Hidden Trauma: Silent Scars That Linger
Narcissistic Abuse Awareness and Guidance with Randi Fine
Psychological trauma can be obvious, highly visible, and easily recognized. At the same time, it may remain hidden, leaving invisible scar tissue that makes it less obvious to others and even to the individual who as suffered less visible forms of trauma. Let’s shine a light on hidden forms of trauma. But first, a quick review of the phenomenon of PTSD is helpful.
Visible and Recognizable Forms of PTSD
Over the last 40 years, we’ve witnessed an explosion of interest in psychological trauma among mental health professionals and the lay public alike. Beginning in the 1980s, attention turned to the effects of combat on soldiers in Vietnam as Post traumatic Stress Disorder, or PTSD, was recognized as an official condition by the DSM.
Countless books and articles have reviewed research about the symptoms and course of psychological trauma, diagnostic methods, and treatment approaches for PTSD. Most of the attention in those first few decades focused on high-impact, life-threatening single-event traumas, such as combat, sexual assault, or natural disasters, which are referred to as “shock” or Type I trauma.
Interest in PTSD broadened to those situations in which posttraumatic symptoms (chiefly, re-experiencing intrusive memories and dreams related to the trauma; avoidance of stimuli associated with the trauma, and alterations in arousal and reactivity) are delayed by more than six months following the traumatic event or are the result of chronic trauma or recurrent episodes of trauma (Type II or “strain” trauma).
What characterizes this form of trauma is not only its repetitive nature but also its inescapable quality. Termed “Complex PTSD,” this form of trauma often occurs in the crucible of an abusive relationship (physically, emotionally, or verbally), often beginning
in childhood, as in the case of child abuse.
Recognized as a separate form of trauma by the ICD-11 (but not the DSM-5-TR), C-PTSD includes symptoms typical for PTSD, along with difficulties in emotional regulation, a damaged sense of self, and mistrust.The fact that relational trauma of child abuse becomes woven into the fabric of the developing personality makes this chronic form of trauma so damaging to the growing youngster.
Hidden Trauma
What is meant by “hidden trauma? In one sense, all forms of psychological
trauma are invisible if we contrast them to physical trauma. In fact, the absence of
physical wounds may make others question the existence of PTSD in an otherwise
healthy-looking individual.
However, hidden forms of trauma, in the context of PTSD,
involve traumatic situations that are (1) less evident to others and, perhaps even to
those who have suffered less overt forms of trauma, (2) less discussible because of the
nature of the traumatizing event, and, relatedly, (3) minimized or ignored. These
categories are not mutually exclusive and may be related to each other. Let’s look at
each.
Less Evident Forms of Traumatization
Two forms of hidden trauma are bullying victimization and what is called “religious trauma syndrome.”
Bullying Victimization. Bullying has been around forever but was not historically
viewed as a form of traumatization. Instead, it was seen as an unfortunate, normative
aspect of growing up. Euphemistically referred to as “teasing” or “scapegoating,”
bullying was generally considered an aspect of a hard-knock life.
However with the widening scope of trauma, attention was directed to untoward childhood experiences that have lasting effects on a growing child’s sense of self, emotional regulation, and social connections and belonging. In more recent years, bullying has been understood as a form of developmental trauma and placed under the rubric of C-PTSD.
Social media has acted as an accelerant playing a significant role in perpetuating
and accentuating childhood bullying. Loneliness, hopeless feelings, and depression
may develop in the wake of chronic, unremitting bullying. Children and teens, especially
girls, show increased risks of suicidal feelings in the context of cyberbullying.
Thirteen year old Aubrey experienced daily taunting at school. Pushed and groped at
school, Aubrey was assailed again online, as cruel taunts and social media posts
made fun of her physical appearance, her clothes, and her family. Bitter, angry,
depressed, and lonely, Aubrey was finally taken to therapy after she attempted to
take her life.
Religious Trauma Syndrome (RTS) relates both to the chronic abuses of harmful
religious indoctrination and the impact of severing the connection with one’s religion and
faith community. Some view RTS as a form of C-PTSD because of the impact on
development in the case of children who are exposed to a system of extreme,
authoritarian religious indoctrination.
