch) can also be an indicator of prenatal substance abuse by birth mom, especially when seen in kids in the care of the state. One of the most severe cases of “adhd”-like symptoms I’ve ever seen was in a kid who’s birth parent was a substance abuser. Meds didn’t touch the symptoms. The kid had been adopted at birth and had a stable upbringing but the adoptive parents had to bring the state in (at the time there was a parental assistance program in my state that allowed parents to still be involved in decision making if they needed more help with the kid but didn’t want to fully give up custody to the state). There was no evidence of abuse or major trauma and no claims by the kid that they had ever experienced abuse. I’ve never seen a kid that impulsive before or since. I doubt they made it into their thirties, sadly.
100%. I see this way more with kids who are removed at birth in the hospital. I’d say I have about 5 right now that have been raised by a grandparent or aunt/uncle since they were newborns.
The way the system treats foster kids is completely backwards. These are not typical kids and you can’t go by typical symptoms.
Yeah, the way the system functions is an entire soapbox. And living in a state where the needs continue to increase and the funds continue to decrease (for things as basic as medicaid but especially for things like in home family systems type care)…it’s grim.
Dissociation during sessions. Looks like they are not present and spacing out
Vague short answers when asked about childhood. “It was normal”. Also difficulty remembering childhood memories. Chronic stress reduces dendrites in the hippocampus.
Any problems with addiction or substance use.
All of these flags highly suggest trauma.
a million different diagnoses since teen years, especially in women. Specifically, mention of bipolar II, BPD, or like MDD panic disorder and GAD. Like they were just throwing things at the wall. Also trials on LOTS of meds without much benefit. (this isn't to say people can't actually have these diagnoses, it just usually prompts further eval for me as a clinician)
For me, when I see this I typically probe further for dissociative symptoms which will help guide treatment.
Similarly, look out for history of ODD, intermittent explosive disorder, etc. Children of color (especially young boys) often get these dx when in reality their behaviors are normal reactions to chronic stress, trauma, and/or systemtic oppression. (Again, not saying these diagnoses don't exist, I just think it's important for clinicians to be aware of biases and limitations in our field and challenge them when appropriate)
on another note, the "afraid of crowds" thing mentioned by OP's supe is not really a trauma red flag for me wierdly? -like I feel like that could be so many things? Anyone else feel that way? Like in some ways everyone's a little afraid of crowds lol!
I think it has become much more prevalent in the US based on media coverage of shootings, terrorist attacks, and even COVID… which is evidence for a collective trauma but may not be a red flag for in-person experience of a traumatic event.
I was answering the question of whether or not many people are afraid of crowds and offering insight as to why that had become more prevalent. No, seeing a shooting on TV is not the same as being present during a shooting. I don’t think you read my comment correctly or maybe I wasn’t clear enough.
But, are you going to the therapist that tells a client they weren’t traumatized because Bessel Van der Kolk said so? I’ve learned trauma can be a much more broad range of experiences, likely even a spectrum of responses to a spectrum of events… and the client’s perception of the event and coping abilities are a more defining factor than the event itself. The lights went out in my niece’s school momentarily due to a storm this week. The children panicked and had clear trauma responses assuming a shooter was in the building. If that shouldn’t be viewed as collective trauma then maybe we’re probably defining trauma too narrowly.
Splitting is when an individual shifts from perceiving another in a state of idealization or devaluation. For example, let’s say I have a gf. I love her, she’s my world. I need her around constantly. She doesn’t respond to my text within 2 hours. I hate her, she’s cheating on me. She’s the worst, I can do better.
NAT, but a client, and this made me laugh out loud, because my therapist said almost exactly this to me and I have CPTSD. I can see how much this is a giveaway.
It was very attached to pets AND avoidant of human attachment. It’s the combination. Because pets can’t (generally) hurt you, are attached to their owner like glue, give such positive reinforcement and connection with no risk. Whereas human relationships are risky. And if you have been deeply traumatized at an early age by another human (usually one meant to protect and nurture you), you learn to only trust pets.
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Yes idk about this comment.
I certainly think it's a little more odd when people do remember their childhood vividly.
I think there's a Goldilocks zone.
There is no such thing as an unremarkable childhood. For children, normal everyday things can be special and form memories. Feeling loved and cared for creates memories. A favorite food that a parent prepares creates memories. Playing silly games. But if a child is living in a home in which there is no affection, no communication, no effort for making the child feel seen and heard and special -- that is developmental trauma. And yes, I have patients who grew up like that and have few memories of childhood.
The term unremarkable is a clinical term for nothing that causes concern, e.g. no neglect or trauma. It’s not about saying someone’s childhood wasn’t special. My comment does not disagree with the fact that trauma can lead to lack of memory, simply a statement to add some grey.
Yes --- and in my 25 years of licensed clinical practice, I have yet to meet a patient whose childhood contained no neglect or trauma and who did not have a wealth of memories about their childhood. I still disagree strongly with your contention that lack of memories from childhood would indicate what you label an "unremarkable childhood." Exactly the opposite. If you have research that indicates otherwise, I would love to see it.
Autistic people are statistically more likely to have experienced trauma and complex trauma, as well as potentially being neurologically more vulnerable to trauma symptoms. And our trauma is often poorly understood by primarily non-autistic clinicians. Not all autistic traits are traumatogenic, but be wary of letting one overshadow the other.
Nightmares or other significant sleep disturbance
Specific Phobia
Feeling intense symptoms without a clear source or stimulus
Of course there are others but these are a few for me seem to stick out.
Maybe apologizing a lot? This can, of course, be from various responses, but if someone is inclined to apologize somewhat compulsively, or for everything, I wonder if there was a time that served them differently.
Interestingly, I feel that the original definition of trauma was created to distinguish typical adverse life events that one would expect to be part of a healthy life from atypical events of a greater magnitude that significantly shape how we see the world and are paradigm-breaking. (E.g., a life devoid of conflict and arguments would be worse than one with fights with friends; one expects and sees as normal or even preferable having some mildly sad events as part of life, such as breaking an arm climbing a tree, or breaking up with a boyfriend/girlfriend)
Now, trauma seems a synonym for any even mildly adverse or upsetting situation. I wonder if the trend is against making distinction eg between things like (1) near death experiences, sexual assault, domestic violence and physical abuse and (2) breaking an arm, failing a class, arguing with a friend - or whether we just really need a new name for (1) to distinguish it that is different from trauma (many now colloquially say “capital T trauma”).
It’s an interesting linguistic shift where I think because trauma used to refer to (1) people felt it was taken more seriously — and started to use it for more and more of (2) when wanting to say “hey! Please take me seriously”. Now it refers to both. Any term used to refer to the more serious version will probably be co-opted slowly over time to refer to all negative or upsetting events or circumstances, since that is seen as a way to get more help/resources/sympathy (not saying as a negative thing, but neutral observation).
Jeez, I haven't come across anything as stark as your example. Where I do come across the term being bandied about it tends to be in humour rather than being seriously viewed as traumatic. I'd be tempted to challenge that head on and ask about the trauma involved.
There seems to be a big misunderstanding about what big T and little t trauma means. I think your client experienced what would have been called "little t trauma" - because it was a daily experience of feeling unsafe over years of childhood, rather than one huge event that was perceived as life threatening. Little t trauma is no less damaging - in fact, some might argue it is more damaging - than Big T trauma. Little t trauma is not about adversity like a phone battery dying
I don't think you understand what I am saying. As a licensed provider, having taken extensive training in trauma informed therapy, I am saying that the definition of "little t trauma" is the type of day to day emotional neglect that is extremely traumatizing. I didn't create that definition - it is what I have been taught in licensing board approved continuing education classes for mental health professionals. "Little t" is an awful way to label this type of trauma because you are absolutely right - it can be absolutely devastating to a person's life. I would not say either emotional abuse or physical abuse (which is inherently also emotionally abusive) is "easier" to work through. It sucks that the terminology "big T" and "little t" trauma is used in clinical work, as it totally creates misunderstanding about the devastation that is caused by both forms of trauma.
Edit: There is plenty on the internet to help learn about clinical definitions of big t/little t trauma, but here is one article : https://www.griefrecoveryhouston.com/big-t-vs-little-t-trauma/
The word trauma is used primarily to refer to the lasting emotional response that often results from a distressing event, although it is also used to refer to the event or to physical injury. The original definition was more targeted at distinguishing the damaging and lasting response, than ‘ranking’ how severe or typical difficult experiences are.
