Subtle Signs of Trauma, Part 1: Symptoms That May Not Even Look Like Mental Health Issues
Most people who carry trauma don’t think of themselves as traumatized. They think of themselves as someone with a bad back, or a sensitive stomach. Someone who falls hard for unavailable people, or who is “just tired all the time,” or who has never quite figured out what the point of any of it is.
Those are the things people bring to a doctor, a friend, or no one at all. And because none of them sound like trauma, the connection often goes unmade for years.
This is the first of two posts about symptoms that can grow out of trauma but rarely get linked to it. This one covers symptoms that don’t look like mental health issues at all—the ones that show up in your body, your relationships, and your sense of who you are. Part 2 covers symptoms that look like, or overlap with, other diagnoses such as ADHD, OCD, anxiety, and depression.
First, What I Mean by Trauma
When I say trauma, I don’t only mean the kind of event that makes the news. A car accident or an assault can certainly leave a mark. But so can growing up with a parent whose moods you had to track to stay safe, years of bullying, having your feelings consistently ignored or ridiculed, repeated medical procedures as a child, or living in a body or identity that the people around you treated as a problem. What these share is a nervous system that had to adapt to conditions it couldn’t escape.
Those adaptations were intelligent at the time. The trouble is that they tend to outlive the circumstances that created them, and they don’t announce where they came from.
One caution before the list. Every symptom below has many possible causes, and trauma is only one of them. The point is not to explain everything with trauma. It is to make sure trauma is on the list of possibilities, because it so often gets left off.
When It Shows Up in Your Body
1. Chronic pain
Back pain, neck and shoulder tension, headaches, a clenched jaw, widespread pain that doesn’t match any scan. Pain is one of the most common places a trauma history turns up, and one of the least likely to be recognized as connected.
The research here is fairly consistent. A 2023 meta-analysis drawing on dozens of studies found that adults who experienced abuse or neglect in childhood were significantly more likely to report chronic pain, and that the risk climbed with each additional type of adversity. An earlier review found that people who had been through trauma were nearly three times as likely to have what are called functional somatic syndromes—conditions like fibromyalgia, chronic widespread pain, and jaw (TMJ) disorders—though many of the underlying studies were small.
Researchers are still working out why. The leading explanations involve a stress response that stayed switched on long after it was needed, muscles that learned to brace and never fully let go, and a nervous system that became more sensitive to threat signals of every kind, pain included.
None of this means your pain is imaginary or “all in your head.” The pain is real. It may simply have more than one source, and treating only the physical side can leave part of the problem untouched.
2. Digestive problems
Irritable bowel syndrome, nausea before social plans, a stomach that knots up when someone raises their voice, appetite that vanishes under stress, food reactions no one can explain. The gut and the brain are in constant two-way communication, and the gut is often where stress lands first.
A 2019 meta-analysis found that people with PTSD had nearly three times the odds of having IBS. In a study of women veterans, a broad range of traumatic experiences were each linked to a higher risk of IBS, even after accounting for PTSD and depression—suggesting the connection isn’t only about how distressed someone feels today.
If you live with digestive symptoms, see a doctor first and rule out other causes. But if the workup comes back clean, or treatment only helps partway, it is worth asking what your nervous system has been carrying.
3. Exhaustion and sleep that doesn’t restore you
Some people describe a tiredness that sleep doesn’t touch. Others sleep lightly, wake at the slightest sound, lie awake at 3 a.m. with their mind scanning, or can’t fall asleep without the TV on. Sleep disturbance is one of the formal symptoms of PTSD, and in the review mentioned above, the link between trauma and chronic fatigue syndrome was stronger than its link with either fibromyalgia or IBS.
Part of this makes intuitive sense. Sleep requires a feeling of safety deep enough to let your guard down. If your system learned that danger could arrive at any hour, it may never quite agree to switch off. And spending your waking hours on alert is exhausting in its own right—vigilance is work, even when you don’t notice you’re doing it.
When It Shows Up in Your Relationships
4. Limerence
Limerence is the term psychologist Dorothy Tennov coined for an intense, involuntary preoccupation with another person: intrusive thoughts about them, a hunger for signs that they feel the same, and moods that soar or crash depending on whether those signs appear. It is often directed at someone unavailable—a colleague, an ex, a married friend, someone who is warm one week and distant the next.
From the inside, limerence feels like love, or fate, or the most alive you have ever been. It rarely occurs to anyone that it might be a symptom.
Research on limerence is still thin, but what exists points toward attachment. Researchers have linked it to anxious attachment, and one research team has described it as a form of separation anxiety directed at the wrong person. Clinicians who write about limerence often identify uncertainty as its fuel: the person who sometimes responds and sometimes doesn’t is far more gripping than the one who reliably shows up. For someone who grew up with love that was intermittent, conditional, or had to be earned, that uncertainty is familiar—and familiarity can feel exactly like chemistry.
Underneath, limerence is often an old longing looking for somewhere to land. If abandonment is part of your history, this post on why abandonment feels like a matter of survival may resonate.
5. Tolerating treatment you shouldn’t have to
People rarely describe this one as a problem. They say they are patient, or loyal, or easygoing. They say they have a high tolerance, that they don’t like drama, that the other person is going through a lot. Meanwhile they are being yelled at, belittled, controlled, cheated on, or ignored, and some part of them has decided this is simply what relationships cost.