In addition to the long-term developmental aspects, RTS also applies to the trauma of breaking away from such a faith-based family and community. Although adolescents and adults may experience breaking away from this kind of restrictive community as liberating, the challenges of leaving are significant.
For people growing up in such a community, the religious environment met all
their major social and emotional needs. It not only provided a predictable structured
support system, but also gave individuals a coherent view of the world, a spiritual
connection and sense of purpose and meaning, and sense of self and morals. As we
can see, the early impact of an authoritarian religious indoctrination, compounded by
the multiple losses in social relationships, sense of self-coherence, and meaning can
have profound effects on such individuals.
Such was the case with Riva, a thirty-something woman raised in a restrictive
religious community, in which her parents were leaders in their insular religious
sect. When she finally left, she felt free; however, her sense of liberation at
freeing herself from the constraints of her family and community, soon gave way
to an emptiness she described as “a gigantic hole that I can’t fill.” She spoke of a
loss of meaning stemming from the belief that “If there isn’t really a God then
nothing matters.”
One can think of RTS as a form of early traumatization followed by a catastrophic social
rupture that leaves the survivor feeling lost and disconnected from family, a mature
spiritual belief system, and herself.
Undiscussable Forms of Trauma
Some traumatic events and losses are not easily discussed. Clearly, an essential healing element involves being able to share one’s traumatic experience with a sympathetic support system. But what happens when the nature of the traumatic event cannot be openly shared?
Talking about the loss of a loved one is generally received by a sympathetic audience, but what happens if the loved one takes his or her own life? How do we share this kind of unspeakable loss? The word ”unspeakable” is key.
It is impossibly hard for survivors to share openly that their loved one has committed suicide. Some listeners find it hard enough to talk with survivors about losing a family member, but this difficulty may be compounded if the loss was the result of suicide. Survivors, themselves, may feel ashamed and unable to open up about the nature of their loved one’s death.
Imagine the trauma to parents whose child, spouse, brother, or sister has perpetrated an act of violence. Parents of school shooters, rapists, and murderers face the trauma of destroyed lives, the shame of what their family member has done, and the loss of that individual, either through death or incarceration. How do they metabolize their trauma? How do they heal? Where can they find a sympathetic ear?
Minimized or Ignored Trauma.
Minimized and ignored forms of trauma and loss overlap with unrecognized traumatization. The key here is that they are overlooked or never considered from the perspective of traumatization. Common types of unrecognized or normalized trauma and loss include miscarriages and abortions.
Miscarriages are viewed normatively because they occur so frequently. However, they
can be devastating losses. Similarly, a stillborn infant is the loss of a child the parents
never knew. Although miscarriages may have a more sympathetic audience, many in
one’s support system may not fully grasp the depth of pain associated with
miscarriages.
Abortion may amplify the traumatization and loss associated with miscarriages. A
heated political issue, those who seek abortions are bombarded by internal and external
pressures regarding their decision. Unlike miscarriages, abortion may be less easily
discussed and shared; and for many, it may remain an unvoiced mixture of shame, guilt,
loss, and relief. Many may find it extremely difficult to share the myriad, conflicting
feelings surrounding this painful, private decision.
There is a category of searing losses that are never put to rest––the disappearance of a
family member with no resolution of the loss. In the wake of such a disappearance,
survivors may experience a great deal of support from a well-meaning community.
However, what happens when the missing family member is never found? The world
moves on, but the surviving family member cannot.
Some forms of trauma are hidden behind violent acts and criminal behavior.
Those who commit crimes need to be accountable, but we too easily overlook the trauma in the pasts of such individuals. Too often, society is indifferent or vindictive toward those who have committed crimes and unwilling to consider the horrible backgrounds of the perpetrators.
At a conference on Evil, renowned psychoanalyst Salman Akhtar said words to the effect, “Show me a serial killer, and I’ll show you an abused child.” Most of us are probably not receptive to such an idea. I recall how many audience members rejected Akhtar’s statement. “Evil is evil,” I heard people say.
While childhood physical, sexual, emotional, and verbal are well-recognized
forms of trauma, what about the effects of neglect and parental uninvolvement?