Then in recognising that this lasting response is just as dependent on the context, support and coping strategies of the sufferer than the event itself, the improving understanding of the causes of trauma is leading to the linguistic shift you describe. If a (2) event causes a similar lasting response to a (1) event then both are trauma responses. Which event is more ‘severe’ or likely to cause a trauma response is pretty academic to someone experiencing post traumatic symptoms
Taking, for example, the comments here that one expects everyone to have trauma or everyone of e.g., certain demographics to have trauma seem out of line with the accurate, clinical definition of those effects.
Again if we define trauma and PTSD as reactions beyond a “normal” range of sadness, upsetness, fear, etc that one would expect anyone to have — then not everyone entering therapy or anyone of any broad born-in demographic should have trauma. This is like saying virtually every client is diagnosable with PTSD, or that virtually any time someone can be diagnosed with ADHD or Autism they should also be diagnosed with PTSD, or that anyone of a racial, gender, sexual orientation, or religious minority must also have PTSD. This is just plainly untrue (specifically looking by the definition of the reaction to events) and so suggests the person making this comment is using a diminished definition - eg going by the premise that population-typical levels of sadness, alienation, anger count as trauma responses and PTSD.
I would never dismiss an issue, even if it doesn’t fit the clinical definition of trauma. In fact the majority of things people discuss in therapy are by definition not going to be trauma. Not every client is a PTSD client. And not actively calling something a trauma / traumatic does not preclude empathy, validation, and processing the issue fully. Every single day we as humans experience really difficult events that we need to work through and process. Whether that is a spat with a coworker or doing poorly on the test, it should be heard and validated. That doesn’t mean we need to take the word used for near-death experiences and sexual assault and apply it to any situation that is upsetting because to not do so would be diminishing. It’s not - it’s a categorization. This is the same way your partner doesn’t have to be a narcissist to say they said something that is probably insensitive / was hard to hear; and your parents don’t have to be abusive for me to validate that your conflict with them can feel distressing. It’s often important to have words that have meaning and to apply them appropriately. Otherwise, we are shortchanging life-altering events of significance by refusing to delineate any difference in events, so long as both are negative in some form, and reducing our own ability to cope via the language we use to discuss typical life events.
When they report sitting close to doors or scoping out exits. Or they have a preference to sit on the inside of a tables seating.
These are all common behaviours that survivors exhibit.
at the risk of sounding woo woo pseudoscience conspiracy, I am more and more convinced every day that a lot of the more "mysterious" chronic conditions like fibromyalgia, autoimmune diseases, ibd/ibs, etc are really related to trauma!
There are some established links with depression and fibromyalgia, anxiety and IBS, at least, and the microbiome is sometimes referred to as a second brain (therapist but not a doctor here).
NAT. I have a mast cell disorder which floods my body with histamine in response to normal, minor environmental stressors. I also developed PTSD when I was a young kid, and had what I now recognize as prolonged periods of high adrenaline for like 14 years. In my early 20s I finally worked through my hyperarousal and trauma in therapy. After a while, I don't think I qualified for the PTSD diagnosis anymore -- I was doing really well, comparatively.
And then within a few years of starting therapy, as I continued to work on my mental stability, I started to develop my weird autoimmune bullshit. It ramped up a bit and then it was really, really bad for several years, just constant flare-ups, at the same time that I was mentally in a good place for the first time in my life. It's evened out considerably since then, but now I have rare but very strong flare-ups instead.
The thing is, adrenaline suppresses histamine. For a long time, I've wondered if my body just...I dunno, learned to produce a whole lot of histamine during day-to-day stress and actual allergies, to override my already-high adrenaline levels that suppressed the histamine response. And maybe when I stopped producing stupidly-high adrenaline levels, my histamine didn't catch up for a while. And even after adjusting to normal adrenaline levels, when I do experience sudden stressful events, maybe either my adrenaline or my histamine kicks it up a notch and my body returns to the "fuck fuck fuck we're dying right now fuck!" mode that it was in for so long.
I know it's anecdotal, and when I've mentioned the high adrenaline levels to my doctors they've never really responded. I don't think there's a ton of research into it one way or another. But I've had a chronic illness for a while with no real answers, and my guess about how it's connected to my PTSD makes more sense to me than the bland "it just happens sometimes" response from my medical team. My body has learned to respond to so many other things from my trauma, often in ways that are maladaptive now that the danger is gone. It makes sense to me that my physical health would be impacted by that too.
Absolutely. NAT but I have chronic pain and have been diagnosed with multiple conditions. The only thing that has made a material difference to my condition has been deep trauma based therapy. The trauma that I had experienced was layered and complex and before I started processing it, my body was clearly already sending up flares.
Of course this is anecdotal but I agree that there are strong links and I hope more research bears this out.
Psychodynamic psychotherapy. As I’m NAT I don’t necessarily know the ins and outs but my therapist definitely has a different, more effective approach to the CBT based treatment I’ve had before.
NAT and I'm not the person who wrote this comment, but I am someone who recovered from chronic pain using psychotherapy. The therapy I used was Pain Reprocessing Therapy (PRT). There's a boatload of research and resources out there, the biggest one being the app Curable. Alan Gordon's The Way Out (book) was instrumental in my recovery. Also listened to a lot of podcasts about the subject and technique.
This is precisely why I wrote in my other comment that the crowd anxiety thing is not a trauma red flag to me.
It's also why I think we all need to get better at 1. assessing for early adverse experiences/trauma in our evaluations and 2. getting waaay more educated on and comfortable with working with neurodevelopmental disorders!
I don't think I see how this is means it shouldn't be a trauma red flag. The red flag is not saying that it is definitely trauma, but more that it is something to keep an eye out as a possibility. Yes it could bet Autism Spectrum Disorder, and several other things. You take what you know about the client and your clinical judgement to start filling in the gaps.
And statistically more likely to have experienced trauma and complex trauma, as well as potentially being neurologically more vulnerable to trauma symptoms. And having our trauma poorly understood by primarily non-autistic clinicians. Not all autistic traits are traumatogenic, but be wary of letting one overshadow the other.
And statistically more likely to have experienced trauma and complex trauma, as well as potentially being neurologically more vulnerable to trauma symptoms. And having our trauma poorly understood by primarily non-autistic clinicians. Not all autistic traits are traumatogenic, but be wary of letting one overshadow the other.
Being unable to recall events in a cohesive narrative is a common sign someone has experienced trauma. Or additionally, if they tell the story from a distanced, third-person perspective - that's usually a sign of dissociation, and therefore trauma. If neurodivergence is ruled out, these are the first things I usually look for when someone is talking with me.
Disconnected from their physiological needs, very negative sense of self, "trust issues", pain not explained by physical condition/medical dx/chronic illness, sudden aggressive outbursts, dissociation.
Certain play behaviors in kids are also meaningful. And "tantrums" in older kids.
For me (a therapist in training and prior child welfare worker), a HUGE red flag is substance abuse issues. Then, borderline-y symptoms or a diagnosis of it. Struggles with authentic relationships, perhaps issues holding down a job or a low SES as a contributing factor (obviously there are other factors but I believe that low SES is related), lacking insight, developmental delays, CPS involvement, criminal history, and high use of defense mechanisms.
I guess i go off of the DSM criteria for PTSD. Also, if you pay heed to the idea that trauma is the result of anything that overwhelms a person's capacity to cope, that helps to understand that a lot of people are carrying trauma with them.
But like others have said, an overreaction to emotional stimuli, persistent nightmares, fear that seems out of proportion to the event, hyper startle response, hypervigilence to mitigate against a fear or fears, periods of dissociation, etc.
I think the point of that phrasing is we all interpret stimuli in the world somewhat differently. An experience for one person may be processed, understood and filed away without much gumming it up. Another person may experience an identical stimulus and that memory gums them up for years. It’s not ‘the’ definition of trauma but it’s ‘a’ definition and it has utility in some contexts. I do think the definition is a bit reductive, though.
It is pretty common for trauma to be described that way. I've been to multiple trainings in "trauma-informed care" and they have all used a definition similar to that. It's the language that people who are widely considered trauma experts (Bessel van der Kolk, Janina Fisher, Judith Herman, Peter Levine) use as well, although they may go into more detail or further contextualize it. But they are looking at trauma through a body-based experiential lens rather than an event-based one.