If mistreatment was normal in your early life, the internal alarm that is supposed to say this is not okay may never have been allowed to develop. In many families it was actively punished. Children in those environments often survive by keeping the people around them happy—anticipating moods, smoothing things over, making themselves small. The psychotherapist Pete Walker named this the fawn response, a fourth option alongside fight, flight, and freeze. In adulthood it can look like kindness. Sometimes it is also a survival strategy that never got the message that the danger has passed.
This is part of why people who were hurt early are, statistically, more likely to be hurt again later. One meta-analysis found that nearly half of childhood sexual abuse survivors were sexually victimized again later in life, and researchers have pointed to factors such as PTSD symptoms, dissociation, and self-blame. I want to be clear about what this does and does not mean: responsibility for abuse always lies with the person doing it. Understanding the pattern is not about blame. It is about recognizing that the sense of this is wrong can be rebuilt.
If you are in a relationship that frightens you, the National Domestic Violence Hotline is available around the clock at 800-799-7233, or you can text START to 88788.
6. Never asking for help
The flip side of tolerating too much is needing too little. Some people are the reliable one in every room: the friend who handles everything, the colleague who never drops a ball, the person who would rather move apartments alone than ask for a hand. It reads as strength, and in many ways it is.
But fierce self-reliance can also be a conclusion a child drew when needing people didn’t work—when asking for comfort brought irritation, or when the adults were too overwhelmed, absent, or unpredictable to lean on. Not needing anyone feels very safe. It is also very lonely, and it tends to leave people burned out, resentful, and unseen in relationships where others would gladly show up if they were let in.
When It Shows Up in How You See Yourself
7. Feeling worthless
Worthlessness doesn’t usually feel like a symptom. It feels like an accurate assessment. People who carry it can list the evidence: the mistakes, the ways they’ve disappointed people, the sense of being a burden. They may be highly accomplished and still be certain that if anyone saw them clearly, they would leave.
That belief is common enough after prolonged trauma that it is written into the diagnosis. The World Health Organization’s definition of complex PTSD includes persistent beliefs about oneself as diminished, defeated, or worthless, along with deep shame or guilt.
There is a painful logic to how this develops. A child who is mistreated by the people they depend on faces an impossible problem: they cannot leave, and they cannot afford to see their caregivers as dangerous. Concluding it must be because of me preserves the relationship and offers an illusion of control—if I am the problem, maybe I can fix myself. That conclusion gets laid down early, below the level of argument, which is why reassurance and affirmations rarely make a dent.
This is one of the places EMDR can be especially useful. Rather than debating the belief, EMDR works with the memories that taught it, so the body can stop treating an old conclusion as a current fact.
If feelings of worthlessness ever slide into thoughts of not wanting to be alive, please reach a person. In the U.S. you can call or text 988, the Suicide and Crisis Lifeline, at any hour.
8. A lack of purpose
Some people come to therapy not because anything is acutely wrong but because nothing feels like it matters. They go to work, see friends, do what they’re supposed to, and feel no pull toward any of it. Asked what they want, they draw a blank. It feels philosophical, or like a personal failing—everyone else seems to know what they’re doing with their life.
Trauma has long been associated with a shrunken sense of the future. The fourth edition of the psychiatric diagnostic manual, the DSM-IV, listed “a sense of a foreshortened future” as a symptom of PTSD: not expecting a career, a family, or a normal life span. If your early years were organized around getting through the day, planning a future may never have felt possible. Wanting things may also have been unsafe, if wanting led to disappointment or punishment. And the emotional numbing that protects people from pain also dampens the signals that tell us what we care about. Purpose depends on those signals.
Studies of trauma survivors consistently find that a stronger sense of meaning goes along with fewer post-traumatic symptoms, though it isn’t clear which comes first. In trauma work, purpose usually isn’t something you find by thinking harder. It tends to return on its own as the nervous system settles and feeling comes back online.
Why the Connection Gets Missed
Part of the reason is that each of these symptoms has an obvious, non-trauma explanation available, and healthcare is set up to treat symptoms one at a time. The gastroenterologist treats the stomach. The physical therapist treats the back. No one is asking about your childhood.
Part of it is that trauma adaptations don’t feel like adaptations from the inside. They feel like your personality. I’m just a worrier. I’ve always had a bad stomach. I’m the strong one.
And part of it is that many people don’t believe what happened to them counts. Other people had it much worse. Nothing that bad ever happened to me. But trauma is not only about what happened. It is also about what didn’t—the comfort that never came, the attention no one paid, the feelings nobody helped you make sense of. That kind of childhood and attachment wounding often leaves no single memory to point to, only a pattern.
What Helps
Trauma therapy is not a replacement for medical care, and it should never be a reason to stop investigating a physical symptom. But it can be an important addition and a resource when symptoms cannot be medically explained. When the underlying alarm system is addressed, symptoms that have resisted other treatment sometimes begin to ease—not always, and rarely overnight, but often enough that it is worth exploring.
Depending on the person, that work might include somatic therapy, which helps the body learn it can let go of bracing; EMDR, which helps the brain reprocess memories that are still being held as if they were happening now; and parts work, which makes room for the different parts of you that learned to cope in different ways. You don’t need a clear memory of what happened, and you don’t need to have had it “bad enough,” to benefit.
If some of this sounded familiar, Part 2: When Trauma Looks Like ADHD, OCD, Anxiety, or Depression looks at symptoms that overlap with other diagnoses, where trauma fits in, and how trauma treatment can work alongside other care.
I see clients in person at my Upper East Side office, on the border of Carnegie Hill and Yorkville, and virtually across New York State. If something here felt familiar and you’d like to understand where it comes from, you can read more about my approach to trauma therapy or reach out for a free consultation.