Childhood Emotional Neglect (CEN) &
Parental involvement involves a trauma that is often hidden because it’s something that didn’t happen. Physical and sexual abuse is something that happened or was done to the child. Neglect and uninvolvement is something that was not given to them.
First responders are occupationally predisposed to secondary trauma in their work. Fire and rescue workers, police officers, and emergency medical personnel (especially during the first years of the pandemic) are especially susceptible to the pile- up of stress secondary to habitual exposure to traumatic events.
Finally, how much do we think about the traumatic plight of migrants? They leave behind a familiar world of home, family, and friends but also, for many, a home that turned hostile and threatening. They make perilous journeys, spend much, if not all, of what they have, risk exploitation, and finally reach a land where the welcome is more than ambivalent. Deep inside whatever it is that has propelled them, they carry scars of unimaginable loss and traumatization.
Recognizing Signs of Hidden Trauma
Hidden trauma is not just hidden from others, but it can also be disguised and veiled to the trauma survivor, who may, like others around them, either discount or minimize the impact of hidden and implicit forms of trauma and loss. However, while the source of the trauma itself may be hidden, its effects are not. Survivors may experience myriad symptoms, including depression, anxiety, anger, moodiness, and shame. Such feelings are not endpoints themselves or the ultimate causes of the individual’s pain and suffering but, instead, they are signals or symptoms of something else. These are pains that tell us something is wrong.
Sleep, the biological truth-teller, knows something is wrong before we do.
Difficulties falling asleep or staying asleep may be somatic signals of things we need to
pay attention to. Hypervigilance and arousability may also be behavioral signals of
unrecognized trauma.
The signs of hidden trauma may be seen in behavior, including avoidance of
people or places that arouse uncomfortable feelings. Such individuals may feel
disconnected, detached, and have difficulties with trust and intimacy without
understanding why. Survivors may attempt to soothe or self-medicate to avoid opening
the doors to their hidden trauma by numbing or distracting themselves.
Although all these symptoms are transdiagnostic, meaning they are not indications of specific causes or sources of pain, they may suggest the presence of unrecognized trauma. The point is that none of these symptoms or behaviors, by themselves, indicates hidden or buried trauma. Finding out more about that possibility with require more information.
For more information about common signs of hidden trauma, see
Getting Help
There are many avenues to getting help. Treatment begins with a good evaluation by a mental health professional (psychologists, psychiatrists, social workers, psychiatric nurses, licensed professional counselors) with experience in recognizing symptoms/behaviors that might represent the presence or unrecognized and unprocessed trauma. Through interviews, history taking, speaking with family members, and possibly psychological assessment, a link between presenting symptoms and underlying problems can be made.
Trauma-specific treatments include a variety of methods including:
Individual talk therapy
Group therapy
EMDR (Eye movement desensitization and reprocessing
Mindfulness, yoga, and meditation
Here is a helpful resource for those interested in understanding more about PTSD,
hidden forms of trauma, signs and symptoms, and available treatments.
Hidden Trauma in Literature
Fictional accounts of trauma provide windows into how we experience, respond
to, try to avoid awareness of, and eventually recover from trauma. For a list of fiction
writers who have deal with various facets of trauma, whether it is overt or hidden, click
on the link to Shepherd.com list: https://shepherd.com/best-books/fiction-authors-that-hide-the-scars-of-trauma
Reading Trauma Narratives: The Contemporary Novel and the Psychology of Oppression, by Laurie Vickroy treats the subject of PTSD by turning to literature for insights into how trauma survivors exist “inside and outside their traumas, wanting both to remember and to forget.”
Lead characters in my novels, The 11th Inkblot and Tears Are Only Water, struggle with a layering of early trauma (the disappearance of a parent and suicide of a family member) and subsequent forms of loss and victimization. Both protagonists, Anton Zellinsky and Carmine Luedke, remain unaware of the traumatic undercurrents in their lives until they are finally helped to face and free themselves from their hidden traumas.
Author Bio
J. Herman Kleiger (Jim) is a psychologist, psychoanalyst, and author., born and raised in Denver Colorado, currently living in Maryland.
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