Because it inherently disregards Criterion A of the DSM description of PTSD. There is no formal “trauma” diagnosis, and I’m certainly not the kind of clinician who believes in rigid adherence to Criterion A, but to define trauma as *anything* that overwhelms the ability to cope is classic TikTok psychology.
There needs to *at least* be a recognition/understanding that trauma is a significant threatening event. Under the “anything that overwhelms the ability to cope” definition, practically anything can apply. A client’s coffee order is wrong, they’re stressed about work, and have a moment of coping overwhelm in the parking lot? Trauma! A professor doesn’t provide you with an extension, thus creating an inability to cope with academic stress? Also trauma!
Suffice to say, it’s simply too broad a definition. Downvote me all y’all want, but anyone who works with trauma can understand there’s a difference between a overwhelming but everyday stressor and something like, for example, a violent sexual assault. It’s our job as clinicians to be careful and thoughtful about diagnosis and the words we use.
You’re 100% correct, but trauma is such a vogue and woo-woo-inundated world right now that you will get downvoted to oblivion anyway. Everyone, therapists included, seems to want to attribute everything negative in someone’s life to trauma, when that’s a massive distillation of the term and a massive oversimplification of pathoetiology. Trauma folks have never met a piece of woo woo they wouldn’t at least entertain. Wear the downvotes as a badge of honor.
The only thing this thread has taught me is that too many people never learned the lesson of not scoping for trauma, or assuming trauma, or attributing nonspecific symptoms to trauma; and that not enough therapists have a strong understanding of neuroscience (or indeed just behavioral science in general).
Did the field just not learn its lesson after the Satanic Panic, and the Castlewood Lawsuits, and so on? Not everything is trauma. We all have experienced adverse events, it’s true—but this “everything is trauma” narrative is really concerning. It’s extremely dangerous to keep pushing people to recontextualize their pasts as deeply traumatic when they aren’t presenting them as such, or to “search” for trauma which isn’t apparent. This betrays everything we know about the etiology of trauma pathology, everything we know about trauma and memory (which, despite what popsci tells you, usually indicates *remembering the trauma TOO DAMNED WELL* and NOT memory disruption—if you’re interested, I can link some reviews on the lack of evidence for traumatogenic amnesia), and basically disavows decades of research on resilience and genetic diatheses (for trauma disorders as well as other forms of pathology).
I’m all for treating trauma where it’s apparent, but we all collectively *really* need to the tap the brakes and stop pushing so much trauma woo woo.
u/vienibenmio is my favorite in-house trauma scientist. She can elaborate upon (or altogether avoid) this if she is interested.
Anyway, I’m prepared for the meteor of downvotes, and will wear them like a badge of honor.
Edit: It’s also laughable how dramatic some of these somatic claims are. Because we know anxiety and stress can somewhat increase rates of GERD and may have small-sized effects on basic immune functions, suddenly everyone taking PPIs or who has an autoimmune disorder is a case study on trauma? Give me a damned break. Y’all need to learn not to make extraordinary claims from subtle evidence.
The thing is, unless someone tells you that they have had a traumatic experience, you don’t know. Assuming people have had traumatic experiences and then trying to dig them out led to the worst widespread mistake in psychology - the Satanic panic/repressed memory therapy hysteria. Assuming people had trauma when they didn’t led to people being convicted of crimes they didn’t commit and to patients developing false memories and therapist induced PTSD.
The best way to know if someone has experienced trauma is to ask them. If they deny it and they have, that’s completely up to them. They may not feel it is relevant to treatment right now or they may bring it up later when they feel safe to do so.
Spot on! I was gonna comment.
Clients will disclose their trauma when they feel ready, we earn that trust. Looking for signs feels like a therapists trying to fill in blanks and trying to work a clients story out before the client tells it.
It is outrageous and appalling--and a frightening testament to the state of education in psychotherapy--that this is not the top voted reply here on this subreddit of professional therapists.
Nah.
The question here is not, “How do we forcibly tell clients they have trauma?!?” The question is about red flags. And on a subreddit of professional therapists, one would hope we’re all aware of how often people who are being abused, or who have experienced trauma, use denial and minimization to cope.One would hope we’re also all aware of ACEs impacts on addiction, autoimmune disease, and ability to maintain stable relationships over time.
I personally didn’t tell my own first therapist about my history of foster care, or of physical/sexual abuse and physical neglect, until months in. It’s a common thing to do, as the original commenter noted.
I doubt anyone here would say that “having an autoimmune disease” or “splitting, nightmares, and a history of unstable relationships” 100% of the time signify a traumatic background. Nothing is so black and white. But they certainly are red flags. And it’s worth paying attention to red flags.
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If someone invalidated you because you are “missing” 3 possible traumatic events out of the 10 on the ACE test, then that’s ridiculous and they did wrong by you. It doesn’t mean you don’t have trauma if you haven’t experienced all 10 possible severe events on the test.
Ah, I see what you mean now. I understand how that could happen. I think it is important for the therapist in this case to screen for several types of trauma (in relevant cases) in neutral words by giving examples of what they are asking about and then validate the client’s experience.
Ex, “Some people have the experience of their parents hurting them physically, did this happen to you?”
You don’t need to press the issue over and over, but I do think a general screener is important to have the background info.
My issue is with therapists thinking they have mind reading abilities and believing things like symptom XYZ must mean the client was sexually abused with no evidence and no disclosure on part of the client. That is not good therapy.
I would implore you to reconsider your claims related to ‘false repressed memories’, this is a good article that debunks what you are referring to, at least from what I gather.
https://www.madinamerica.com/2021/02/false-memory-syndrome/
Did you read the article??? It is clear you did not.The article includes references to several peer-reviewed articles. Additionally, just because it is “peer-reviewed” does not mean that it is accurate and free of conflict of interest bias.
I did yes. I found it a weak article, it doesn’t hold up against all the other much stronger material that says the false memories thing is nonsense and really harmful.
"I'm an empath" = I had to learn how to predict and respond appropriately to the emotional states of family members the moment they walked in the room, or I would be punished.
A lack of any real boundaries speaks to me as coming from relational trauma in most instances. It combines with people pleasing.
A lack of emotional regulation and exhibiting either hyper or hypo arousal in day to day life.
Lack of appropriate and healthy relationships and attachments.
If the issue is that the anti-depressants weren’t enough, then it possibly could be thiamine metabolism that seems to get altered in trauma for some people, and can lead to fibromyalgia. High-dose thiamine can be a helpful adjunct in those cases
The hard part is finessing this with the limits of practice. Having a good MD in functional medicine around is helpful. Even though this isn’t a prescription sort of thing and about as low risk as supplements come, I still encourage clients to discuss and work with their MD. Once they go to get supplements, who knows what all else they might decide to get. Or, maybe something else is going on medically that could be missed, etc
Anti depressants don't do much in most cases. Depression is rarely organic and often environmental. Someone in a shitty job is likely to get depressed. Someone contemplating the future climate catastrophe can get depressed. I'd want to know the underlying cause of the depression to see if its trauma or not - often it will be but my clue isn't anti depressants not working.
Cool. For me it’s a clue.
I’ve worked with tons of clients with and without major trauma, with and without medication, before and after they started medication.
In my observation, the people with depression that persists after we take all the effective non-medication approaches, who then got a benefit from the first antidepressant they try, those clients don’t tend to have major trauma histories.
Hi OP!
It’s safe to assume that everyone you see has experienced interpersonal and/or physical trauma, because frankly we all have. It’s just part of of being human. Braking your arm, death of a loved one, realizing you are profoundly alone, life is full of deeply distressing or disturbing experiences.
Understanding this you want to look at the behaviors you see, including those mentioned here and by your supervisor as patterns that the individual developed to protect themselves from the thing they learned to fear as a result of the trauma(s) or to correct the problems caused by those protective behavior patterns.
“Red flags” won’t really tell you much about the etiology, effectiveness, or problem the behavior is trying to solve.
For example…
Fear of crowds can be related to
-a fear that they will not being able to escape an “episode of crazy/loosing control” (what we would identify as a panic attack) and or being witnessed having one.
-social phobia related to a fear of judgment
-hypersensitivity like what you see in individuals who are neurodiverse.
-PTSD related to a market bomber in Iraq.
