Dawn M Delgado LMFT, CEDS-S, EMDR

Eating Disorders

Trauma

7 Signs of Underlying Trauma Therapists Don’t Want To Miss

Savvy trauma-informed therapists use common complaints to look deeper.

Posted May 28, 2019

Katarzyna Bialasiewicz/iStock
Trauma-informed care
Source: Katarzyna Bialasiewicz/iStock

Thorough assessment and history-taking are vital components of a solid and comprehensive treatment plan. Working in a safe therapeutic alliance will often stimulate client insight and connections about how events from the past are influencing current behaviors and symptoms. It may take some time for clients to disclose a history of trauma. Often times, clients may not even be aware that what they experienced was trauma.

Here are 7 signs of underlying trauma you don’t want to miss:

1. Digestive Issues

Digestive problems and irritable bowel syndrome, IBS can be symptoms of trauma.  PTSD and IBS often occur together.  Our brains and levels of stress influence the activity in our gut, as well as our microbiome and gut activity influence our thoughts and mental health.  This paraphrases the gut-brain axis, a complex bi-directional communication system.  Digestive issues can easily be overlooked as a food allergy or could go unreported due to embarrassment.

2. Sleep Problems

Sleep is involved in regulating mood, energy, metabolism, and hormones.  Deep sleep, also known as rapid eye movement, REM sleep, helps us to process thoughts as well as to consolidate memories in our brains. Disrupted sleep can stem from a number of factors, including depression or anxiety, nutritional deficiencies, environmental factors, as well as nightmares and other trauma-related disruptions.  At times, nighttime, the dark, or noises at night can trigger hypervigilance and fear that make it difficult to get restful, deep sleep.  Lack of sleep generally increases negative emotions, which can cause a vicious cycle of feeling anxious or depressed.  Ask more questions and delve deeper into sleep problems, because sleep plays a major role in mental health and feeling good. 

3. Anxiety  

Window of tolerance is a term coined by Dan Siegel, which describes the comfortable zone of arousal in which a person is able to function most effectively. Trauma impacts an individual’s brain, which can shrink their window of tolerance comfort zone and cause dysregulated mood states. Anxiety occurs in the fight or flight response state of hyper-arousal.  This is not just normal nerves about a test, extended periods of hyper-arousal anxiety can take its toll on the nervous system, immune system, and adrenal glands.  While trauma shrinks our window of tolerance, there are effective methods of processing trauma, like EMDR, that have been proven to increase the window of tolerance and thus, increase our sense of wellbeing. Anxiety can be overlooked as basic stress.

4. Dissociation

In Dan Siegel’s window of tolerance, the opposite end of hyper-arousal and anxiety as a symptom is hypo-arousal, which is correlated with the trauma response to freeze (from fight, flight, or freeze).  Dissociation is a defense mechanism of the brain, which learns to disconnect a trauma victim from the experience of what is happening to them.  Clients may find it hard to remain present, pupils may become dilated, there may be memory loss, a sense of being detached from the body and emotions, a blurred sense of identity, as well as a whole host of other symptoms. Dissociation can be overlooked as spacing out, forgetting, acting weird, or faking.

5. Addictions

The 1990s ACE study conducted by Kaiser Permanente and Center For Disease Control, CDC, looked at the impact of adverse childhood experiences like childhood abuse, neglect, and household challenges on later life health and well-being.  The ACE study showed a high correlation between ACE scores and the adoption of high-risk behaviors that led to later addictive behaviors, like smoking, alcohol and drug abuse, and IV drug use.  This is vital information in ensuring our treatment plans are centered around early life traumatic experiences.  Often the difficulty with sobriety attempts will also correlate with triggers connected to roots of the original trauma.  Addictions can be oversimplified as issues with substances or “addictive personality”.

6. Compulsive or Inhibited Sex

Issues for males and females around intimate relationships and sex can sometimes be connected to timelines with physical and sexual abuse histories.  Often the individual may not be aware of the connection and simply think there is something wrong with them.  A good example is a heterosexual adult male client who mentioned in passing during the assessment phase that his girlfriend wanted to have more sex than he did.  Thorough history gathering led to eventual trauma work around being molested by an adult female during his childhood. Both compulsive, as well as inhibited sexual behavior can be a symptom of a sexual abuse history.  Sexual behavior issues can be missed when therapists or clients shy away from the topic.

7. Eating Disorders

Eating disorders have been shown to have higher than normal rates of underlying sexual abuse, as well as other traumatic experiences. 1 in 4 individuals diagnosed with Anorexia Nervosa has a history of sexual abuse.  The same is true for 1 in 3 for individuals diagnosed with Bulimia Nervosa.  And 1 in 2 individuals with Binge Eating Disorder has a history of sexual abuse.  Both eating disorders and trauma can be secretive in nature, with individuals struggling silently or often minimizing the full extent of their suffering. Eating disorders can be overlooked or oversimplified as issues with weight.  Eating disorders should always be assessed by a qualified professional with the CEDS certified eating disorder specialist designation, or by a qualified treatment center that specializes with this population.