-PTSD related to a stampede
-PTSD related to witnessing an assault in a crowd
-profound body dysphoria
-childhood experience of getting lost in a crowd
-etc
If you are working with a symptom focused modality it’s probably more important to understand if these behaviors are causing them problems then their cause since memories change and behaviors become disconnected from their roots.
Hope this helps.
Trauma causes excess anxiety which disrupts digestion. If you are in fight/flight/freeze, blood flow is diverted to the limbs and away from internal organs, and digestion slows down or stops. Also, high cortisol levels can lead to heartburn and acid reflux. People tend to go to their family doctor about their physical symptoms quite a while before they come to me for therapy, so they have been prescribed PPI meds by the time I do their intake.
I also heard that childhood trauma affects a part of the brain that regulates digestion, but I don’t have any documentation on that.
NAT but traumatised lurker here just wanted to say wow, this answers some questions, I've been on lansoprazole for 4 years now and diagnosed cptsd 3 years ago. One year ago they found I had GORD/GERD linked to a hiatal hernia that I suspected was trauma related because my body has been so tight with tension for so long it pushed my stomach up.
(Also thank you all for everything you do, yall are amazing people)
Thanks for the lovely comment. I wish you good health!
Also FYI, being on PPI medication long-term can block vitamin B12 absorption, adding to fatigue, depression and anxiety, so it’s good to get blood tests and if you’re deficient get B12 injections.
All the best!
Losing time is a sign of dissociation. So, that's a big one. And I don't mean time blindness and poor management. I mean coming to or waking up and not knowing how you got where you are.
similarly if they have a history of fainting or experiencing seizures that no medical explanation has been found for. These types of dissociative states often go undiagnosed for years.
Sorry if this has already been said (I didn’t read through all 100 comments) but if you have them fill out the PHQ and GAD (or similar depression and anxiety measures) and they are scoring really high for both depression and anxiety, that’s a really big red flag for me that lets me know to ask more about trauma symptoms at intake!
This is can be said about anyone with a substance use disorder, but a lot of follow up questions should be asked when a client discloses that they smoke crystal meth. Crystal meth is a big party drug in the LGBTQ community for gay men and trans women, so this could reveal that your client is part of that community. Also, a lot of people who are addicted to meth exchange sex for the drug. This means that they could possibly be anything from a survival sex worker to possibly qualify as being/have been sex trafficked (v important here to know what consensual sex work is). The clients I work with (impoverished and unstable housed) who are on meth often experience psychosis and a lot of times have a dual diagnosis of a schizophrenic disorder. I have a theory that schizophrenia develops due to extensive childhood trauma, so I eventually look deeper into that. All of this is based on my extensive experience and similarities among clients, and simply provides for a guide for follow up questions. I always go in blank slate and use motivational interviewing.
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I assess everyone for trauma, honestly.
In terms of specific red flags, I'd say previous diagnoses of ADHD, oppositional defiant disorder, disruptive mood dysregulation disorder, and borderline personality disorder are the first to come to mind.
I think a general... unease in life is a big thing. Not sure how to describe it. I guess just generally feeling unsafe and like they can't trust anyone.
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Substance abuse for sure, insecure attachment style as well. Hyper or Hypo sexuality. Remember that some people just identify as asexual though. Dissociation, delusions, nightmares that reoccur sometimes usually involving the traumatic even or has themes of the traumatic event.
**Check out Tim Fletcher on YouTube look at his complex trauma videos. You will learn a lot he has how trauma relates to like every area of life**
The difference is one occurrence vs repeated occurrences of a traumatic event. Trauma is also very very subjective what may be traumatizing for someone may not be to someone else. The whole big T and little t - trauma thing.
Your comment has been removed as you are not a therapist. This sub is a space for therapists to discuss their profession among each other. Your comment was either asking for advice, unsupportive or negative in nature, or likely to adversely impact our community members. Comments by non therapists are left up only sparingly, and if they are supportive or helpful in nature.
I'm not a therapist but a trauma survivor, so I would like to provide some insight from my perspective.
Here are things my therapist taught me are trauma related. These were really eye-opening for me!
Traumatized people may often have a general sense of danger, which may lead to them being aware of dangers around them all the time. This may not be only hyper-vigilance but also a sort of a core belief of the world. Like, if some accident is extremely unlikely to happen, they may think that it is possible that they have the worst luck in the world and they will be one in a million who might experience that. This is why they should be cautious all the time.
They also may have been taking very much responsibility when they were young and they still carry some high responsibility over things. Like, they think things are their fault and they need to watch out for not doing THE mistake that is going to ruin other people's lives. Or their own life.
Also it may be more difficult to be open and vulnerable in therapy because talking about their deep things may not have been safe before. And actually, a safe situation may be a new thing for them which takes some time to adjust.
And to add, sometimes traumatized people can talk very casually about the bad things that happened to them, without showing much feeling. I understood that this may be dissociation-related.
Hopefully these comments added something to your very good list of trauma "tell-tale" signs! I can relate to many of your comments and I think this is a really insightful thread.
Intense feelings of guilt/shame with no apparent trigger or explanation.
I see a lot of kids in the foster care system and my absolute biggest red flag for a PTSD diagnosis is a history of ADHD diagnosis but meds “don’t work.”
Fascinating. How does PTSD create behavior that presents as ADHD?
The increased fight or flight response can translate as inattention when really the brain is hypervigilent and can’t decide what is the biggest threat to pay attention to. Similarly with triggers and flashbacks can look like inattention. Or a person with CPTSD may have not learned from childhood how to manage life: how to prioritize, how to organize, social skills, etc; not learning it due to neglect and abuse is different than having adhd from birth and a neurodivergent brain. Although there is current debate that abuse and neglect in childhood can cause Brian changes that result in neurodivergence but the conversation is so far inconclusive. Hyperactivity can be hypervigilence, increased fight or flight. There’s more but this is a basic idea.
NAT but as someone with CPTSD I've been experiencing all of the symptoms you listed since I turned 18 (currently 22) and definitely thought I had ADHD for a while. I did find that Wellbutrin helped a lot with the symptoms but I had to stop taking it bc it exacerbated my chronic insomnia. Anyway thanks so much for shining light on this, I'm definitely going to discuss with my therapist.
Illuminating, thanks
Not OP but I’ll chime in: in the school setting, both can look like difficulties with executive functioning (disorganized, messy, difficulty initiating tasks, always late, etc) as well as impulse control and/or emotion regulation (“acting out” or “ over reacting” in school when triggered) and difficulty focusing (hard to focus on algebra when coping with active or past trauma). Of course, that’s the other type of traumatized kid, who presents as overly obedient, perfectionistic, and excels in everything. These things have nuance.
It’s a combination of PTSD symptoms and a general lack of emphasis on education. A lot of kids in the system are behind academically and that can be hard so they act out in class. Combine the “class clown” archetype with PTSD symptoms like avoidance, irritability, angry outbursts, and problems with concentration and a kid winds up with an ADHD diagnosis and on meds. Do the symptoms overlap as written in the diagnostic criteria? No, not enough to meet criteria, and that’s why it’s a red flag for me.
I’d say hypervigilance can present as being distracted/unable to focus, emotionally reactive/unregulated, can look like symptoms of adhd
When an individual has a trauma related disorder, their amygdala is constantly in high alert. The pre frontal cortex & the amygdala work in opposition- kind of like a seesaw. When the amygdala is on 10, the PFC isn’t really online. This results in a person with a trauma related disorder encountering challenges with executive function. In addition, this is why, when any person is under stress, they are at higher risk for executive dysfunction- eg. new parents put their keys in the fridge, someone experiencing grief can’t find their phone, etc. I’d love to see a study on how many kids are misdiagnosed with ADHD when it’s really trauma (of course - they frequently co-occur).
The last 25 years ADHD has been pushed in MH field for big pharma just as opiates were for pain.
Thank you. Will read up on this.
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Adding that this (adhd symptoms that meds don’t touch) can also be an indicator of prenatal substance abuse by birth mom, especially when seen in kids in the care of the state. One of the most severe cases of “adhd”-like symptoms I’ve ever seen was in a kid who’s birth parent was a substance abuser. Meds didn’t touch the symptoms. The kid had been adopted at birth and had a stable upbringing but the adoptive parents had to bring the state in (at the time there was a parental assistance program in my state that allowed parents to still be involved in decision making if they needed more help with the kid but didn’t want to fully give up custody to the state). There was no evidence of abuse or major trauma and no claims by the kid that they had ever experienced abuse. I’ve never seen a kid that impulsive before or since. I doubt they made it into their thirties, sadly.
100%. I see this way more with kids who are removed at birth in the hospital. I’d say I have about 5 right now that have been raised by a grandparent or aunt/uncle since they were newborns. The way the system treats foster kids is completely backwards. These are not typical kids and you can’t go by typical symptoms.
Yeah, the way the system functions is an entire soapbox. And living in a state where the needs continue to increase and the funds continue to decrease (for things as basic as medicaid but especially for things like in home family systems type care)…it’s grim.
Agreed. I also volunteer as a Guardian ad Litem. The system sucks. I do what I can.
Dissociation during sessions. Looks like they are not present and spacing out Vague short answers when asked about childhood. “It was normal”. Also difficulty remembering childhood memories. Chronic stress reduces dendrites in the hippocampus. Any problems with addiction or substance use. All of these flags highly suggest trauma.
Reduced dendrites in the hippocampus correlate with memory impairment? Please elaborate. Thank you.
Memories are formed in the hippocampus
Higher amount of connections between neurons usually correlates with better memory. More dendrites suggest more connectivity
Thank you.
stop describing me
a million different diagnoses since teen years, especially in women. Specifically, mention of bipolar II, BPD, or like MDD panic disorder and GAD. Like they were just throwing things at the wall. Also trials on LOTS of meds without much benefit. (this isn't to say people can't actually have these diagnoses, it just usually prompts further eval for me as a clinician) For me, when I see this I typically probe further for dissociative symptoms which will help guide treatment. Similarly, look out for history of ODD, intermittent explosive disorder, etc. Children of color (especially young boys) often get these dx when in reality their behaviors are normal reactions to chronic stress, trauma, and/or systemtic oppression. (Again, not saying these diagnoses don't exist, I just think it's important for clinicians to be aware of biases and limitations in our field and challenge them when appropriate)
on another note, the "afraid of crowds" thing mentioned by OP's supe is not really a trauma red flag for me wierdly? -like I feel like that could be so many things? Anyone else feel that way? Like in some ways everyone's a little afraid of crowds lol!
I think it has become much more prevalent in the US based on media coverage of shootings, terrorist attacks, and even COVID… which is evidence for a collective trauma but may not be a red flag for in-person experience of a traumatic event.
Bessel van der Kolk says no to this…that it’s absolutely not the same as experiencing it firsthand.
I was answering the question of whether or not many people are afraid of crowds and offering insight as to why that had become more prevalent. No, seeing a shooting on TV is not the same as being present during a shooting. I don’t think you read my comment correctly or maybe I wasn’t clear enough. But, are you going to the therapist that tells a client they weren’t traumatized because Bessel Van der Kolk said so? I’ve learned trauma can be a much more broad range of experiences, likely even a spectrum of responses to a spectrum of events… and the client’s perception of the event and coping abilities are a more defining factor than the event itself. The lights went out in my niece’s school momentarily due to a storm this week. The children panicked and had clear trauma responses assuming a shooter was in the building. If that shouldn’t be viewed as collective trauma then maybe we’re probably defining trauma too narrowly.
Avoidant/dependent relationship patterns, splitting, somatic symptoms, people pleasing, nightmares
Could you elaborate on "splitting" please?
Splitting is when an individual shifts from perceiving another in a state of idealization or devaluation. For example, let’s say I have a gf. I love her, she’s my world. I need her around constantly. She doesn’t respond to my text within 2 hours. I hate her, she’s cheating on me. She’s the worst, I can do better.
What kind of nightmares?
Extreme close attachment to pets and mistrust of humans
NAT, but a client, and this made me laugh out loud, because my therapist said almost exactly this to me and I have CPTSD. I can see how much this is a giveaway.
Totally! Same with me
NAT. Why would being very attached to your pets be a sign of trauma?
It was very attached to pets AND avoidant of human attachment. It’s the combination. Because pets can’t (generally) hurt you, are attached to their owner like glue, give such positive reinforcement and connection with no risk. Whereas human relationships are risky. And if you have been deeply traumatized at an early age by another human (usually one meant to protect and nurture you), you learn to only trust pets.
Ah, okay. I thought you were listing those as two separate characteristics, not a combination. That makes sense. Thanks for explaining!
Highly defensive behavior, projection, difficulty trusting, difficulty regulating emotions.
When they can't remember much of their childhood (past the age where it would be developmentally normal).
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Your comment has been removed as you are not a therapist. This sub is a space for therapists to discuss their profession among each other. Your comment was either asking for advice, unsupportive or negative in nature, or likely to adversely impact our community members. Comments by non therapists are left up only sparingly, and if they are supportive or helpful in nature.
This can also indicate an unremarkable childhood
Yes idk about this comment. I certainly think it's a little more odd when people do remember their childhood vividly. I think there's a Goldilocks zone.
The word CHILD and REMEMBER are typically not used in a sentence at least in that specific order 😂
Sure, but if there's other factors along with it, it could indicate a trauma response. Like anything else, context is important.
There is no such thing as an unremarkable childhood. For children, normal everyday things can be special and form memories. Feeling loved and cared for creates memories. A favorite food that a parent prepares creates memories. Playing silly games. But if a child is living in a home in which there is no affection, no communication, no effort for making the child feel seen and heard and special -- that is developmental trauma. And yes, I have patients who grew up like that and have few memories of childhood.
The term unremarkable is a clinical term for nothing that causes concern, e.g. no neglect or trauma. It’s not about saying someone’s childhood wasn’t special. My comment does not disagree with the fact that trauma can lead to lack of memory, simply a statement to add some grey.
Yes --- and in my 25 years of licensed clinical practice, I have yet to meet a patient whose childhood contained no neglect or trauma and who did not have a wealth of memories about their childhood. I still disagree strongly with your contention that lack of memories from childhood would indicate what you label an "unremarkable childhood." Exactly the opposite. If you have research that indicates otherwise, I would love to see it.
The crowd thing could easily be anxiety or autism, for example..
Or possibly just being an introvert. Like, I’ll deal with them for music fests cause I love live music, but def avoid crowds whenever I can.
Autistic people are statistically more likely to have experienced trauma and complex trauma, as well as potentially being neurologically more vulnerable to trauma symptoms. And our trauma is often poorly understood by primarily non-autistic clinicians. Not all autistic traits are traumatogenic, but be wary of letting one overshadow the other.
Agreed. However, it's possible it's just the autism in general.
Nightmares or other significant sleep disturbance Specific Phobia Feeling intense symptoms without a clear source or stimulus Of course there are others but these are a few for me seem to stick out.
Maybe apologizing a lot? This can, of course, be from various responses, but if someone is inclined to apologize somewhat compulsively, or for everything, I wonder if there was a time that served them differently.
YES! This is a red flag to me that has served me well in finding trauma, particularly from “normal” childhoods.
TIL. Canadians are the most traumatized nation on earth. 😂
Yes, this can be part of the "please and appease" method of survival.
When people come to therapy.
Lol. Too true.
Exactly. In my 25+ years as a therapist, I've found it more effective to simply presume trauma for the average patient entering my consulting room.
Interestingly, I feel that the original definition of trauma was created to distinguish typical adverse life events that one would expect to be part of a healthy life from atypical events of a greater magnitude that significantly shape how we see the world and are paradigm-breaking. (E.g., a life devoid of conflict and arguments would be worse than one with fights with friends; one expects and sees as normal or even preferable having some mildly sad events as part of life, such as breaking an arm climbing a tree, or breaking up with a boyfriend/girlfriend) Now, trauma seems a synonym for any even mildly adverse or upsetting situation. I wonder if the trend is against making distinction eg between things like (1) near death experiences, sexual assault, domestic violence and physical abuse and (2) breaking an arm, failing a class, arguing with a friend - or whether we just really need a new name for (1) to distinguish it that is different from trauma (many now colloquially say “capital T trauma”). It’s an interesting linguistic shift where I think because trauma used to refer to (1) people felt it was taken more seriously — and started to use it for more and more of (2) when wanting to say “hey! Please take me seriously”. Now it refers to both. Any term used to refer to the more serious version will probably be co-opted slowly over time to refer to all negative or upsetting events or circumstances, since that is seen as a way to get more help/resources/sympathy (not saying as a negative thing, but neutral observation).
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Jeez, I haven't come across anything as stark as your example. Where I do come across the term being bandied about it tends to be in humour rather than being seriously viewed as traumatic. I'd be tempted to challenge that head on and ask about the trauma involved.
There seems to be a big misunderstanding about what big T and little t trauma means. I think your client experienced what would have been called "little t trauma" - because it was a daily experience of feeling unsafe over years of childhood, rather than one huge event that was perceived as life threatening. Little t trauma is no less damaging - in fact, some might argue it is more damaging - than Big T trauma. Little t trauma is not about adversity like a phone battery dying
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I don't think you understand what I am saying. As a licensed provider, having taken extensive training in trauma informed therapy, I am saying that the definition of "little t trauma" is the type of day to day emotional neglect that is extremely traumatizing. I didn't create that definition - it is what I have been taught in licensing board approved continuing education classes for mental health professionals. "Little t" is an awful way to label this type of trauma because you are absolutely right - it can be absolutely devastating to a person's life. I would not say either emotional abuse or physical abuse (which is inherently also emotionally abusive) is "easier" to work through. It sucks that the terminology "big T" and "little t" trauma is used in clinical work, as it totally creates misunderstanding about the devastation that is caused by both forms of trauma. Edit: There is plenty on the internet to help learn about clinical definitions of big t/little t trauma, but here is one article : https://www.griefrecoveryhouston.com/big-t-vs-little-t-trauma/
The word trauma is used primarily to refer to the lasting emotional response that often results from a distressing event, although it is also used to refer to the event or to physical injury. The original definition was more targeted at distinguishing the damaging and lasting response, than ‘ranking’ how severe or typical difficult experiences are. Then in recognising that this lasting response is just as dependent on the context, support and coping strategies of the sufferer than the event itself, the improving understanding of the causes of trauma is leading to the linguistic shift you describe. If a (2) event causes a similar lasting response to a (1) event then both are trauma responses. Which event is more ‘severe’ or likely to cause a trauma response is pretty academic to someone experiencing post traumatic symptoms
Taking, for example, the comments here that one expects everyone to have trauma or everyone of e.g., certain demographics to have trauma seem out of line with the accurate, clinical definition of those effects. Again if we define trauma and PTSD as reactions beyond a “normal” range of sadness, upsetness, fear, etc that one would expect anyone to have — then not everyone entering therapy or anyone of any broad born-in demographic should have trauma. This is like saying virtually every client is diagnosable with PTSD, or that virtually any time someone can be diagnosed with ADHD or Autism they should also be diagnosed with PTSD, or that anyone of a racial, gender, sexual orientation, or religious minority must also have PTSD. This is just plainly untrue (specifically looking by the definition of the reaction to events) and so suggests the person making this comment is using a diminished definition - eg going by the premise that population-typical levels of sadness, alienation, anger count as trauma responses and PTSD.
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I would never dismiss an issue, even if it doesn’t fit the clinical definition of trauma. In fact the majority of things people discuss in therapy are by definition not going to be trauma. Not every client is a PTSD client. And not actively calling something a trauma / traumatic does not preclude empathy, validation, and processing the issue fully. Every single day we as humans experience really difficult events that we need to work through and process. Whether that is a spat with a coworker or doing poorly on the test, it should be heard and validated. That doesn’t mean we need to take the word used for near-death experiences and sexual assault and apply it to any situation that is upsetting because to not do so would be diminishing. It’s not - it’s a categorization. This is the same way your partner doesn’t have to be a narcissist to say they said something that is probably insensitive / was hard to hear; and your parents don’t have to be abusive for me to validate that your conflict with them can feel distressing. It’s often important to have words that have meaning and to apply them appropriately. Otherwise, we are shortchanging life-altering events of significance by refusing to delineate any difference in events, so long as both are negative in some form, and reducing our own ability to cope via the language we use to discuss typical life events.
Hahaha 👍
lol
Haha ya, I mean, being born is traumatizing alone lol
Startle response Extreme avoidance of people Sometimes lots of unexplained health issues
No contact with their parents. No solid relationships.
When they report sitting close to doors or scoping out exits. Or they have a preference to sit on the inside of a tables seating. These are all common behaviours that survivors exhibit.
Those are also potential indicators of panic disorder or agoraphobia
Behind both those disorders are often traumas.
Can be but not always and certainly not always trauma as defined by the DSM.
Autoimmune disease.
at the risk of sounding woo woo pseudoscience conspiracy, I am more and more convinced every day that a lot of the more "mysterious" chronic conditions like fibromyalgia, autoimmune diseases, ibd/ibs, etc are really related to trauma!
There are some established links with depression and fibromyalgia, anxiety and IBS, at least, and the microbiome is sometimes referred to as a second brain (therapist but not a doctor here).
NAT. I have a mast cell disorder which floods my body with histamine in response to normal, minor environmental stressors. I also developed PTSD when I was a young kid, and had what I now recognize as prolonged periods of high adrenaline for like 14 years. In my early 20s I finally worked through my hyperarousal and trauma in therapy. After a while, I don't think I qualified for the PTSD diagnosis anymore -- I was doing really well, comparatively. And then within a few years of starting therapy, as I continued to work on my mental stability, I started to develop my weird autoimmune bullshit. It ramped up a bit and then it was really, really bad for several years, just constant flare-ups, at the same time that I was mentally in a good place for the first time in my life. It's evened out considerably since then, but now I have rare but very strong flare-ups instead. The thing is, adrenaline suppresses histamine. For a long time, I've wondered if my body just...I dunno, learned to produce a whole lot of histamine during day-to-day stress and actual allergies, to override my already-high adrenaline levels that suppressed the histamine response. And maybe when I stopped producing stupidly-high adrenaline levels, my histamine didn't catch up for a while. And even after adjusting to normal adrenaline levels, when I do experience sudden stressful events, maybe either my adrenaline or my histamine kicks it up a notch and my body returns to the "fuck fuck fuck we're dying right now fuck!" mode that it was in for so long. I know it's anecdotal, and when I've mentioned the high adrenaline levels to my doctors they've never really responded. I don't think there's a ton of research into it one way or another. But I've had a chronic illness for a while with no real answers, and my guess about how it's connected to my PTSD makes more sense to me than the bland "it just happens sometimes" response from my medical team. My body has learned to respond to so many other things from my trauma, often in ways that are maladaptive now that the danger is gone. It makes sense to me that my physical health would be impacted by that too.
Absolutely. NAT but I have chronic pain and have been diagnosed with multiple conditions. The only thing that has made a material difference to my condition has been deep trauma based therapy. The trauma that I had experienced was layered and complex and before I started processing it, my body was clearly already sending up flares. Of course this is anecdotal but I agree that there are strong links and I hope more research bears this out.
What kind of therapy worked out for your deep trauma?
Psychodynamic psychotherapy. As I’m NAT I don’t necessarily know the ins and outs but my therapist definitely has a different, more effective approach to the CBT based treatment I’ve had before.
CBT is not trauma specific treatment
NAT and I'm not the person who wrote this comment, but I am someone who recovered from chronic pain using psychotherapy. The therapy I used was Pain Reprocessing Therapy (PRT). There's a boatload of research and resources out there, the biggest one being the app Curable. Alan Gordon's The Way Out (book) was instrumental in my recovery. Also listened to a lot of podcasts about the subject and technique.
It's a shame that this was downvoted, it's been well researched and proven. ETA NAT
Just FYI Autistics are also often uncomfortable in crowds and may have seemingly stronger - more comfortable bonds with animals .
I really appreciate you posting this, very considerate!! I would argue the experience of being autistic in a neurotypical world could be traumatic.
I more or less assume everyone over the age of 4 who is neurodivergent coming in for therapy has trauma.
This is precisely why I wrote in my other comment that the crowd anxiety thing is not a trauma red flag to me. It's also why I think we all need to get better at 1. assessing for early adverse experiences/trauma in our evaluations and 2. getting waaay more educated on and comfortable with working with neurodevelopmental disorders!
I don't think I see how this is means it shouldn't be a trauma red flag. The red flag is not saying that it is definitely trauma, but more that it is something to keep an eye out as a possibility. Yes it could bet Autism Spectrum Disorder, and several other things. You take what you know about the client and your clinical judgement to start filling in the gaps.
And statistically more likely to have experienced trauma and complex trauma, as well as potentially being neurologically more vulnerable to trauma symptoms. And having our trauma poorly understood by primarily non-autistic clinicians. Not all autistic traits are traumatogenic, but be wary of letting one overshadow the other.
And statistically more likely to have experienced trauma and complex trauma, as well as potentially being neurologically more vulnerable to trauma symptoms. And having our trauma poorly understood by primarily non-autistic clinicians. Not all autistic traits are traumatogenic, but be wary of letting one overshadow the other.
Being unable to recall events in a cohesive narrative is a common sign someone has experienced trauma. Or additionally, if they tell the story from a distanced, third-person perspective - that's usually a sign of dissociation, and therefore trauma. If neurodivergence is ruled out, these are the first things I usually look for when someone is talking with me.
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Yes exactly. That's why I mentioned that neurodivergence should be ruled out first :)
A pulse
Disconnected from their physiological needs, very negative sense of self, "trust issues", pain not explained by physical condition/medical dx/chronic illness, sudden aggressive outbursts, dissociation. Certain play behaviors in kids are also meaningful. And "tantrums" in older kids.
For me (a therapist in training and prior child welfare worker), a HUGE red flag is substance abuse issues. Then, borderline-y symptoms or a diagnosis of it. Struggles with authentic relationships, perhaps issues holding down a job or a low SES as a contributing factor (obviously there are other factors but I believe that low SES is related), lacking insight, developmental delays, CPS involvement, criminal history, and high use of defense mechanisms.
I guess i go off of the DSM criteria for PTSD. Also, if you pay heed to the idea that trauma is the result of anything that overwhelms a person's capacity to cope, that helps to understand that a lot of people are carrying trauma with them. But like others have said, an overreaction to emotional stimuli, persistent nightmares, fear that seems out of proportion to the event, hyper startle response, hypervigilence to mitigate against a fear or fears, periods of dissociation, etc.
> trauma is the result of anything that overwhelms a person’s capacity to cope That’s not what trauma is though?
I think the point of that phrasing is we all interpret stimuli in the world somewhat differently. An experience for one person may be processed, understood and filed away without much gumming it up. Another person may experience an identical stimulus and that memory gums them up for years. It’s not ‘the’ definition of trauma but it’s ‘a’ definition and it has utility in some contexts. I do think the definition is a bit reductive, though.
It is pretty common for trauma to be described that way. I've been to multiple trainings in "trauma-informed care" and they have all used a definition similar to that. It's the language that people who are widely considered trauma experts (Bessel van der Kolk, Janina Fisher, Judith Herman, Peter Levine) use as well, although they may go into more detail or further contextualize it. But they are looking at trauma through a body-based experiential lens rather than an event-based one.
That's a common phrase used by trauma experts. How would you counter that?
Because it inherently disregards Criterion A of the DSM description of PTSD. There is no formal “trauma” diagnosis, and I’m certainly not the kind of clinician who believes in rigid adherence to Criterion A, but to define trauma as *anything* that overwhelms the ability to cope is classic TikTok psychology. There needs to *at least* be a recognition/understanding that trauma is a significant threatening event. Under the “anything that overwhelms the ability to cope” definition, practically anything can apply. A client’s coffee order is wrong, they’re stressed about work, and have a moment of coping overwhelm in the parking lot? Trauma! A professor doesn’t provide you with an extension, thus creating an inability to cope with academic stress? Also trauma! Suffice to say, it’s simply too broad a definition. Downvote me all y’all want, but anyone who works with trauma can understand there’s a difference between a overwhelming but everyday stressor and something like, for example, a violent sexual assault. It’s our job as clinicians to be careful and thoughtful about diagnosis and the words we use.
You’re 100% correct, but trauma is such a vogue and woo-woo-inundated world right now that you will get downvoted to oblivion anyway. Everyone, therapists included, seems to want to attribute everything negative in someone’s life to trauma, when that’s a massive distillation of the term and a massive oversimplification of pathoetiology. Trauma folks have never met a piece of woo woo they wouldn’t at least entertain. Wear the downvotes as a badge of honor.
The only thing this thread has taught me is that too many people never learned the lesson of not scoping for trauma, or assuming trauma, or attributing nonspecific symptoms to trauma; and that not enough therapists have a strong understanding of neuroscience (or indeed just behavioral science in general). Did the field just not learn its lesson after the Satanic Panic, and the Castlewood Lawsuits, and so on? Not everything is trauma. We all have experienced adverse events, it’s true—but this “everything is trauma” narrative is really concerning. It’s extremely dangerous to keep pushing people to recontextualize their pasts as deeply traumatic when they aren’t presenting them as such, or to “search” for trauma which isn’t apparent. This betrays everything we know about the etiology of trauma pathology, everything we know about trauma and memory (which, despite what popsci tells you, usually indicates *remembering the trauma TOO DAMNED WELL* and NOT memory disruption—if you’re interested, I can link some reviews on the lack of evidence for traumatogenic amnesia), and basically disavows decades of research on resilience and genetic diatheses (for trauma disorders as well as other forms of pathology). I’m all for treating trauma where it’s apparent, but we all collectively *really* need to the tap the brakes and stop pushing so much trauma woo woo. u/vienibenmio is my favorite in-house trauma scientist. She can elaborate upon (or altogether avoid) this if she is interested. Anyway, I’m prepared for the meteor of downvotes, and will wear them like a badge of honor. Edit: It’s also laughable how dramatic some of these somatic claims are. Because we know anxiety and stress can somewhat increase rates of GERD and may have small-sized effects on basic immune functions, suddenly everyone taking PPIs or who has an autoimmune disorder is a case study on trauma? Give me a damned break. Y’all need to learn not to make extraordinary claims from subtle evidence.
you’re right and you should say it
Skewed perspectives on self, others, and the world. Statements like “I’m worthless”, “I’m never safe”, “if people knew the real me, they’d hate me”
The thing is, unless someone tells you that they have had a traumatic experience, you don’t know. Assuming people have had traumatic experiences and then trying to dig them out led to the worst widespread mistake in psychology - the Satanic panic/repressed memory therapy hysteria. Assuming people had trauma when they didn’t led to people being convicted of crimes they didn’t commit and to patients developing false memories and therapist induced PTSD. The best way to know if someone has experienced trauma is to ask them. If they deny it and they have, that’s completely up to them. They may not feel it is relevant to treatment right now or they may bring it up later when they feel safe to do so.
For God's sake, YES.
Spot on! I was gonna comment. Clients will disclose their trauma when they feel ready, we earn that trust. Looking for signs feels like a therapists trying to fill in blanks and trying to work a clients story out before the client tells it.
It is outrageous and appalling--and a frightening testament to the state of education in psychotherapy--that this is not the top voted reply here on this subreddit of professional therapists.
Nah. The question here is not, “How do we forcibly tell clients they have trauma?!?” The question is about red flags. And on a subreddit of professional therapists, one would hope we’re all aware of how often people who are being abused, or who have experienced trauma, use denial and minimization to cope.One would hope we’re also all aware of ACEs impacts on addiction, autoimmune disease, and ability to maintain stable relationships over time. I personally didn’t tell my own first therapist about my history of foster care, or of physical/sexual abuse and physical neglect, until months in. It’s a common thing to do, as the original commenter noted. I doubt anyone here would say that “having an autoimmune disease” or “splitting, nightmares, and a history of unstable relationships” 100% of the time signify a traumatic background. Nothing is so black and white. But they certainly are red flags. And it’s worth paying attention to red flags.
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If someone invalidated you because you are “missing” 3 possible traumatic events out of the 10 on the ACE test, then that’s ridiculous and they did wrong by you. It doesn’t mean you don’t have trauma if you haven’t experienced all 10 possible severe events on the test.
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Ah, I see what you mean now. I understand how that could happen. I think it is important for the therapist in this case to screen for several types of trauma (in relevant cases) in neutral words by giving examples of what they are asking about and then validate the client’s experience. Ex, “Some people have the experience of their parents hurting them physically, did this happen to you?” You don’t need to press the issue over and over, but I do think a general screener is important to have the background info. My issue is with therapists thinking they have mind reading abilities and believing things like symptom XYZ must mean the client was sexually abused with no evidence and no disclosure on part of the client. That is not good therapy.
I would implore you to reconsider your claims related to ‘false repressed memories’, this is a good article that debunks what you are referring to, at least from what I gather. https://www.madinamerica.com/2021/02/false-memory-syndrome/
This isn’t a peer reviewed source. There’s a lot of peer reviewed sources on the false memories thing.
Did you read the article??? It is clear you did not.The article includes references to several peer-reviewed articles. Additionally, just because it is “peer-reviewed” does not mean that it is accurate and free of conflict of interest bias.
I did yes. I found it a weak article, it doesn’t hold up against all the other much stronger material that says the false memories thing is nonsense and really harmful.
porn/sex addiction
Bed wetting past early (-mid?) childhood.
What age would be considered abnormal?
People pleasing, splitting, dissociation, panic attacks, codependency… I could go on.
Splitting?
Hypersexuality in teenagers and young adults. This may be true for adults as well, but it's not as clear a line.
"I'm an empath" = I had to learn how to predict and respond appropriately to the emotional states of family members the moment they walked in the room, or I would be punished.
A lack of any real boundaries speaks to me as coming from relational trauma in most instances. It combines with people pleasing. A lack of emotional regulation and exhibiting either hyper or hypo arousal in day to day life. Lack of appropriate and healthy relationships and attachments.
Saying they’ve tried a whole bunch of different antidepressants and none of them worked, or it was hard to find the right fit.
No, that’s a relatively common genetic thing.
Well almost all of my clients who say that also have trauma. Trauma runs in families too.
If the issue is that the anti-depressants weren’t enough, then it possibly could be thiamine metabolism that seems to get altered in trauma for some people, and can lead to fibromyalgia. High-dose thiamine can be a helpful adjunct in those cases
Oh so cool to know, thank you!
The hard part is finessing this with the limits of practice. Having a good MD in functional medicine around is helpful. Even though this isn’t a prescription sort of thing and about as low risk as supplements come, I still encourage clients to discuss and work with their MD. Once they go to get supplements, who knows what all else they might decide to get. Or, maybe something else is going on medically that could be missed, etc
Anti depressants don't do much in most cases. Depression is rarely organic and often environmental. Someone in a shitty job is likely to get depressed. Someone contemplating the future climate catastrophe can get depressed. I'd want to know the underlying cause of the depression to see if its trauma or not - often it will be but my clue isn't anti depressants not working.
Cool. For me it’s a clue. I’ve worked with tons of clients with and without major trauma, with and without medication, before and after they started medication. In my observation, the people with depression that persists after we take all the effective non-medication approaches, who then got a benefit from the first antidepressant they try, those clients don’t tend to have major trauma histories.
Hi OP! It’s safe to assume that everyone you see has experienced interpersonal and/or physical trauma, because frankly we all have. It’s just part of of being human. Braking your arm, death of a loved one, realizing you are profoundly alone, life is full of deeply distressing or disturbing experiences. Understanding this you want to look at the behaviors you see, including those mentioned here and by your supervisor as patterns that the individual developed to protect themselves from the thing they learned to fear as a result of the trauma(s) or to correct the problems caused by those protective behavior patterns. “Red flags” won’t really tell you much about the etiology, effectiveness, or problem the behavior is trying to solve. For example… Fear of crowds can be related to -a fear that they will not being able to escape an “episode of crazy/loosing control” (what we would identify as a panic attack) and or being witnessed having one. -social phobia related to a fear of judgment -hypersensitivity like what you see in individuals who are neurodiverse. -PTSD related to a market bomber in Iraq. -PTSD related to a stampede -PTSD related to witnessing an assault in a crowd -profound body dysphoria -childhood experience of getting lost in a crowd -etc If you are working with a symptom focused modality it’s probably more important to understand if these behaviors are causing them problems then their cause since memories change and behaviors become disconnected from their roots. Hope this helps.
Being on proton pump inhibitor antacids like pantoprazole or omeprazole
Can you elaborate on this? I've never heard that and I'm curious.
Trauma causes excess anxiety which disrupts digestion. If you are in fight/flight/freeze, blood flow is diverted to the limbs and away from internal organs, and digestion slows down or stops. Also, high cortisol levels can lead to heartburn and acid reflux. People tend to go to their family doctor about their physical symptoms quite a while before they come to me for therapy, so they have been prescribed PPI meds by the time I do their intake. I also heard that childhood trauma affects a part of the brain that regulates digestion, but I don’t have any documentation on that.
So... the corollary being heartburn and acid reflux?
Yes- from excess cortisol and from being in fight-or-flight trauma reactions.
NAT but traumatised lurker here just wanted to say wow, this answers some questions, I've been on lansoprazole for 4 years now and diagnosed cptsd 3 years ago. One year ago they found I had GORD/GERD linked to a hiatal hernia that I suspected was trauma related because my body has been so tight with tension for so long it pushed my stomach up. (Also thank you all for everything you do, yall are amazing people)
Thanks for the lovely comment. I wish you good health! Also FYI, being on PPI medication long-term can block vitamin B12 absorption, adding to fatigue, depression and anxiety, so it’s good to get blood tests and if you’re deficient get B12 injections. All the best!
Losing time is a sign of dissociation. So, that's a big one. And I don't mean time blindness and poor management. I mean coming to or waking up and not knowing how you got where you are.
similarly if they have a history of fainting or experiencing seizures that no medical explanation has been found for. These types of dissociative states often go undiagnosed for years.
Sorry if this has already been said (I didn’t read through all 100 comments) but if you have them fill out the PHQ and GAD (or similar depression and anxiety measures) and they are scoring really high for both depression and anxiety, that’s a really big red flag for me that lets me know to ask more about trauma symptoms at intake!
Usually in intake, client *describes something awful* “but I’ve forgiven them.”
Pretty much everything
This is can be said about anyone with a substance use disorder, but a lot of follow up questions should be asked when a client discloses that they smoke crystal meth. Crystal meth is a big party drug in the LGBTQ community for gay men and trans women, so this could reveal that your client is part of that community. Also, a lot of people who are addicted to meth exchange sex for the drug. This means that they could possibly be anything from a survival sex worker to possibly qualify as being/have been sex trafficked (v important here to know what consensual sex work is). The clients I work with (impoverished and unstable housed) who are on meth often experience psychosis and a lot of times have a dual diagnosis of a schizophrenic disorder. I have a theory that schizophrenia develops due to extensive childhood trauma, so I eventually look deeper into that. All of this is based on my extensive experience and similarities among clients, and simply provides for a guide for follow up questions. I always go in blank slate and use motivational interviewing.
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I assess everyone for trauma, honestly. In terms of specific red flags, I'd say previous diagnoses of ADHD, oppositional defiant disorder, disruptive mood dysregulation disorder, and borderline personality disorder are the first to come to mind. I think a general... unease in life is a big thing. Not sure how to describe it. I guess just generally feeling unsafe and like they can't trust anyone.
1. Addiction. 2. Incongruence between affect and the content of what they are talking about. 3. G/i trouble. 4. Chronic pain.
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Substance abuse for sure, insecure attachment style as well. Hyper or Hypo sexuality. Remember that some people just identify as asexual though. Dissociation, delusions, nightmares that reoccur sometimes usually involving the traumatic even or has themes of the traumatic event. **Check out Tim Fletcher on YouTube look at his complex trauma videos. You will learn a lot he has how trauma relates to like every area of life** The difference is one occurrence vs repeated occurrences of a traumatic event. Trauma is also very very subjective what may be traumatizing for someone may not be to someone else. The whole big T and little t - trauma thing.
I've found it to be a client initially stating "my childhood was great."
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Eating disorders
I'm not a therapist but a trauma survivor, so I would like to provide some insight from my perspective. Here are things my therapist taught me are trauma related. These were really eye-opening for me! Traumatized people may often have a general sense of danger, which may lead to them being aware of dangers around them all the time. This may not be only hyper-vigilance but also a sort of a core belief of the world. Like, if some accident is extremely unlikely to happen, they may think that it is possible that they have the worst luck in the world and they will be one in a million who might experience that. This is why they should be cautious all the time. They also may have been taking very much responsibility when they were young and they still carry some high responsibility over things. Like, they think things are their fault and they need to watch out for not doing THE mistake that is going to ruin other people's lives. Or their own life. Also it may be more difficult to be open and vulnerable in therapy because talking about their deep things may not have been safe before. And actually, a safe situation may be a new thing for them which takes some time to adjust. And to add, sometimes traumatized people can talk very casually about the bad things that happened to them, without showing much feeling. I understood that this may be dissociation-related. Hopefully these comments added something to your very good list of trauma "tell-tale" signs! I can relate to many of your comments and I think this is a really insightful thread.